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Liu KQ, Dallas J, Wenger TA, Ristianto Z, Ding L, Chow F, Zada G, Mack WJ, Attenello FJ. Increased time to surgery and worse perioperative outcome in benign brain tumor patients with COVID-19. J Clin Neurosci 2023; 117:20-26. [PMID: 37740998 PMCID: PMC10686786 DOI: 10.1016/j.jocn.2023.09.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 08/23/2023] [Accepted: 09/14/2023] [Indexed: 09/25/2023]
Abstract
BACKGROUND The COVID-19 pandemic caused significant disruptions to healthcare systems around the world, due to both high resource utilization and concern for disease spread. Delays in non-emergent surgeries have also affected chronic disease management, including that of benign brain tumors such as meningiomas and pituitary adenomas. To evaluate the effect of COVID-19 infection on benign brain tumor resection rates and subsequent perioperative and inpatient outcomes, this study utilized the 2020 National Inpatient Sample (NIS) to investigate rates of surgical resection, time to surgery, and mortality among benign brain tumor patients with and without COVID-19. METHODS Patient data from April 2020 to December 2020 was extracted from the NIS. Confirmed COVID-19 diagnosis was identified using the ICD-10 diagnosis code U07.1. Patients with benign neoplasms of the cerebral meninges, cranial nerves, pituitary gland, craniopharyngeal duct, and brain were included in the study. Patient socio-demographics, hospital characteristics, and clinical comorbidities were obtained. Outcome variables included rates of surgical resection, time to surgery, in-hospital mortality, length of stay, and discharge disposition. RESULTS The study analysis consisted of 13,053 patients with benign intracranial neoplasms who met inclusion criteria; 597 (4.6%) patients were COVID-19 positive. Patients with COVID-19 were more likely to be older and male than COVID-19 negative patients. Patients with COVID-19 had increased overall likelihood of mortality (OR 2.36, 95% CI 1.72-3.25, p < 0.0001). Even when controlling for sociodemographic/hospital factors and comorbidities, COVID-19 positive patients had a significantly longer time to surgery (8.7 days vs. 0.9 days, p < 0.0001) than COVID negative patients, and were associated with a decreased likelihood of undergoing surgery on index admission overall (OR 0.17, 95% CI 0.10-0.29, p < 0.0001). CONCLUSIONS As expected, COVID-19 infection was associated with worse inpatient outcomes in effectively all measured categories, including longer time to surgery, decreased likelihood of receiving surgery on index admission, and increased likelihood of in-hospital mortality. These findings emphasize the effect that COVID-19 has on other aspects of patient care and highlight the importance of appropriate avenues of care for patients who are COVID-19 positive. Although the COVID-19 pandemic is no longer a public health emergency, understanding the pandemic's impact on outcome for these patients is essential in efficient triage and optimizing treatment for these patients in the future. Further study is needed to elucidate causal relationships on the outcomes of benign brain tumor patients.
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Affiliation(s)
- Kristie Q Liu
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA.
| | - Jonathan Dallas
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State Street Suite 3300, Los Angeles, CA 90033, USA
| | - Talia A Wenger
- Keck School of Medicine, University of Southern California, 1975 Zonal Ave, Los Angeles, CA 90033, USA
| | - Zasca Ristianto
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State Street Suite 3300, Los Angeles, CA 90033, USA
| | - Li Ding
- Department of Preventive Medicine, Keck School of Medicine, University of Southern California, 2001 North Soto Street, Los Angeles, CA 90032, USA
| | - Frances Chow
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State Street Suite 3300, Los Angeles, CA 90033, USA
| | - Gabriel Zada
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State Street Suite 3300, Los Angeles, CA 90033, USA
| | - William J Mack
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State Street Suite 3300, Los Angeles, CA 90033, USA
| | - Frank J Attenello
- Department of Neurological Surgery, Keck School of Medicine, University of Southern California, 1200 North State Street Suite 3300, Los Angeles, CA 90033, USA
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Munda M, Velnar T, Bosnjak R, Zele T, Gradisnik L, Spazzapan P, Kos N, Kocivnik N, Benedicic M, Prestor B. COVID-19 and Surgical Practice in Slovenia: Managing the Crisis in Neurosurgery during the COVID-19 Pandemic. Life (Basel) 2023; 13:2095. [PMID: 37895476 PMCID: PMC10608538 DOI: 10.3390/life13102095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/16/2023] [Accepted: 10/20/2023] [Indexed: 10/29/2023] Open
Abstract
Worldwide, the novel coronavirus disease 2019 (COVID-19) has become a significant threat to global health. Worldwide, COVID-19 has affected the health service also in Slovenia. During this time, neurosurgery is facing difficulties in its service, both in emergency and elective surgeries. In the article, we describe the anti-COVID-19 measures taken at our neurosurgical department in a medical centre in Ljubljana, Slovenia, and analysed and compared the number of emergency and elective neurosurgical procedures during the time of the pandemic.
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Affiliation(s)
- Matic Munda
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
| | - Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
- AMEU-ECM Maribor, 2000 Maribor, Slovenia;
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
| | - Tilen Zele
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
- AMEU-ECM Maribor, 2000 Maribor, Slovenia;
| | - Lidija Gradisnik
- Institute of Biomedical Sciences, Medical Faculty Maribor, 2000 Maribor, Slovenia;
| | - Peter Spazzapan
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
| | - Natasa Kos
- AMEU-ECM Maribor, 2000 Maribor, Slovenia;
- Department of Rehabilitation, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia
| | - Nina Kocivnik
- Faculty of Pharmacy, University of Ljubljana, 1000 Ljubljana, Slovenia;
| | - Mitja Benedicic
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
| | - Borut Prestor
- Department of Neurosurgery, University Medical Centre Ljubljana, 1000 Ljubljana, Slovenia; (M.M.); (R.B.); (T.Z.); (P.S.); (M.B.); (B.P.)
