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Lee CH, Kim YH, Oh BK, Lee CH, Kim CH, Sung SK, Lee SW, Song GS. Does the COVID-19 Screening Test Affect the Postoperative Prognosis of Patients Who Undergo Emergency Surgery for Cerebral Hemorrhage? Korean J Neurotrauma 2022; 18:198-207. [PMID: 36381433 PMCID: PMC9634325 DOI: 10.13004/kjnt.2022.18.e48] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 07/26/2022] [Accepted: 08/04/2022] [Indexed: 11/18/2022] Open
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has affected all medical fields, including neurosurgery. Particularly, performing preoperative screening tests has become mandatory, potentially extending the time from admission to the emergency room and operating room, thus possibly affecting patients' prognosis. This study aimed to determine the influence of COVID-19 screening time on patients' postoperative prognosis. Methods From September 10, 2020, to May 31, 2021, we retrospectively evaluated 54 patients with cerebral hemorrhage who underwent emergency surgery in the emergency room after the screening test. The control group included 89 patients with cerebral hemorrhage who underwent emergency surgery between January 2019 and March 2020, i.e., the period before the COVID-19 pandemic. Prognosis was measured using the Glasgow Coma Scale scores, which were obtained preoperatively, postoperatively, and at discharge, and the modified Rankin Scale (mRS). Additionally, unfavorable outcomes (mRS score 3-6) and in-hospital mortality rates were investigated for postoperative prognostic assessments. Results No remarkable differences were observed in the time to surgical intervention and prognostic evaluation scores between patients with cerebral hemorrhage who underwent COVID-19 screening tests and subjects in the control group. Conclusion This study confirmed that patient treatment and prognosis were not significantly affected by additional preoperative screening testing times during the pandemic. We believe that our results are informative for the evaluation and performance of emergency neurosurgery during the pandemic.
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Affiliation(s)
- Chang Ho Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Young Ha Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Bu Kwang Oh
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Chi Hyung Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Chang Hyeun Kim
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Soon Ki Sung
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Pusan National University Yangsan Hospital, Yangsan, Korea
- Department of Neurosurgery, School of Medicine, Pusan National University, Yangsan, Korea
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Pero G, Dória HM, Giavarini M, Quilici L, Cervo A, Macera A, Piano M. Impact of the SARS-COV-2 Pandemic on the Endovascular Treatment of Acute Stroke - an Italian Single-Center Experience. J Stroke Cerebrovasc Dis 2021; 30:106028. [PMID: 34392026 PMCID: PMC8324420 DOI: 10.1016/j.jstrokecerebrovasdis.2021.106028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 07/12/2021] [Accepted: 07/24/2021] [Indexed: 01/19/2023] Open
Abstract
Objectives The SARS-CoV-2 pandemic greatly influenced the overall quality of healthcare. The purpose of this study was to compare the time variables for acute stroke treatment and evaluate differences in the pre-hospital and in-hospital care before and during the SARS-CoV-2 pandemic, as well as between the first and second waves. Materials and methods Observational and retrospective study from an Italian hospital, including patients who underwent thrombectomy between January 1st 2019 and December 31st 2020. Results Out of a total of 594 patients, 301 were treated in 2019 and 293 in 2020. The majority observed in 2019 came from spoke centers (67,1%), while in 2020 more than half (52%, p < 0.01) were evaluated at the hospital's emergency room directly (ER-NCGH). When compared to 2019, time metrics were globally increased in 2020, particularly in the ER-NCGH groups during the period of the first wave (N = 24 and N = 56, respectively): “Onset-to-door”:50,5 vs 88,5, p < 0,01; “Arrival in Neuroradiology – groin”:13 vs 25, p < 0,01; “Door-to-groin”:118 vs 143,5, p = 0,02; “Onset-to-groin”:180 vs 244,5, p < 0,01; “Groin-to-recanalization”: 41 vs 49,5, p = 0,03. When comparing ER-NCGH groups between the first (N = 56) and second (N = 49) waves, there was an overall improvement in times, namely in the “Door-to-CT” (47,5 vs 37, p < 0,01), “Arrival in Neuroradiology – groin” (25 vs 20, p = 0,03) and “Onset-to-groin” (244,5 vs 227,5, p = 0,02). Conclusions During the SARS-CoV-2 pandemic, treatment for stroke patients was delayed, particularly during the first wave. Reallocation of resources and the shutting down of spoke centers may have played a determinant role.
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Affiliation(s)
- Guglielmo Pero
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda (Niguarda Ca' Granda), Milan, Italy.
| | - Hugo Mota Dória
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda (Niguarda Ca' Granda), Milan, Italy; Department of Neuroradiology, Centro Hospitalar Universitário do Porto, Porto, Portugal; Department of Neuroradiology, Hospital Central do Funchal, Rua Nova do Comboio, N. 13, Funchal, Madeira 9050-054, Portugal.
| | - Matteo Giavarini
- Facoltà di Medicina e Chirurgia dell'Università Statale di Milano, Milan, Italy
| | - Luca Quilici
- Department of Neuroradiology, ASST Ospedale Papa Giovanni XXIII, Bergamo, Italy.
| | - Amedeo Cervo
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda (Niguarda Ca' Granda), Milan, Italy.
| | - Antonio Macera
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda (Niguarda Ca' Granda), Milan, Italy
| | - Mariangela Piano
- Department of Neuroradiology, ASST Grande Ospedale Metropolitano Niguarda (Niguarda Ca' Granda), Milan, Italy.
