From Crisis Response to Lasting Transformation: Five-Year Insights from the Implementation of Telemedicine in Neurosurgical Care During COVID-19

Background: The COVID-19 pandemic profoundly disrupted healthcare systems worldwide, compelling rapid adaptation of clinical workflows and accelerating the integration of telemedi-cine. Objective: This study evaluates the implementation of telemedicine in neurosurgical outpa-tient care at a tertiary referral hospital in Madrid during the first epidemic wave (March–May 2020) and explores its long-term significance five years later. Methods: A retrospective observa-tional analysis compared neurosurgical outpatient consultations performed during the first epi-demic wave of COVID-19 (2,070 teleconsultations) with the equivalent period in 2019 (3,105 in-person visits). Demographic, clinical, and procedural data were analyzed, including six-month follow-up outcomes. Univariate and multivariate analyses were performed to identify factors associated with teleconsultation use and follow-up delay. Results: Total consultations decreased by 40% in 2020, but more than 70% of visits were conducted remotely by May. Conti-nuity of care was preserved (follow-up adherence >80%), and missed appointments declined to zero. Cranial and oncological pathologies were prioritized, while degenerative and benign cases were largely deferred. Teleconsultation independently predicted delayed six-month follow-up (aOR 1.9, 95% CI 1.3–2.8, p = 0.002) and a lower likelihood of surgical indication (aOR 0.4, 95% CI 0.2–0.7, p = 0.004). Despite these differences, remote care ensured accessibility, safety, and clin-ical continuity under extreme healthcare system strain. Conclusions: This study represents one of the earliest structured telemedicine experiences in Spanish neurosurgery. The rapid adaptation of the Hospital General Universitario Gregorio Marañón ensured care continuity during the pan-demic and catalyzed the lasting adoption of hybrid models that enhance accessibility, safety, ef-ficiency, and healthcare system resilience.