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Gerlach R, Dengler J, Bollmann A, Stoffel M, Youssef F, Carl B, Rosahl S, Ryang YM, Terzis J, Kristof R, Westermaier T, Kuhlen R, Steinbrecher A, Pellissier V, Hohenstein S, Heese O. Neurosurgical care for patients with high-grade gliomas during the coronavirus disease 2019 pandemic: Analysis of routine billing data of a German nationwide hospital network. Neurooncol Pract 2023; 10:429-436. [PMID: 37720392 PMCID: PMC10502769 DOI: 10.1093/nop/npad015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
Background Little is known about delivery of neurosurgical care, complication rate and outcome of patients with high-grade glioma (HGG) during the coronavirus disease 2019 (Covid-19) pandemic. Methods This observational, retrospective cohort study analyzed routine administrative data of all patients admitted for neurosurgical treatment of an HGG within the Helios Hospital network in Germany. Data of the Covid-19 pandemic (March 1, 2020-May 31, 2022) were compared to the pre-pandemic period (January 1, 2016-February 29, 2020). Frequency of treatment and outcome (in-hospital mortality, length of hospital stay [LOHS], time in intensive care unit [TICU] and ventilation outside the operating room [OR]) were separately analyzed for patients with microsurgical resection (MR) or stereotactic biopsy (STBx). Results A total of 1763 patients underwent MR of an HGG (648 patients during the Covid-19 pandemic; 1115 patients in the pre-pandemic period). 513 patients underwent STBx (182 [pandemic]; 331 patients [pre-pandemic]). No significant differences were found for treatment frequency (MR: 2.95 patients/week [Covid-19 pandemic] vs. 3.04 patients/week [pre-pandemic], IRR 0.98, 95% CI: 0.89-1.07; STBx (1.82 [Covid-19 pandemic] vs. 1.86 [pre-pandemic], IRR 0.96, 95% CI: 0.80-1.16, P > .05). Rates of in-hospital mortality, infection, postoperative hemorrhage, cerebral ischemia and ventilation outside the OR were similar in both periods. Overall LOHS was significantly shorter for patients with MR and STBx during the Covid-19 pandemic. Conclusions The Covid-19 pandemic did not affect the frequency of neurosurgical treatment of patients with an HGG based on data of a large nationwide hospital network in Germany. LOHS was significantly shorter but quality of neurosurgical care and outcome was not altered during the Covid-19 pandemic.
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Affiliation(s)
- Ruediger Gerlach
- Department of Neurosurgery, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Julius Dengler
- Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany and Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany
| | - Andreas Bollmann
- Helios Health Institute, Berlin and Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Michael Stoffel
- Department of Neurosurgery, HELIOS Hospital Krefeld, Krefeld, Germany
| | - Farid Youssef
- Department of Neurosurgery, HELIOS Vogtland-Hospital Plauen, Plauen, Germany
| | - Barbara Carl
- Department of Neurosurgery, HELIOS Dr. Horst Schmidt Kliniken Wiesbaden, Wiesbaden, Germany
| | - Steffen Rosahl
- Department of Neurosurgery, HELIOS Klinikum Erfurt, Erfurt, Germany
| | - Yu-Mi Ryang
- Department of Neurosurgery, HELIOS Klinikum Berlin-Buch, Berlin, Germany
| | - Jorge Terzis
- Department of Neurosurgery; HELIOS Universitätsklinikum Wuppertal, Wuppertal, Germany
| | - Rudolf Kristof
- Department of Neurosurgery, HELIOS Klinikum Meiningen, Meiningen, Germany
| | - Thomas Westermaier
- Department of Neurosurgery, Helios Amper-Klinikum Dachau, Dachau, Germany
| | | | | | - Vincent Pellissier
- HELIOS Health Institute, Berlin and Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Sven Hohenstein
- HELIOS Health Institute, Berlin and Department of Electrophysiology, Heart Center Leipzig at University of Leipzig, Leipzig, Germany
| | - Oliver Heese
- Department of Neurosurgery and Spinal Surgery, HELIOS Medical Center, Campus of MSH Medical School Hamburg, Schwerin, Germany
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Liu KQT, Dallas J, Wenger TA, Richards H, Ding L, Chow FE, Zada G, Mack WJ, Attenello FJ. Coronavirus disease-19 is associated with decreased treatment access and worsened outcomes in malignant brain tumor patients. Surg Neurol Int 2023; 14:292. [PMID: 37680935 PMCID: PMC10481862 DOI: 10.25259/sni_440_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Accepted: 07/23/2023] [Indexed: 09/09/2023] Open
Abstract
Background The global coronavirus disease-19 (COVID-19) pandemic has resulted in procedural delays around the world; however, timely and aggressive surgical resection for malignant brain tumor patients is essential for outcome optimization. To investigate the association between COVID-19 and outcomes of these patients, we queried the 2020 National Inpatient Sample (NIS) for differences in rates of surgical resection, time to surgery, mortality, and discharge disposition between patients with and without confirmed COVID-19 infection. Methods Patient data were taken from the NIS from April 2020 to December 2020. COVID-19 diagnosis was determined with the International Classification of Diseases, Tenth Revision, Clinical Modification code U07.1. Results A total of 30,671 malignant brain tumor patients met inclusion criteria and 738 (2.4%) patients had a confirmed COVID-19 diagnosis. COVID-19-positive patients had lower likelihood of receiving surgery (Odds ratio [OR] 0.43, 95% confidence interval [CI] 0.29-0.63, P < 0.0001), increased likelihood of mortality (OR 2.18, 95% CI 1.78-2.66, P < 0.0001), and increased likelihood of non-routine discharge (OR 1.25, 95% CI 1.13-1.39, P < 0.0001). Notably, COVID patients receiving surgery were not associated with surgical delay (P = 0.17). Conclusion COVID-19 infection was associated with worse patient outcome in malignant brain tumor patients, including decreased likelihood of receiving surgery, increased likelihood of mortality, and increased likelihood of non-routine discharge. Our study highlights the need to balance the risks and benefits of delaying surgery for malignant brain tumor patients with COVID-19. Although the COVID-19 pandemic is no longer a public health emergency, understanding the pandemic's impact on outcome provides important insight in effective triage for these patients in the situations where resources are limited.