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Neurosurgical emergency management during the lockdown period in health care regions in Spain with different COVID-19 impact: lessons learned to improve outcomes on the future waves. Eur J Trauma Emerg Surg 2021; 48:2189-2198. [PMID: 34401937 PMCID: PMC8366745 DOI: 10.1007/s00068-021-01767-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2021] [Accepted: 07/18/2021] [Indexed: 12/02/2022]
Abstract
Background COVID-19 has overloaded health care systems, testing the capacity and response in every European region. Concerns were raised regarding the impact of resources’ reorganization on certain emergency pathology management. The aim of the present study was to assess the impact of the outbreak (in terms of reduction of neurosurgical emergencies) during lockdown in different regions of Spain. Methods We analyzed the impact of the outbreak in four different affected regions by descriptive statistics and univariate comparison with same period of two previous years. These regions differed in their incidence level (high/low) and in the time of excess mortality with respect to lockdown declaration. That allowed us to analyze their influence on the characteristics of neurosurgical emergencies registered for every region. Results 1185 patients from 18 neurosurgical centers were included. Neurosurgical emergencies that underwent surgery dropped 24.41% and 28.15% in 2020 when compared with 2019 and 2018, respectively. A higher reduction was reported for the most affected regions by COVID-19. Non-traumatic spine experienced the most significant decrease in number of cases. Life-threatening conditions did not suffer a reduction in any health care region. Conclusions COVID-19 affected dramatically the neurosurgical emergency management. The most significant reduction in neurosurgical emergencies occurred on those regions that were hit unexpectedly by the pandemic, as resources were focused on fighting the virus. As a consequence, life-threating and non-life-threatening conditions’ mortality raised. Results in regions who had time to prepare for the hit were congruent with an organized and sensible neurosurgical decision-making.
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Tavanaei R, Ahmadi P, Yazdani KO, Zali A, Oraee-Yazdani S. The Impact of the Coronavirus Disease 2019 Pandemic on Neurosurgical Practice and Feasibility of Safe Resumption of Elective Procedures During this Era in a Large Referral Center in Tehran, Iran: An Unmatched Case-Control Study. World Neurosurg 2021; 154:e370-e381. [PMID: 34284156 PMCID: PMC8285939 DOI: 10.1016/j.wneu.2021.07.047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2021] [Accepted: 07/09/2021] [Indexed: 12/23/2022]
Abstract
Objective The coronavirus disease 2019 (COVID-19) pandemic has considerably affected surgical practice. The present study aimed to investigate the effects of the pandemic on neurosurgical practice and the safety of the resumption of elective procedures through implementing screening protocols in a high-volume academic public center in Iran, as one of the countries severely affected by the pandemic. Methods This unmatched case-control study compared 2 populations of patients who underwent neurosurgical procedures between June 1, 2019 and September 1, 2019 and the same period in 2020. In the prospective part of the study, patients who underwent elective procedures were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection postoperatively to evaluate the viability of our screening protocol. Results Elective and emergency procedures showed significant reduction during the pandemic (59.4%, n = 168 vs. 71.3%, n = 380) and increase (28.7%, n = 153 vs. 40.6%, n = 115, respectively; P = 0.003). The proportional distribution of neurosurgical categories remained unchanged during the pandemic. Poisson regression showed that the reduction in total daily admissions and some categories, including spine, trauma, oncology, and infection were significantly correlated with the pandemic. Among patients who underwent elective procedures, 0 (0.0%) and 26 (16.25%) had positive test results on days 30 and 60 postoperatively, respectively. Overall mortality was comparable between the pre–COVID-19 and COVID-19 periods, yet patients with concurrent SARS-CoV-2 infection showed substantially higher mortality (65%). Conclusions By implementing safety and screening protocols with proper resource allocation, the emergency care capacity can be maintained and the risk minimized of hospital-acquired SARS-CoV-2 infection, complications, and mortality among neurosurgical patients during the pandemic. Similarly, for elective procedures, according to available resources, hospital beds can be allocated for patients with a higher risk of delayed hospitalization and those who are concerned about the risk of hospital-acquired infection can be reassured.
