E-ISSN: 1019-5157
ISSN: 2651-5024
Research
Emergency Department Neurosurgical Consultations at a Tertiary University Hospital: A Six-Year Retrospective Analysis Including the COVID-19 Pandemic Period
Onur ERDOGAN ,
Mustafa Şenses ,
Devrim Yıldız ,
Fatih Akbulut ,
Yener Şahin ,
Mustafa Sakar ,
Fatih Bayraklı ,
Adnan Dağçınar✉
Neurosurgery, Marmara University, School of Medicine; Neurosurgery, Marmara Üniversitesi Eğitim ve Araştırma Hastanesi; Neurosurgery, Marmara University; SCHOOL OF MEDICINE, DEPARTMENT OF NEUROSURGERY, Marmara Üniversitesi; Neurosurgery, Memorial Göztepe Hospital İstanbul
Accepted: 26/08/2026
Article in Press
Corresponding Author:
Adnan Dağçınar (adnandagcinar@yahoo.com)
Abstract
Aim
This study aimed to analyze the demographic characteristics, clinical spectrum, temporal trends, and outcomes of all emergency department neurosurgical consultations at a tertiary university hospital in Turkey over a six-year period, with emphasis on the COVID-19 pandemics impact on consultation patterns
Material and Methods
Retrospective, single-center longitudinal cohort study including all consecutive ED neurosurgical consultations (January 2019 – December 2024). Consultations were classified into nine diagnostic categories through systematic review of clinical notes. Three pandemic phases were defined (pre-pandemic, pandemic, post-pandemic). Surgical procedures within 30 days were stratified by urgency (emergency, urgent-elective, elective).
Results
Of 13,656 consultations analyzed (median age 46 years; IQR 19–67), trauma was the leading indication (46.4%), followed by CNS tumors (13.9%), cerebrovascular conditions (12.4%), and hydrocephalus (10.5%). Annual volume increased 22.1% over the study period, with a post-pandemic surge (mean 209 consultations/month). In contrast to the 57–66% volume reductions reported by Western centers, our institution demonstrated only a 2.8% full-year decline in 2020; a temporally aligned March–December comparison yielded a 6.8% reduction, with the monthly nadir in April 2020 (27.9% below April 2019). Cerebrovascular patients carried the greatest clinical burden: mean GCS 11.9 ± 4.5 and an ICU admission rate of 28.8% (vs. 6.0% for trauma). A total of 2,190 patients (16.0%) underwent neurosurgical intervention within 30 days; 50.4% were emergency procedures and 49.6% were urgent-elective or elective. Surgical timing profiles differed significantly across diagnostic categories, with shunt malfunction constituting the most common single surgical indication (15.0% of all operations). CNS tumors had the highest surgical conversion rate (31.8%), predominantly through non-emergency pathways (80.7%).
Conclusion
n a high-volume Turkish tertiary center, the ED admits the whole range of neurosurgical disease rather than acute emergencies alone.Because so much non-emergency surgery begins with an ED consultation, on-call rosters and operating-room capacity should be planned around this workload rather than around emergencies alone.
This study aimed to analyze the demographic characteristics, clinical spectrum, temporal trends, and outcomes of all emergency department neurosurgical consultations at a tertiary university hospital in Turkey over a six-year period, with emphasis on the COVID-19 pandemics impact on consultation patterns
Material and Methods
Retrospective, single-center longitudinal cohort study including all consecutive ED neurosurgical consultations (January 2019 – December 2024). Consultations were classified into nine diagnostic categories through systematic review of clinical notes. Three pandemic phases were defined (pre-pandemic, pandemic, post-pandemic). Surgical procedures within 30 days were stratified by urgency (emergency, urgent-elective, elective).
Results
Of 13,656 consultations analyzed (median age 46 years; IQR 19–67), trauma was the leading indication (46.4%), followed by CNS tumors (13.9%), cerebrovascular conditions (12.4%), and hydrocephalus (10.5%). Annual volume increased 22.1% over the study period, with a post-pandemic surge (mean 209 consultations/month). In contrast to the 57–66% volume reductions reported by Western centers, our institution demonstrated only a 2.8% full-year decline in 2020; a temporally aligned March–December comparison yielded a 6.8% reduction, with the monthly nadir in April 2020 (27.9% below April 2019). Cerebrovascular patients carried the greatest clinical burden: mean GCS 11.9 ± 4.5 and an ICU admission rate of 28.8% (vs. 6.0% for trauma). A total of 2,190 patients (16.0%) underwent neurosurgical intervention within 30 days; 50.4% were emergency procedures and 49.6% were urgent-elective or elective. Surgical timing profiles differed significantly across diagnostic categories, with shunt malfunction constituting the most common single surgical indication (15.0% of all operations). CNS tumors had the highest surgical conversion rate (31.8%), predominantly through non-emergency pathways (80.7%).
Conclusion
n a high-volume Turkish tertiary center, the ED admits the whole range of neurosurgical disease rather than acute emergencies alone.Because so much non-emergency surgery begins with an ED consultation, on-call rosters and operating-room capacity should be planned around this workload rather than around emergencies alone.
Keywords
emergency
turkey
neurosurgery
consultation
epidemiology
covid-19
trauma