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Affiliation(s)
- Kristie Qwan-Ting Liu
- Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Jonathan Dallas
- Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Talia A. Wenger
- Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Hunter Richards
- Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, United States
| | - Li Ding
- Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Frances Elaine Chow
- Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Gabriel Zada
- Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - William J. Mack
- Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
| | - Frank J. Attenello
- Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, United States
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Kumarapuram S, Sreenivasan S, Mathivanan A, Manchiraju P, Khuroo M, Sundararajan S, Nanda A, Roychowdhury S, Gupta G. Network analysis of neurosurgical literature: an increased focus on training during the COVID-19 pandemic. Neurosurg Rev 2023; 46:178. [PMID: 37466764 DOI: 10.1007/s10143-023-02069-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Revised: 05/10/2023] [Accepted: 06/20/2023] [Indexed: 07/20/2023]
Abstract
The COVID-19 pandemic led to stringent guidelines to restrict the conduct of non-emergent surgical procedures. Consequently, neurosurgery departments experienced a decline in case volumes and greater educational time being spent on virtual research projects. In our report, we reveal how neurosurgical research has changed during the pandemic compared to the pre-pandemic phase. The WebOfScience database was searched for neurosurgical articles published between 2012-2019 (pre-pandemic) and 2020-2022 (pandemic). From this data, the keywords, terms, and countries were analyzed using networks formed by the VOS Viewer software. In addition, the analysis was repeated for neurosurgical articles specific to COVID-19. Network analyses of terms and keywords revealed an increased popularity of virtual research projects, including case reports, meta-analyses, reviews, surveys, and database studies. Additionally, there was increased interest in research pertaining to neurosurgical education during the post-pandemic era, including topics regarding virtual training modalities, mental health, and telemedicine. Our bibliometrics analysis suggests that the impact of COVID-19 restrictions on hospital systems affected neurosurgical training programs. Future investigations should explore the effects of the trainee experience during the COVID-19 pandemic on the outlook for neurosurgical education.
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Affiliation(s)
- Siddhant Kumarapuram
- Department of Neurosurgery, Robert Wood Johnson Medical School, RUTGERS University, New Brunswick, NJ, USA
| | - Sanjeev Sreenivasan
- Department of Neurosurgery, Robert Wood Johnson Medical School, RUTGERS University, New Brunswick, NJ, USA
| | - Akanksha Mathivanan
- Department of Neurosurgery, Robert Wood Johnson Medical School, RUTGERS University, New Brunswick, NJ, USA
| | - Pranav Manchiraju
- Department of Neurosurgery, Robert Wood Johnson Medical School, RUTGERS University, New Brunswick, NJ, USA
| | - Mohammad Khuroo
- Department of Neurosurgery, Rice University, Houston, TX, USA
| | - Srihari Sundararajan
- Department of Neurosurgery, Robert Wood Johnson Medical School, RUTGERS University, New Brunswick, NJ, USA
| | - Anil Nanda
- Department of Neurosurgery, Robert Wood Johnson Medical School, RUTGERS University, New Brunswick, NJ, USA
| | - Sudipta Roychowdhury
- Department of Neurosurgery, Robert Wood Johnson Medical School, RUTGERS University, New Brunswick, NJ, USA
| | - Gaurav Gupta
- Department of Neurosurgery, Robert Wood Johnson Medical School, RUTGERS University, New Brunswick, NJ, USA.
- Rutgers RWJ Barnabas Healthcare System, Rutgers Robert Wood Johnson Medical School, 10 Plum Street, 5th floor, # 548, New Brunswick, NJ, 08903-2601, USA.