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Affiliation(s)
- Roozbeh Tavanaei
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Pooria Ahmadi
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Kaveh Oraii Yazdani
- Department of Cardiovascular Diseases, Zahedan University of Medical Science, Zahedan, Iran
| | - Alireza Zali
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Saeed Oraee-Yazdani
- Functional Neurosurgery Research Center, Shohada Tajrish Comprehensive Neurosurgical Center of Excellence, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
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Xie L, Lin Y, Deng Y, Lei B. The Effect of SARS-CoV-2 on the Spleen and T Lymphocytes. Viral Immunol 2021; 34:416-420. [PMID: 33902347 DOI: 10.1089/vim.2020.0320] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023] Open
Abstract
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which has infected millions of individuals in the world. However, the long-term effect of SARS-CoV-2 on the organs of recovered patients remains unclear. This study is to evaluate the impact of SARS-CoV-2 on the spleen and T lymphocytes. Seventy-six patients recovered from COVID-19, including 66 cases of moderate pneumonia and 10 cases of severe pneumonia were enrolled in the observation group. The control group consisted of 55 age-matched healthy subjects. The thickness and length of spleen were measured by using B-ultrasound and the levels of T lymphocytes were detected by flow cytometry. Results showed that the mean length of spleen in the observation group was 89.57 ± 11.49 mm, which was significantly reduced compared with that in the control group (103.82 ± 11.29 mm, p < 0.001). The mean thicknesses of spleen between observation group and control group were 29.97 ± 4.04 mm and 32.45 ± 4.49 mm, respectively, and the difference was significant (p < 0.001). However, no significant difference was observed in the size of spleen between common pneumonia and severe pneumonia (p > 0.05). In addition, the decreased count of T lymphocyte was observed in part of recovered patients. The counts of T suppressor lymphocytes in patients with severe pneumonia were significantly decreased compared with those with moderate pneumonia (p = 0.005). Therefore, these data indicate that SARS-CoV-2 infection affects the size of spleen and T lymphocytes.
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Affiliation(s)
- Lixia Xie
- Department of Ultrasound, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yuanlan Lin
- Department of Ultrasound, Guangzhou Eighth People's Hospital, Guangzhou Medical University, Guangzhou, China
| | - Yushu Deng
- Department of Neurosurgery, Hospital of Integrated Traditional Chinese Medicine & Western Medicine, Southern Medical University, Guangzhou, China
| | - Bin Lei
- Department of Urology, The First Affiliated Hospital of Jinan University, Guangzhou, China
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Sadhasivam S, Arora RK, Rekapalli R, Chaturvedi J, Goyal N, Bhargava P, Mittal RS. A Systematic Review on the Impact of the COVID-19 Pandemic on Neurosurgical Practice and Indian Perspective. Asian J Neurosurg 2021; 16:24-32. [PMID: 34211863 PMCID: PMC8202370 DOI: 10.4103/ajns.ajns_379_20] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Revised: 09/22/2020] [Accepted: 09/28/2020] [Indexed: 01/08/2023] Open
Abstract
OBJECTIVE The study objective was to systematically review the impact of the current pandemic on neurosurgical practice and to find out a safe way of practicing neurosurgery amid the highly infectious patients with COVID-19. MATERIALS AND METHODS A review of the PubMed and EMBASE databases was performed. The literature was systematically searched using keywords such as "COVID-19" and "Neurosurgery." RESULTS Among the 425 records, 128 articles were found to be eligible for analysis. These articles described the perspectives of the neurosurgical departments during the pandemic, departmental models, and organizational schemes for triaging emergent and nonemergent neurosurgical cases for the optimal utilization of limited resources, and solutions to continue academic and research activities. Triaging systems help us to optimally utilize the limited resources available. Guidelines have been developed for safe neurosurgical practice and for the continuation of clinical and academic activities during this pandemic by various national and international neurosurgical societies. Key changes in the telemedicine regulatory guidelines would help us to continue to provide neurosurgical care. Videoconferences, online education programs, and webinars could help us to overcome the disadvantages brought upon the neurosurgical education by the social-distancing norms. CONCLUSION In an unprecedented time like this, no single algorithm is going to clear the ethical dilemma faced by us. Individual patient triage is a way for maintaining our ethical practice and at the same time, for efficiently utilizing the limited resources. As the pandemic progresses, new guidelines and protocols will continue to evolve for better neurosurgical practice.
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Affiliation(s)
- Saravanan Sadhasivam
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rajnish Kumar Arora
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Rajasekhar Rekapalli
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Jitender Chaturvedi
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Nishant Goyal
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Pranshu Bhargava
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Radhey Shyam Mittal
