Dataset Information

Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study.

ABSTRACT:

Objectives

The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery.

Design

This was an observational retrospective study.

Settings

A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020.

Participants

A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease.

Primary and secondary outcome measures

The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection.

Results

More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p<0.001), degenerative spine (OR=0.296, p=0.027) and expedited indications (OR=6.095, p<0.001) were independent factors for being operated on during the pandemic.

Conclusions

Patients awaiting neurosurgery experienced significant collateral damage even when they were considered for scheduled procedures.

SUBMITTER: Castano-Leon AM

PROVIDER: S-EPMC9388715 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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Publications

Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study.

Castaño-Leon Ana M AM Paredes Igor I Lagares Alfonso A Gomez Pedro A PA González-Leon Pedro P Perez-Nuñez Angel A Jiménez-Roldán Luis L Delgado-Fernández Juan J Eiriz Fernández Carla C García-Pérez Daniel D Moreno-Gómez Luis M LM Esteban-Sinovas Olga O Delgado-López Pedro D PD Martín-Alonso Javier J Kaen Ariel A Tirado-Caballero Jorge J Ordóñez-Carmona Marta M Arteaga-Romero Francisco F González-Pombo Marta M F Alén José J Gil-Simoes Ricardo R Torres Cristina V CV Navas-García Marta M Blasco García de Andoain Guillermo G Frade-Porto Natalia N González-Tarno Patricia P Martin Segura Adrian A Gelabert-González Miguel M Menéndez-Cortezón Beatriz B Rodríguez-Botana Brais B Pérez-Alfayate Rebeca R Fernández-García Carla C Ferrández-Pujante Borja B Vargas-Jiménez Andres C AC Cotúa Carlos C de la Lama Adolfo A Calero Félix Lourdes L Ruiz-Juretschke Fernando F García-Leal Roberto R Valera-Melé Marc M Casitas Hernando Vicente V Rivero Belén B Orduna-Martínez Javier J Casado Pellejero Juan J Fustero De Miguel David D Díaz Molina Jorge J Moles Herbera Jesús J Castelló-Ruiz Maria J MJ Gomar-Alba Mario M García-Pérez Fernando F Hernández-García Borja J BJ Villaseñor-Ledezma Jorge J JJ Otero-Rodríguez Álvaro Á Ailagas de Las Heras Juan J JJ Gonçalves-Estella Jesus J Sousa-Casasnovas Pablo P Pascual-Argente Daniel D Ruiz Martín Laura L Roa Montes de Oca Juan C JC Arandia Guzmán Daniel D García Martín Andoni A Torres Carretero Luis L Garrido Ruiz Alejandra A Calvo Marta M Miranda-Lloret Pablo P Rodríguez-Cadarso Miguel M Antón Joan J Roca Barber Amparo A Quiroz-Tejada Arnold A Carbayo-Lozano Guillermo G Bermúdez Garazi G Paternain Martin Clara C De la Fuente Villa Pablo P Fidalgo De la Rosa Marina M Sistiaga-Gracia Íñigo L ÍL Zabalo Gorka G

BMJ open 20220817 8

<h4>Objectives</h4>The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patient ...[more]

PMID: 35977759

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Project description:ObjectiveTo assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain.SettingsThe initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied.ParticipantsThis was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020.InterventionsAn exploratory factorial analysis was performed to select the most relevant variables of the sample.Primary and secondary outcome measuresUnivariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection.ResultsSixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/105 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade ≥3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/105 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated.ConclusionsPerioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/105 people/week) was a statistically independent predictor of mortality.Trial registration numberCEIM 20/217.

Project description:ObjectivesThe decade-long Syrian war led to fragile health infrastructures lacking in personal and physical resources. The public health of the Syrian population was, therefore, vulnerable to the COVID-19 pandemic, which devastated even well-resourced healthcare systems. Nevertheless, the officially reported incidence and fatality rates were significantly lower than the forecasted numbers.DesignA retrospective cohort study.SettingThe four main responding hospitals in Damascus, which received most of the cases during the first pandemic wave in Syria (i.e., June-August 2020).ParticipantsOne thousand one hundred eighty-four patients who were managed as inpatient COVID-19 cases.Primary and secondary outcome measuresThe records of hospitalised patients were screened for clinical history, vital signs, diagnosis modality, major interventions and status at discharge.ResultsThe diagnostic and therapeutic preparedness for COVID-19 was significantly heterogeneous among the different centres and depleted rapidly after the arrival of the first wave. Only 32% of the patients were diagnosed based on positive reverse transcription-PCR tests. Five hundred twenty-six patients had an indication for intensive care unit admission, but only 82% of them received it. Two hundred fifty-seven patients needed mechanical ventilation, but ventilators were not available to 14% of them, all of whom died. Overall mortality during hospitalisation reached 46% and no significant difference was found in fatality between those who received and did not receive these care options.ConclusionsThe Syrian healthcare system expressed minor resilience in facing the COVID-19 pandemic, as its assets vanished swiftly with a limited number of cases. This forced physicians to reserve resources (e.g., ventilators) for the most severe cases, which led to poor outcomes of in-hospital management and limited the admission capacity for milder cases. The overwhelmed system additionally suffered from constrained coordination, suboptimal allocation of the accessible resources and a severe inability to informatively report on the catastrophic pandemic course in Syria.

Dataset Information

Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study.

Objectives

Design

Settings

Participants

Primary and secondary outcome measures

Results

Conclusions

Publications

Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study.

Similar Datasets

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