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Kim MS, Go SI, Wee CW, Lee MH, Kang SG, Go KO, Kwon SM, Kim W, Dho YS, Park SH, Seo Y, Song SW, Ahn S, Oh HJ, Yoon HI, Lee SW, Lee JH, Cho KR, Choi JW, Hong JB, Hwang K, Park CK, Lim DH. The Korean Society for Neuro-Oncology (KSNO) Guideline for the Management of Brain Tumor Patients During the Crisis Period: A Consensus Recommendation Using the Delphi Method (Version 2023.1). Brain Tumor Res Treat 2023; 11:123-132. [PMID: 37151154 PMCID: PMC10172012 DOI: 10.14791/btrt.2023.0009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/04/2023] [Indexed: 05/09/2023] Open
Abstract
BACKGROUND During the coronavirus disease 2019 (COVID-19) pandemic, the need for appropriate treatment guidelines for patients with brain tumors was indispensable due to the lack and limitations of medical resources. Thus, the Korean Society for Neuro-Oncology (KSNO), a multidisciplinary academic society, has undertaken efforts to develop a guideline that is tailored to the domestic situation and that can be used in similar crisis situations in the future. METHODS The KSNO Guideline Working Group was composed of 22 multidisciplinary experts on neuro-oncology in Korea. In order to reach consensus among the experts, the Delphi method was used to build up the final recommendations. RESULTS All participating experts completed the series of surveys, and the results of final survey were used to draft the current consensus recommendations. Priority levels of surgery and radiotherapy during crises were proposed using appropriate time window-based criteria for management outcome. The highest priority for surgery is assigned to patients who are life-threatening or have a risk of significant impact on a patient's prognosis unless immediate intervention is given within 24-48 hours. As for the radiotherapy, patients who are at risk of compromising their overall survival or neurological status within 4-6 weeks are assigned to the highest priority. Curative-intent chemotherapy has the highest priority, followed by neoadjuvant/adjuvant and palliative chemotherapy during a crisis period. Telemedicine should be actively considered as a management tool for brain tumor patients during the mass infection crises such as the COVID-19 pandemic. CONCLUSION It is crucial that adequate medical care for patients with brain tumors is maintained and provided, even during times of crisis. This guideline will serve as a valuable resource, assisting in the delivery of treatment to brain tumor patients in the event of any future crisis.
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Affiliation(s)
- Min-Sung Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Se-Il Go
- Division of Hematology and Oncology, Department of Internal Medicine, Institute of Health Science, Gyeongsang National University Changwon Hospital, Gyeongsang National University College of Medicine, Changwon, Korea
| | - Chan Woo Wee
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Min Ho Lee
- Department of Neurosurgery, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Seoul, Korea
| | - Seok-Gu Kang
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Kyeong-O Go
- Department of Neurosurgery, Gyeongsang National University Hospital, Gyeongsang National University College of Medicine, Jinju, Korea
| | - Sae Min Kwon
- Department of Neurosurgery, Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea
| | - Woohyun Kim
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Yun-Sik Dho
- Neuro-Oncology Clinic, National Cancer Center, Goyang, Korea
| | - Sung-Hye Park
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Youngbeom Seo
- Department of Neurosurgery, Yeungnam University Hospital, Yeungnam University College of Medicine, Daegu, Korea
| | - Sang Woo Song
- Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Stephen Ahn
- Department of Neurosurgery, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Hyuk-Jin Oh
- Department of Neurosurgery, Soonchunhyang University Cheonan Hospital, Cheonan, Korea
| | - Hong In Yoon
- Department of Radiation Oncology, Yonsei Cancer Center, Heavy Ion Therapy Research Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Sea-Won Lee
- Department of Radiation Oncology, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Joo Ho Lee
- Department of Radiation Oncology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Kyung Rae Cho
- Department of Neurosurgery, Konkuk University Medical Center, Seoul, Korea
| | - Jung Won Choi
- Department of Neurosurgery, Brain Tumor Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Je Beom Hong
- Department of Neurosurgery, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Kihwan Hwang
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Chul-Kee Park
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea.
| | - Do Hoon Lim
- Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
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Hussain MM, Zaida SAA, Khalil M, Baqai W, Laghari AA, Bari E. Tailoring of neurosurgical practice during COVID-19 in a developing country: Insights gained and a way forward. Surg Neurol Int 2023; 14:117. [PMID: 37151428 PMCID: PMC10159316 DOI: 10.25259/sni_116_2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 03/15/2023] [Indexed: 04/03/2023] Open
Abstract
Background:
The coronavirus disease-19 pandemic has aggravated the already neglected neurosurgical specialty in developing countries with a mounting shortage of specialists, long queues of operative patients, and a lack of adequate critical care units.
Methods:
We have reviewed the innovative strategies adopted for maintaining an optimal surgical practice while ensuring team safety at the Aga Khan University Hospital, Karachi Pakistan.
Results:
There is already a scarcity of resources in developing countries. The international guidelines had to be tailored to the context of the developing world. A multimodal strategy that focused on infection control, continuum of care, and the well-being of staff was adopted at Aga Khan University. Patients were screened and seen either in person or through telemedicine, depending on the severity of the disease. All educational activities for residents were shifted online, and this helped in preventing overcrowding.
Conclusion:
Optimal surgical practice while ensuring team safety can be achieved through a multimodal strategy focusing on infection control, continuum of care, and the well-being of staff.
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Munda M, Bosnjak R, Velnar T. Problematics of neurosurgical service during the COVID-19 pandemic in Slovenia. World J Clin Cases 2022; 10:12462-12469. [PMID: 36579102 PMCID: PMC9791516 DOI: 10.12998/wjcc.v10.i34.12462] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2022] [Revised: 09/17/2022] [Accepted: 11/07/2022] [Indexed: 12/02/2022] Open
Abstract
The novel coronavirus disease 2019 (COVID-19) is an ongoing disease caused by severe acute respiratory syndrome coronavirus-2 that still poses an important and urgent threat to global health. In Slovenia, the epidemic was declared on March 12th, 2020, and since then COVID-19 has had a great impact on our health system. The field of neurosurgery in particular has been experiencing difficulties in both elective and emergency service. In this article, we described epidemiologic protocols and the effect that the COVID-19 pandemic had on the surgical practice and workflow of the Department of Neurosurgery at the University Medical Centre Ljubljana. We analyzed and compared the number of elective and emergency neurosurgical procedures in a 2-year period before and during the pandemic. We recorded a drop in cases mostly on account of elective procedures whilst emergency service remained relatively unaffected.