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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Raneri F, Rustemi O, Zambon G, Del Moro G, Magrini S, Ceccaroni Y, Basso E, Volpin F, Cappelletti M, Lardani J, Ferraresi S, Guida F, Chioffi F, Pinna G, Canova G, d'Avella D, Sala F, Volpin L. Neurosurgery in times of a pandemic: a survey of neurosurgical services during the COVID-19 outbreak in the Veneto region in Italy. Neurosurg Focus 2020; 49:E9. [PMID: 33260134 DOI: 10.3171/2020.9.focus20691] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Accepted: 09/21/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The purpose of this study was to analyze the effect of the coronavirus disease 2019 (COVID-19) outbreak and of the subsequent lockdown on the neurosurgical services of the Veneto region in Italy compared to the previous 4 years. METHODS A survey was conducted in all 6 neurosurgical departments in the Veneto region to collect data about surgical, inpatient care and endovascular procedures during the month of March for each year from 2016 to 2020. Safety measures to avoid infection from SARS-CoV-2 and any COVID-19 cases reported among neurosurgical patients or staff members were considered. RESULTS The mean number of neurosurgical admissions for the month of March over the 2016-2019 period was 663, whereas in March 2020 admissions decreased by 42%. Emergency admissions decreased by 23%. The average number of neurosurgical procedures was 697, and declined by 30% (range -10% to -51% in individual centers). Emergency procedures decreased in the same period by 23%. Subarachnoid hemorrhage and spontaneous intracerebral hemorrhage both decreased in Veneto-by 25% and 22%, respectively. Coiling for unruptured aneurysm, coiling for ruptured aneurysm, and surgery for ruptured aneurysm or arteriovenous malformation diminished by 49%, 27%, and 78%, respectively. Endovascular procedures for acute ischemic stroke (AIS) increased by 33% in 2020 (28 procedures in total). There was a slight decrease (8%) in brain tumor surgeries. Neurosurgical admissions decreased by 25% and 35% for head trauma and spinal trauma, respectively, while surgical procedures for head trauma diminished by 19% and procedures for spinal trauma declined by 26%. Admissions and surgical treatments for degenerative spine were halved. Eleven healthcare workers and 8 patients were infected in the acute phase of the pandemic. CONCLUSIONS This multicenter study describes the effects of a COVID-19 outbreak on neurosurgical activities in a vast region in Italy. Remodulation of neurosurgical activities has resulted in a significant reduction of elective and emergency surgeries compared to previous years. Most likely this is a combined result of cancellation of elective and postponable surgeries, increase of conservative management, increase in social restrictions, and in patients' fear of accessing hospitals. Curiously, only endovascular procedures for AIS have increased, possibly due to reduced physical activity or increased thrombosis in SARS-CoV-2. The confounding effect of thrombectomy increase over time cannot be excluded. No conclusion can be drawn on AIS incidence. Active monitoring with nasopharyngeal swabs, wearing face masks, and using separate pathways for infected patients reduce the risk of infection.
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Affiliation(s)
- Fabio Raneri
- 1Azienda ULSS 8 Berica, Ospedale San Botolo, Vicenza
| | | | | | - Giulia Del Moro
- 2Azienda ULSS Marca Trevigiana, Ospedale Cà Foncello, Treviso
| | - Salima Magrini
- 3Azienda ULSS 3 Serenissima, Ospedale dell'Angelo, Mestre
| | - Yuri Ceccaroni
- 3Azienda ULSS 3 Serenissima, Ospedale dell'Angelo, Mestre
| | - Elisabetta Basso
- 4Azienda ULSS 18 Rovigo, Ospedale Santa Maria della Misericordia, Rovigo
| | - Francesco Volpin
- 5Università degli Studi di Padova, Azienda Ospedaliera di Padova, Padua
| | | | - Jacopo Lardani
- 6Università degli Studi di Verona, Azienda Ospedaliera Universitaria Integrata, Verona; and
| | - Stefano Ferraresi
- 4Azienda ULSS 18 Rovigo, Ospedale Santa Maria della Misericordia, Rovigo
| | - Franco Guida
- 3Azienda ULSS 3 Serenissima, Ospedale dell'Angelo, Mestre
| | - Franco Chioffi
- 5Università degli Studi di Padova, Azienda Ospedaliera di Padova, Padua
| | - Giampietro Pinna
- 6Università degli Studi di Verona, Azienda Ospedaliera Universitaria Integrata, Verona; and
| | - Giuseppe Canova
- 2Azienda ULSS Marca Trevigiana, Ospedale Cà Foncello, Treviso
| | - Domenico d'Avella
- 5Università degli Studi di Padova, Azienda Ospedaliera di Padova, Padua.,7Academic Neurosurgery, Department of Neurosciences, University of Padua Medical School, Padua, Italy
| | - Francesco Sala
- 6Università degli Studi di Verona, Azienda Ospedaliera Universitaria Integrata, Verona; and
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Bernucci C, Fanti A, Veiceschi P, Costi E, Sicignano AM, Brembilla C. Neurosurgeons on the front line: experience from the center of the storm in Italy. Neurosurg Focus 2020; 49:E6. [PMID: 33260135 DOI: 10.3171/2020.9.focus20577] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2020] [Accepted: 09/19/2020] [Indexed: 11/06/2022]
Abstract
In this tumultuous time, the entire world has been shaken up by the COVID-19 outbreak. Italy has had one of the highest infection-related mortality rates. Bergamo, a city in eastern Lombardy, was among the most affected. Here, the authors describe the main healthcare actions taken at their institution to stem the crisis, with particular concern regarding the fate of their neurosurgery department. Among the different topics, the authors particularly focus on the retraining of neurosurgeons, organization of activities, and what should be the role of neurosurgeons during a pandemic.
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Affiliation(s)
- Claudio Bernucci
- 1Department of Neurosurgery, ASST Papa Giovanni XXIII Hospital, Bergamo
| | - Andrea Fanti
- 1Department of Neurosurgery, ASST Papa Giovanni XXIII Hospital, Bergamo.,2Department of Neurosurgery, Scuola di Specializzazione in Neurochirurgia, Università degli Studi di Pavia; and
| | - Pierlorenzo Veiceschi
- 2Department of Neurosurgery, Scuola di Specializzazione in Neurochirurgia, Università degli Studi di Pavia; and.,3Department of Neurosurgery, Scuola di Specializzazione in Neurochirurgia, Università degli Studi dell'Insubria, Varese, Italy
| | - Emanuele Costi
- 1Department of Neurosurgery, ASST Papa Giovanni XXIII Hospital, Bergamo
| | | | - Carlo Brembilla
- 1Department of Neurosurgery, ASST Papa Giovanni XXIII Hospital, Bergamo
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Lubansu A, Assamadi M, Barrit S, Dembour V, Yao G, El Hadwe S, De Witte O. COVID-19 Impact on Neurosurgical Practice: Lockdown Attitude and Experience of a European Academic Center. World Neurosurg 2020; 144:e380-e388. [PMID: 32891850 PMCID: PMC7470722 DOI: 10.1016/j.wneu.2020.08.168] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2020] [Revised: 08/22/2020] [Accepted: 08/23/2020] [Indexed: 12/23/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge. Different models of reorganization have been described aiming to preserve resources and ensure optimal medical care. Limited clinical neurosurgical experience with patients with COVID-19 has been reported. We share organizational experience, attitudes, and preliminary data of patients treated at our institution. METHODS Institutional guidelines and patient workflow are described and visualized. A cohort of all neurosurgical patients managed during the lockdown period is presented and analyzed, assessing suspected nosocomial infection risk factors. A comparative surgical subcohort from the previous year was used to investigate the impact on surgical activity. RESULTS A total of 176 patients were admitted in 66 days, 20 of whom tested positive for COVID-19. Patients initially admitted to the neurosurgical ward were less likely to be suspected for a COVID-19 infection compared with patients admitted for critical emergencies, particularly with neurovascular and stroke-related diseases. The mortality of patients with COVID-19 was remarkably high (45%), and even higher in patients who underwent surgical intervention (77%). In addition to the expected decrease in surgical activity (-53%), a decrease in traumatic emergencies was noted. CONCLUSIONS By applying infection prevention and resource-sparing logistics measures shared by the international medical community, we were able to maintain essential neurosurgical care in a pandemic with controlled nosocomial infection risk. Special consideration should be given to medical management and surgical indications in patients infected with severe acute respiratory syndrome coronavirus 2, because they seem to show a problematic hemostatic profile that might result in an unfavorable clinical and surgical outcome.
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Affiliation(s)
- Alphonse Lubansu
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Belgium.
| | - Mouhssine Assamadi
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Belgium; Department of Neurosurgery, Ibn Tofail Hospital, Université Cadi Ayyad, CHU Mohammed Sixth, Marrakech, Morocco
| | - Sami Barrit
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Belgium
| | - Victoria Dembour
- Department of Neurosurgery, Delta Hospital, CHIREC, Brussels, Belgium
| | - Gedeon Yao
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Belgium; Department of Neurosurgery, Hospital University of Yopougon, Abidjan, Ivory Coast
| | - Salim El Hadwe
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Belgium
| | - Olivier De Witte
- Department of Neurosurgery, Erasme Hospital, Université Libre de Bruxelles, Belgium
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Candeloro E, Carimati F, Tabaee Damavandi P, Princiotta Cariddi L, Banfi P, Clemenzi A, Gallazzi M, Mauri M, Rebecchi V, Baruzzi F, Giorgianni A, Tozzi M, Bianchi M, Ageno W, Versino M. An Example of a Stroke Unit Reshaping in the Context of a Regional Hub and Spoke System in the COVID-19 Era. Front Neurol 2020; 11:1029. [PMID: 33178094 PMCID: PMC7593656 DOI: 10.3389/fneur.2020.01029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 08/06/2020] [Indexed: 12/23/2022] Open
Abstract
During the COVID-19 outbreak, the Neurology and Stroke Unit (SU) of the hospital of Varese had to serve as a cerebrovascular hub, meaning that the referral area for the unit doubled. The number of beds in the SU was increased from 4 to 8. We took advantage of the temporary suspension of the out-patient clinic and reshaped our activity to guarantee the 24/7 availability of recombinant tissue Plasminogen Activator (rtPA) intravenous therapy (IVT) in the SU, and to ensure we were able to admit patients to the SU as soon as they completed endovascular treatment (EVT). In 42 days, 46 stroke patients were admitted to our hospital, and 34.7% of them underwent IVT and/or EVT, which means that we treated 0.38 patients per day; in the baseline period from 2016 to 2018, these same figures had been 23.5% and 0.23, respectively. The mean values of the door-to-first CT/MRI and the door-to-groin puncture, but not of the onset-to-door and the door-to-needle periods were slightly but significantly longer than those observed in the baseline period in 276 patients. On an individual basis, only one patient exceeded the door-to-groin puncture time limit computed from the baseline period by about 10 min. None of the patients had a major complication following the procedures. None of the patients was or became SARS-CoV2 positive. In conclusion, we were able to manage the new hub-and-spoke system safely and without significant delays. The reshaping of the SU was made possible by the significant reduction of out-patient activity. The consequences of this reduction are still unknown but eventually, this emergency will suggest ways to reconsider the management and the allocation of health system resources.