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Affiliation(s)
- Matic Munda
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| | - Roman Bosnjak
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
| | - Tomaz Velnar
- Department of Neurosurgery, University Medical Centre Ljubljana, Ljubljana 1000, Slovenia
- Alma Mater Europaea, AMEU-ECM, Maribor 2000, Slovenia
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Arora RK, Shakya J, Pannem R, Sharma S, Sadhasivam S, Rawat VS, Rekhapalli R, Sihag RK, Mittal RS. Impact of the COVID-19 Pandemic and Lockdown on Non-COVID Neurosurgical Patients: Lessons Learned. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0042-1757203] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Abstract
Objective The COVID-19 pandemic has challenged the basic functioning of the health care system. There has been an adverse impact on non-COVID-19 patients due to a shift in healthcare delivery, which is underreported. This study aims to explore the impact of the pandemic on various aspects of non-COVID neurosurgical patients.
Methods This descriptive cross-sectional study was conducted with a structured questionnaire to assess the physical, economic, and psychological impacts of the COVID-19 pandemic and lockdown measures on neurosurgical patients presenting to our hospital after a nationwide lockdown.
Results Among 203 patients, non-neurotrauma and neurotrauma cases were 175 (86%) and 28 (16%), respectively. Among non-neurotrauma patients, 130 (64%) patients had cranial pathology. All 56 (27.6%) preoperative patients experienced rescheduling of surgery. Among 52 postsurgical patients, 47 (90%) had their adjuvant therapy delayed. Forty patients experienced deterioration in their neurological symptoms. Seventy-six (37%) patients sought medical attention from private hospitals. A severe contraction of income (≥ 25% of the income before lockdown) was experienced by families of 29 (14.3%) patients. Severe and very severe stress have been experienced by 24 (11.8%) and 14 (6.9%) patients, respectively. Severe and very severe anxiety was experienced by 32 (15.8%) and 9 (4.4%) patients.
Conclusion The COVID-19 pandemic and nationwide lockdown had a tremendous impact on the physical, social, and psychological well-being of patients with non-COVID illnesses. We are yet to face the long-term implications of the delay due to this pandemic in scheduled surgical and adjuvant treatments of non-COVID neurosurgical patients.
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Affiliation(s)
- Rajnish Kumar Arora
- Department of Neurosurgery, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Jitendra Shakya
- Department of Neurosurgery, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Rajkumar Pannem
- Department of Neurosurgery, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Suresh Sharma
- College of Nursing, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Saravanan Sadhasivam
- Department of Neurosurgery, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Vikram Singh Rawat
- Department of Psychiatry, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Rajashekhar Rekhapalli
- Department of Neurosurgery, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Rakesh Kumar Sihag
- Department of Neurosurgery, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
| | - Radhey Shyam Mittal
- Department of Neurosurgery, All India Institute of Medical Science, Rishikesh, Uttarakhand, India
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10
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DEZZANI EO. COVID-19 and surgery. Chirurgia (Bucur) 2022. [DOI: 10.23736/s0394-9508.22.05497-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Impact of the COVID-19 Pandemic on Neurosurgical Transfers: A Single Tertiary Center Study. World Neurosurg 2022; 166:e915-e923. [PMID: 35944857 PMCID: PMC9356759 DOI: 10.1016/j.wneu.2022.07.137] [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: 02/27/2022] [Revised: 07/28/2022] [Accepted: 07/28/2022] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Interfacility transfers represent a large proportion of neurosurgical admissions to tertiary care centers each year. In this study, the authors examined the impact of the COVID-19 pandemic on the number of transfers, timing of transfers, demographic profile of transfer patients, and clinical outcomes including rates of surgical intervention. METHODS A retrospective review of neurosurgical transfer patients at a single tertiary center was performed. Patients transferred from April to November 2020 (the "COVID Era") were compared with an institutional database of transfer patients collected before the COVID-19 pandemic (the "Pre-COVID Era"). During the COVID Era, both emergent and nonemergent neurosurgical services had resumed. A comparison of demographic and clinical factors between the 2 cohorts was performed. RESULTS A total of 674 patients were included in the study (331 Pre-COVID and 343 COVID-Era patients). Overall, there was no change in the average monthly number of transfers (P = 0.66) or in the catchment area of referral hospitals. However, COVID-Era patients were more likely to be uninsured (1% vs. 4%), had longer transfer times (COVID vs. Pre-COVID Era: 18 vs. 9 hours; P < 0.001), required higher rates of surgical intervention (63% vs. 50%, P = 0.001), had higher rates of spine pathology (17% vs. 10%), and less frequently were admitted to the intensive care unit (34% vs. 52%, P < 0.001). Overall, COVID-Era patients did not experience delays to surgical intervention (3.1 days vs. 3.6 days, P = 0.2). When analyzing the subgroup of COVID-Era patients, COVID infection status did not impact the time of transfer or rates of operation, although COVID-infected patients experienced a longer time to surgery after admission (14 vs. 2.9 days, P < 0.001). CONCLUSION The COVID-19 pandemic did not reduce the number of monthly transfers, operation rates, or catchment area for transfer patients. Transfer rates of uninsured patients increased during the COVID Era, potentially reflecting changes in access to community neurosurgery care. Shorter time to surgery seen in COVID-Era patients possibly reflects institutional policies that improved operating room efficiency to compensate for surgical backlogs. COVID status affeted time to surgery, reflecting the preoperative care that these patients require before intervention.