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Affiliation(s)
- Elisa Candeloro
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Federico Carimati
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Payam Tabaee Damavandi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy.,Department of Medicine and Surgery, Bicocca University, Milan, Italy
| | - Lucia Princiotta Cariddi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy.,Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Paola Banfi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Alessandro Clemenzi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Marco Gallazzi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Marco Mauri
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy.,Department of Medicine and Surgery, Insubria University, Varese, Italy
| | - Valentina Rebecchi
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Fabio Baruzzi
- Neuroradiology Unit, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Andrea Giorgianni
- Neuroradiology Unit, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Matteo Tozzi
- Department of Medicine and Surgery, Insubria University, Varese, Italy.,Vascular Surgery Unit, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Massimo Bianchi
- Emergency Department, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Walter Ageno
- Department of Medicine and Surgery, Insubria University, Varese, Italy.,Emergency Department, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy
| | - Maurizio Versino
- Neurology and Stroke Units, ASST-Settelaghi, Ospedale di Circolo Varese, Varese, Italy.,Department of Medicine and Surgery, Insubria University, Varese, Italy
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11
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Rahman MM, Azam MG, Garcia-Ballestas E, Agrawal A, Moscote-Salazar LR, Khan RA. Letter to the Editor: Pain Management Strategy in Neurosurgical Patients During the Coronavirus Pandemic. World Neurosurg 2020; 141:577. [PMID: 32871738 PMCID: PMC7444904 DOI: 10.1016/j.wneu.2020.06.225] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 06/29/2020] [Indexed: 01/30/2023]
Affiliation(s)
- Md Moshiur Rahman
- Neurosurgery Department, Holy Family Red Crescent Medical College, Dhaka, Bangladesh.
| | | | - Ezequiel Garcia-Ballestas
- Center for Biomedical Research (CIB), Faculty of Medicine, University of Cartagena, Cartagena, Colombia
| | - Amit Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhopal, India
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12
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Ozoner B, Gungor A, Hasanov T, Toktas ZO, Kilic T. Neurosurgical Practice During Coronavirus Disease 2019 (COVID-19) Pandemic. World Neurosurg 2020; 140:198-207. [PMID: 32474101 PMCID: PMC7255756 DOI: 10.1016/j.wneu.2020.05.195] [Citation(s) in RCA: 43] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 12/12/2022]
Abstract
Coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a highly contagious life-threatening condition with unprecedented impacts for worldwide societies and health care systems. Since the first detection in China, it has spread rapidly worldwide. The increased burden has substantially affected neurosurgical practice and intensive modifications have been required in surgical scheduling, inpatient and outpatient clinics, management of emergency cases, and even in academic activities. In some systems, nonoverlapping teams have been created to minimize transmission among health care workers. In cases of a massive burden, neurosurgeons may need to be reassigned to COVID-19 wards, or teams from other regions may need to be sent to severely affected areas. Recommendations are as following. In outpatient practice, if possible, appointments should be undertaken via telemedicine. All staff assigned to the non-COVID treatment unit should be clothed in level 1 personal protective equipment. If possible, postponement is recommended for operations that do not require urgent or emergent intervention. All patients indicated for surgery must receive COVID-19 screening, including a nasopharyngeal swab and thorax computed tomography. Level 2 protection measures are appropriate during COVID-19-negative patients' operations. Operations of COVID-19-positive patients and emergency operations, in which screening cannot be obtained, should be performed after level 3 protective measures. During surgery, the use of high-speed drills and electrocautery should be reduced to minimize aerosol production. Screening is crucial in all patients because the surgical outcome is highly mortal in patients with COVID-19. All educational and academic conferences can be undertaken as virtual webinars.
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Affiliation(s)
- Baris Ozoner
- Department of Neurosurgery, School of Medicine, Bahcesehir University, Istanbul, Turkey.
| | - Abuzer Gungor
- Department of Neurosurgery, Umraniye Research and Education Hospital, University of Medical Sciences, Istanbul, Turkey
| | - Teyyup Hasanov
- Department of Neurosurgery, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Zafer Orkun Toktas
- Department of Neurosurgery, School of Medicine, Bahcesehir University, Istanbul, Turkey
| | - Turker Kilic
- Department of Neurosurgery, School of Medicine, Bahcesehir University, Istanbul, Turkey
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13
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Bajunaid K, Alqurashi A, Alatar A, Alkutbi M, Alzahrani AH, Sabbagh AJ, Alobaid A, Barnawi A, Alferayan AA, Alkhani AM, Salamah AB, Sheikh BY, Alotaibi FE, Alabbas F, Farrash F, Al-Jehani HM, Alhabib H, Alnaami I, Altweijri I, Khoja I, Taha M, Alzahrani M, Bafaquh MS, Binmahfoodh M, Algahtany MA, Al-Rashed S, Raza SM, Elwatidy S, Alomar SA, Al-Issawi W, Khormi YH, Ammar A, Al-Habib A, Baeesa SS, Ajlan A. Neurosurgical Procedures and Safety During the COVID-19 Pandemic: A Case-Control Multicenter Study. World Neurosurg 2020; 143:e179-e187. [PMID: 32702490 PMCID: PMC7370909 DOI: 10.1016/j.wneu.2020.07.093] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 12/20/2022]
Abstract
Objective Quantitative documentation of the effects of outbreaks, including the coronavirus disease 2019 (COVID-19) pandemic, is limited in neurosurgery. Our study aimed to evaluate the effects of the COVID-19 pandemic on neurosurgical practice and to determine whether surgical procedures are associated with increased morbidity and mortality. Methods A multicenter case-control study was conducted, involving patients who underwent neurosurgical intervention in the Kingdom of Saudi Arabia during 2 periods: pre-COVID-19 and during the COVID-19 pandemic. The surgical intervention data evaluated included diagnostic category, case priority, complications, length of hospital stay, and 30-day mortality. Results A total of 850 procedures were included, 36% during COVID-19. The median number of procedures per day was significantly lower during the COVID-19 period (5.5 cases) than during the pre-COVID-19 period (12 cases; P < 0.0001). Complications, length of hospital stay, and 30-day mortality did not differ during the pandemic. In a multivariate analysis comparing both periods, case priority levels 1 (immediate) (odds ratio [OR], 1.82; 95% confidence interval [CI], 1.24–2.67), 1 (1–24 h) (OR, 1.63; 95% CI, 1.10–2.41), and 4 (OR, 0.28; 95% CI, 0.19–0.42) showed significant differences. Conclusions During the early phase of the COVID-19 pandemic, the overall number of neurosurgical procedures declined, but the load of emergency procedures remained the same, thus highlighting the need to allocate sufficient resources for emergencies. More importantly, performing neurosurgical procedures during the pandemic in regions with limited effects of the outbreak on the health care system was safe. Our findings may aid in developing guidelines for acute and long-term care during pandemics in surgical subspecialties.
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Affiliation(s)
- Khalid Bajunaid
- Department of Surgery, Faculty of Medicine, University of Jeddah, Jeddah, Saudi Arabia; Department of Neurology and Neurosurgery, Montreal Neurological Institute and hospital, McGill University, Montreal, Quebec, Canada
| | - Ashwag Alqurashi
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Abdullah Alatar
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Mohammad Alkutbi
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Anas H Alzahrani
- Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulrahman J Sabbagh
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdullah Alobaid
- Department of Adult Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Abdulwahed Barnawi
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | | | - Ahmed M Alkhani
- Division of Neurosurgery, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Ali Bin Salamah
- Department of Neurosurgery, King Saud Medical City, Riyadh, Saudi Arabia
| | - Bassem Yousef Sheikh
- Vascular Endovascular and Skull Base Neurosurgery, College of Medicine, Taibah University, Madinah, Saudi Arabia
| | - Fahad E Alotaibi
- Department of Pediatric Neurosurgery, National Neuroscience institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Faisal Alabbas
- Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Faisal Farrash
- Department of Neuroscience, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hosam M Al-Jehani
- Department of Neurology and Neurosurgery, Montreal Neurological Institute and hospital, McGill University, Montreal, Quebec, Canada; Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Husam Alhabib
- Department of Spine Surgery, Dr Sulaiman Alhabib Hospital, Khobar, Saudi Arabia
| | - Ibrahim Alnaami
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Ikhlass Altweijri
- Division of Neurosurgery, Department of Surgery, King Khalid University Hospital, Riyadh, Saudi Arabia
| | - Isam Khoja
- Department of Neurosurgery, International Medical Center, Jeddah, Saudi Arabia
| | - Mahmoud Taha
- Department of Neurosurgery, King Fahad specialist Hospital, Dammam, Saudi Arabia
| | - Moajeb Alzahrani
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed S Bafaquh
- Department of Adult Neurosurgery, National Neuroscience Institute, King Fahad Medical City, Riyadh, Saudi Arabia
| | - Mohammed Binmahfoodh
- Neurosciences Department, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Mubarak Ali Algahtany
- Division of Neurosurgery, Department of Surgery, College of Medicine, King Khalid University, Abha, Saudi Arabia
| | - Sabah Al-Rashed
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Syed Muhammad Raza
- Department of Neurosurgery, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Sherif Elwatidy
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Soha A Alomar
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Wisam Al-Issawi
- Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Yahya H Khormi
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, Jazan University, Jazan, Saudi Arabia
| | - Ahmad Ammar
- Department of Neurosurgery, Imam Abdulrahman bin Faisal University, Dammam, Saudi Arabia
| | - Amro Al-Habib
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Saleh S Baeesa
- Division of Neurosurgery, Department of Surgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia
| | - Abdulrazag Ajlan
- Neurosurgery Division, Department of Surgery, College of Medicine, King Saud University, Riyadh, Saudi Arabia.
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14
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Murthy NK, Spinner RJ. Letter to the Editor: Priority Considerations of Patients with Peripheral Nerve Pathology in the Time of COVID-19. World Neurosurg 2020; 140:493-494. [PMID: 32592967 PMCID: PMC7315158 DOI: 10.1016/j.wneu.2020.06.146] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/18/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Nikhil K Murthy
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Robert J Spinner
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota, USA.