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Alam I, Garg K, Raheja A, Tandon V, Sharma R, Singh M, Singh GP, Mishra S, Singh PK, Agrawal D, Soni KD, Suri A, Chandra PS, Kale SS. Managing Traumatic Brain Injury During the Coronavirus Disease 2019 Pandemic-A Case-Matched Controlled Analysis of Immediate Outcomes. World Neurosurg 2022; 165:e59-e73. [PMID: 35643408 PMCID: PMC9131442 DOI: 10.1016/j.wneu.2022.05.076] [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: 03/23/2022] [Revised: 05/17/2022] [Accepted: 05/18/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE The primary objective of this study was to evaluate the outcome of patients with traumatic brain injury (TBI) during the coronavirus disease 2019 (COVID-19) pandemic and to compare their outcome with case-matched controls from the prepandemic phase. METHODS This is a retrospective case-control study in which all patients with TBI admitted during COVID-19 pandemic phase (Arm A) from March 24, 2020 to November 30, 2020 were matched with age and Glasgow Coma Scale score-matched controls from the patients admitted before March 2020 (Arm B). RESULTS The total number of patients matched in each arm was 118. The length of hospital stay (8 days vs. 5 days; P < 0.001), transit time from emergency room to operation room (150 minutes vs. 97 minutes; P = 0.271), anesthesia induction time (75 minutes vs. 45 minutes; P = 0.002), and operative duration (275 minutes vs. 180 minutes; P = 0.002) were longer in arm A. Although the incidence of fever and pneumonia was significantly higher in arm A than in arm B (50% vs. 26.3%, P < 0.001 and 27.1% vs. 1.7%, P < 0.001, respectively), outcome (Glasgow Outcome Scale-Extended) and mortality (18.6% vs. 14.4% respectively; P = 0.42) were similar in both the groups. CONCLUSIONS The outcome of the patients managed for TBI during the COVID-19 pandemic was similar to matched patients with TBI managed at our center before the onset of the COVID-19 pandemic. This finding suggests that the guidelines followed during the COVID-19 pandemic were effective in dealing with patients with TBI. This model can serve as a guide for any future pandemic waves for effective management of patients with TBI without compromising their outcome.
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Affiliation(s)
- Intekhab Alam
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India,To whom correspondence should be addressed: Vivek Tandon, M.B.B.S., M.S., M.Ch
| | - Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manmohan Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Gyaninder Pal Singh
- Department of Neuroanaesthesiology and Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Shashwat Mishra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Pankaj Kumar Singh
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Deepak Agrawal
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kapil Dev Soni
- Critical and Intensive Care, JPN Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | | | - Shashank Sharad Kale
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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13
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Benner D, Hendricks BK, Elahi C, White MD, Kocharian G, Albertini Sanchez LE, Zappi KE, Garton AL, Carnevale JA, Schwartz TH, Dowlati E, Felbaum DR, Sack KD, Jean WC, Chan AK, Burke JF, Mummaneni PV, Strong MJ, Yee TJ, Oppenlander ME, Ishaque M, Shaffrey ME, Syed HR, Lawton MT. Neurosurgery Subspecialty Practice During a Pandemic: A Multicenter Analysis of Operative Practice in 7 U.S. Neurosurgery Departments During Coronavirus Disease 2019. World Neurosurg 2022; 165:e242-e250. [PMID: 35724884 PMCID: PMC9212868 DOI: 10.1016/j.wneu.2022.06.010] [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: 02/16/2022] [Revised: 06/01/2022] [Accepted: 06/02/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVE Changes to neurosurgical practices during the coronavirus disease 2019 (COVID-19) pandemic have not been thoroughly analyzed. We report the effects of operative restrictions imposed under variable local COVID-19 infection rates and health care policies using a retrospective multicenter cohort study and highlight shifts in operative volumes and subspecialty practice. METHODS Seven academic neurosurgery departments' neurosurgical case logs were collected; procedures in April 2020 (COVID-19 surge) and April 2019 (historical control) were analyzed overall and by 6 subspecialties. Patient acuity, surgical scheduling policies, and local surge levels were assessed. RESULTS Operative volume during the COVID-19 surge decreased 58.5% from the previous year (602 vs. 1449, P = 0.001). COVID-19 infection rates within departments' counties correlated with decreased operative volume (r = 0.695, P = 0.04) and increased patient categorical acuity (P = 0.001). Spine procedure volume decreased by 63.9% (220 vs. 609, P = 0.002), for a significantly smaller proportion of overall practice during the COVID-19 surge (36.5%) versus the control period (42.0%) (P = 0.02). Vascular volume decreased by 39.5% (72 vs. 119, P = 0.01) but increased as a percentage of caseload (8.2% in 2019 vs. 12.0% in 2020, P = 0.04). Neuro-oncology procedure volume decreased by 45.5% (174 vs. 318, P = 0.04) but maintained a consistent proportion of all neurosurgeries (28.9% in 2020 vs. 21.9% in 2019, P = 0.09). Functional neurosurgery volume, which declined by 81.4% (41 vs. 220, P = 0.008), represented only 6.8% of cases during the pandemic versus 15.2% in 2019 (P = 0.02). CONCLUSIONS Operative restrictions during the COVID-19 surge led to distinct shifts in neurosurgical practice, and local infective burden played a significant role in operative volume and patient acuity.