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15
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D'Antona L, Palasz J, Haq H, Usher I, De-Saram S, Curtis C, Thorne L, Watkins LD, Toma AK. Letter to the Editor: Risk of Hospital-Acquired Coronavirus Disease 2019 (COVID-19) Infection During Admission for Semiurgent Neurosurgical Procedures. World Neurosurg 2020; 140:486-488. [PMID: 32535052 PMCID: PMC7289109 DOI: 10.1016/j.wneu.2020.06.034] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Accepted: 06/05/2020] [Indexed: 12/27/2022]
Affiliation(s)
- Linda D'Antona
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; UCL Queen Square Institute of Neurology, London, United Kingdom. linda.d'
| | - Joanna Palasz
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Huzaifah Haq
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Inga Usher
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Sophia De-Saram
- Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Carmel Curtis
- Department of Clinical Microbiology, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Lewis Thorne
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Laurence Dale Watkins
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom
| | - Ahmed Kassem Toma
- Victor Horsley Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, Queen Square, London, United Kingdom; UCL Queen Square Institute of Neurology, London, United Kingdom
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16
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Borsa S, Pluderi M, Carrabba G, Ampollini A, Pirovano M, Lombardi F, Tomei M, Locatelli M. Letter to the Editor: Impact of COVID-19 Outbreak on Acute Low Back Pain. World Neurosurg 2020; 139:749. [PMID: 32479910 PMCID: PMC7256499 DOI: 10.1016/j.wneu.2020.05.218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 05/24/2020] [Indexed: 12/03/2022]
Affiliation(s)
- Stefano Borsa
- Department of Neurosurgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy.
| | - Mauro Pluderi
- Department of Neurosurgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Giorgio Carrabba
- Department of Neurosurgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Antonella Ampollini
- Department of Neurosurgery, ASST Santi Paolo e Carlo, San Carlo Hospital, Milan, Italy
| | - Marta Pirovano
- Department of Neurosurgery, ASST Santi Paolo e Carlo, San Carlo Hospital, Milan, Italy
| | - Francesco Lombardi
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Massimo Tomei
- Department of Neurosurgery, IRCCS Istituto Clinico Humanitas, Rozzano, Milan, Italy
| | - Marco Locatelli
- Department of Neurosurgery, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milan, Italy; Department of Pathophysiology and Transplantation, University of Milan, Milan, Italy
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17
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Antony J, James WT, Neriamparambil AJ, Barot DD, Withers T. An Australian Response to the COVID-19 Pandemic and Its Implications on the Practice of Neurosurgery. World Neurosurg 2020; 139:e864-e871. [PMID: 32450310 PMCID: PMC7243763 DOI: 10.1016/j.wneu.2020.05.136] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 05/14/2020] [Accepted: 05/15/2020] [Indexed: 11/02/2022]
Abstract
OBJECTIVE This study was designed to assess the impact of public health policy in Australia in response to the coronavirus disease identified in 2019 (COVID-19) pandemic on the delivery of neurosurgical services. Being essential services, we postulated that there would not be a decrease in elective and emergency neurosurgical presentations and surgeries. METHODS This is a prospective, observational, epidemiologic study in strict adherence to the "STROBE" (Strengthening The Reporting of OBservational studies in Epidemiology) guidelines. It is a cross-sectional, multicentric study involving 5 tertiary neurosurgical centers to capture all public neurosurgical admissions in Queensland during the past 3 months (February-April, 2020) of significant public health policy changes to combat COVID-19. RESULTS An analysis of the 1298 admissions for the Queensland population of 5.07 million Australians demonstrated a decrease in the number of elective and emergency admissions. The decline in elective admissions, particularly degenerative spine, benign neoplasms, and vascular pathologies, was a direct response of government strategy to curb activity to urgent surgical interventions only. Moreover, a trend toward fewer emergency admissions was also noted, partly explained by less trauma and also a decline in vascular pathologies including subarachnoid hemorrhage. CONCLUSIONS In comparison with Europe and North America, this study demonstrates the impact of proactive public health measures in Australia that successfully flattened the COVID-19 curve while facilitating ongoing care of acutely unwell neurosurgical patients.
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Affiliation(s)
- Joyce Antony
- Department of Neurosurgery, Gold Coast University Hospital, Gold Coast, Australia; School of Medicine, The University of Queensland, Brisbane, Australia.
| | - William Thomas James
- Department of Neurosurgery, Gold Coast University Hospital, Gold Coast, Australia
| | | | | | - Teresa Withers
- Department of Neurosurgery, Gold Coast University Hospital, Gold Coast, Australia
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18
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Giorgianni A, Vinacci G, Agosti E, Mercuri A, Baruzzi F. Neuroradiological features in COVID-19 patients: First evidence in a complex scenario. J Neuroradiol 2020; 47:474-476. [PMID: 32417159 PMCID: PMC7227540 DOI: 10.1016/j.neurad.2020.05.005] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Revised: 05/10/2020] [Accepted: 05/10/2020] [Indexed: 11/21/2022]
Affiliation(s)
- Andrea Giorgianni
- Department of Neuroradiology, ASST settelaghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Gabriele Vinacci
- Department of Radiology, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy.
| | - Edoardo Agosti
- Department of Neurosurgery, Ospedale di Circolo e Fondazione Macchi, University of Insubria, Varese, Italy
| | - Anna Mercuri
- Department of Neuroradiology, ASST settelaghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
| | - Fabio Baruzzi
- Department of Neuroradiology, ASST settelaghi, Ospedale di Circolo e Fondazione Macchi, Varese, Italy
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