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Affiliation(s)
- Dimitri Benner
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Benjamin K. Hendricks
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Cyrus Elahi
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Michael D. White
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA
| | - Gary Kocharian
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | | | - Kyle E. Zappi
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Andrew L.A. Garton
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Joseph A. Carnevale
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Theodore H. Schwartz
- Department of Neurosurgery, New York-Presbyterian Hospital at Weill Cornell Medicine, New York, New York, USA
| | - Ehsan Dowlati
- Department of Neurosurgery, Georgetown University, Washington, DC, USA
| | - Daniel R. Felbaum
- Department of Neurosurgery, Georgetown University, Washington, DC, USA
| | - Kenneth D. Sack
- Department of Neurosurgery, The George Washington University, Washington, DC, USA
| | - Walter C. Jean
- Department of Neurosurgery, The George Washington University, Washington, DC, USA
| | - Andrew K. Chan
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - John F. Burke
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Praveen V. Mummaneni
- Department of Neurosurgery, University of California, San Francisco, San Francisco, California, USA
| | - Michael J. Strong
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Timothy J. Yee
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mark E. Oppenlander
- Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA
| | - Mariam Ishaque
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Mark E. Shaffrey
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Hasan R. Syed
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA
| | - Michael T. Lawton
- Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, Arizona, USA,To whom correspondence should be addressed: Michael T. Lawton, M.D
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14
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Castaño-Leon AM, Paredes I, Lagares A, Gomez PA, González-Leon P, Perez-Nuñez A, Jiménez-Roldán L, Delgado-Fernández J, Eiriz Fernández C, García-Pérez D, Moreno-Gómez LM, Esteban-Sinovas O, Delgado-López PD, Martín-Alonso J, Kaen A, Tirado-Caballero J, Ordóñez-Carmona M, Arteaga-Romero F, González-Pombo M, F Alén J, Gil-Simoes R, Torres CV, Navas-García M, Blasco García de Andoain G, Frade-Porto N, González-Tarno P, Martin Segura A, Gelabert-González M, Menéndez-Cortezón B, Rodríguez-Botana B, Pérez-Alfayate R, Fernández-García C, Ferrández-Pujante B, Vargas-Jiménez AC, Cotúa C, de la Lama A, Calero Félix L, Ruiz-Juretschke F, García-Leal R, Valera-Melé M, Casitas Hernando V, Rivero B, Orduna-Martínez J, Casado Pellejero J, Fustero De Miguel D, Díaz Molina J, Moles Herbera J, Castelló-Ruiz MJ, Gomar-Alba M, García-Pérez F, Hernández-García BJ, Villaseñor-Ledezma JJ, Otero-Rodríguez Á, Ailagas de Las Heras JJ, Gonçalves-Estella J, Sousa-Casasnovas P, Pascual-Argente D, Ruiz Martín L, Roa Montes de Oca JC, Arandia Guzmán D, García Martín A, Torres Carretero L, Garrido Ruiz A, Calvo M, Miranda-Lloret P, Rodríguez-Cadarso M, Antón J, Roca Barber A, Quiroz-Tejada A, Carbayo-Lozano G, Bermúdez G, Paternain Martin C, De la Fuente Villa P, Fidalgo De la Rosa M, Sistiaga-Gracia ÍL, Zabalo G. Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study. BMJ Open 2022; 12:e061208. [PMID: 35977759 PMCID: PMC9388715 DOI: 10.1136/bmjopen-2022-061208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 07/31/2022] [Indexed: 11/07/2022] Open
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.
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Affiliation(s)
- Ana M Castaño-Leon
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Igor Paredes
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Lagares
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro A Gomez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Pedro González-Leon
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Angel Perez-Nuñez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Jiménez-Roldán
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Daniel García-Pérez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis M Moreno-Gómez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Ariel Kaen
- Neurosurgery Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | | | | | | | - Marta González-Pombo
- Neurosurgery Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - José F Alén
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ricardo Gil-Simoes
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Cristina V Torres
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Marta Navas-García
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Natalia Frade-Porto
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | - Miguel Gelabert-González
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Beatriz Menéndez-Cortezón
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Brais Rodríguez-Botana
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | - Carlos Cotúa
- Neurosurgery Department, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Adolfo de la Lama
- Neurosurgery Department, Complejo Hospitalario de Vigo Alvaro Cunqueiro, Vigo, Spain
| | - Lourdes Calero Félix
- Neurosurgery Department, Complejo Hospitalario de Vigo Alvaro Cunqueiro, Vigo, Spain
| | | | - Roberto García-Leal
- Neurosurgery Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Marc Valera-Melé
- Neurosurgery Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | | | - Belén Rivero
- Neurosurgery Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | - Jorge Díaz Molina
- Neurosurgery Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Jesús Moles Herbera
- Neurosurgery Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Maria J Castelló-Ruiz
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | - Mario Gomar-Alba
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | - Fernando García-Pérez
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | | | | | - Álvaro Otero-Rodríguez
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | | | - Pablo Sousa-Casasnovas
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Daniel Pascual-Argente
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Laura Ruiz Martín
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Daniel Arandia Guzmán
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Andoni García Martín
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Luis Torres Carretero
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Alejandra Garrido Ruiz
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Marta Calvo
- Neurosurgery Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Pablo Miranda-Lloret
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | | | - Joan Antón
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - Amparo Roca Barber
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - Arnold Quiroz-Tejada
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | | | - Garazi Bermúdez
- Neurosurgery Department, Hospital Universitario Cruces, Barakaldo, Spain
| | | | | | | | | | - Gorka Zabalo
- Neurosurgery Department, Hospital Universitario Cruces, Barakaldo, Spain
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15
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Kuroda N, Kubota T, Horinouchi T, Ikegaya N, Kitazawa Y, Kodama S, Kuramochi I, Matsubara T, Nagino N, Neshige S, Soga T, Takayama Y, Sone D. Impact of COVID-19 pandemic on epilepsy care in Japan: A national-level multicenter retrospective cohort study. Epilepsia Open 2022; 7:431-441. [PMID: 35633311 PMCID: PMC9348370 DOI: 10.1002/epi4.12616] [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: 12/27/2021] [Accepted: 05/25/2022] [Indexed: 11/06/2022] Open
Abstract
OBJECTIVE The impact of the coronavirus disease 2019 (COVID-19) pandemic on epilepsy care across Japan was investigated by conducting a multicenter retrospective cohort study. METHODS This study included monthly data on the frequency of (1) visits by outpatients with epilepsy, (2) outpatient electroencephalography (EEG) studies, (3) telemedicine for epilepsy, (4) admissions for epilepsy, (5) EEG monitoring, and (6) epilepsy surgery in epilepsy centers and clinics across Japan between January 2019 and December 2020. We defined the primary outcome as epilepsy-center-specific monthly data divided by the 12-month average in 2019 for each facility. We determined whether the COVID-19 pandemic-related factors (such as year [2019 or 2020], COVID-19 cases in each prefecture in the previous month, and the state of emergency) were independently associated with these outcomes. RESULTS In 2020, the frequency of outpatient EEG studies (-10.7%, p<0.001) and cases with telemedicine (+2,608%, p=0.031) were affected. The number of COVID-19 cases was an independent associated factor for epilepsy admission (-3.75*10-3 % per case, p<0.001) and EEG monitoring (-3.81*10-3 % per case, p = 0.004). Further, the state of emergency was an independent factor associated with outpatient with epilepsy (-11.9%, p<0.001), outpatient EEG (-32.3%, p<0.001), telemedicine for epilepsy (+12,915%, p<0.001), epilepsy admissions (-35.3%; p<0.001), EEG monitoring (-24.7%: p<0.001), and epilepsy surgery (-50.3%, p<0.001). SIGNIFICANCE We demonstrated the significant impact that the COVID-19 pandemic had on epilepsy care. These results support those of previous studies and clarify the effect size of each pandemic-related factor on epilepsy care.
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Affiliation(s)
- Naoto Kuroda
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Pediatrics, Wayne State UniversityDetroitMichiganUSA
| | - Takafumi Kubota
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurology, University Hospitals of Cleveland Medical CenterCase Western Reserve UniversityClevelandOhioUSA
| | - Toru Horinouchi
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Psychiatry and NeurologyHokkaido University Graduate School of MedicineSapporoJapan
| | - Naoki Ikegaya
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurosurgery, Graduate School of MedicineYokohama City UniversityYokohamaJapan
| | - Yu Kitazawa
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurology and Stroke MedicineYokohama City University Graduate School of MedicineYokohamaJapan
| | - Satoshi Kodama
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurology, Graduate School of MedicineThe University of TokyoTokyoJapan
| | - Izumi Kuramochi
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Psychiatry, Saitama Medical CenterSaitama Medical UniversitySaitamaJapan
| | - Teppei Matsubara
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Athinoula A. Martinos Center for Biomedical ImagingMassachusetts General HospitalCharlestownMassachusettsUSA
| | - Naoto Nagino
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Epilepsy Center, TMG Asaka Medical CenterSaitamaJapan
| | - Shuichiro Neshige
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Clinical Neuroscience and Therapeutics, Hiroshima UniversityGraduate School of Biomedical and Health SciencesHiroshimaJapan
| | - Temma Soga
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of EpileptologyTohoku University Graduate School of MedicineMiyagiJapan
| | - Yutaro Takayama
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Neurosurgery, National Center HospitalNational Center of Neurology and PsychiatryTokyoJapan
| | - Daichi Sone
- Japan Young Epilepsy Section (YES‐Japan)TokyoJapan
- Department of Clinical and Experimental EpilepsyUCL Institute of NeurologyLondonUK
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Zhang AS, Berreta RS, Osorio C, Daniels AH. Nosocomial COVID-19 infection mortality following surgery for severe progressive cervical myelopathy: a case report. Spinal Cord Ser Cases 2021; 7:100. [PMID: 34799558 PMCID: PMC8603333 DOI: 10.1038/s41394-021-00465-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2021] [Revised: 11/02/2021] [Accepted: 11/08/2021] [Indexed: 11/18/2022] Open
Abstract
Introduction We present the unique case of a nosocomial COVID infection acquired after urgent surgical intervention for cervical myelopathy, as well as the sequelae that followed in the postoperative period. Case presentation An initially COVID-negative patient underwent urgent surgical intervention for cervical myelopathy with significant neurological deterioration. She underwent an uncomplicated staged anterior cervical discectomy and fusion with corpectomy, as well as a subsequent posterior cervical instrumented fusion within the same hospitalization. The patient would refuse to adhere to standard COVID precautions during her admission and demonstrated rapid decompensation following her particularly uneventful surgeries, ultimately leading to her expiration. A laboratory test confirmed that she had contracted COVID at the time of the patient’s death. Discussion This report highlights the repercussions of COVID-19 infection during the perioperative period and its implications on surgical outcomes. The stresses of surgery and the body’s immunosuppressive responses during this time place patients at particular risk for the contraction of this virus. The standard precautions should be followed and vaccination should be considered for surgical candidates prior to their operations, as they become more readily accessible.
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Affiliation(s)
- Andrew S Zhang
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI, USA.
| | - Rodrigo Saad Berreta
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Camilo Osorio
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Brown University Warren Alpert Medical School, Providence, RI, USA
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17
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Krueger EM, DiGiorgio AM, Jagid J, Cordeiro JG, Farhat H. Current Trends in Mild Traumatic Brain Injury. Cureus 2021; 13:e18434. [PMID: 34737902 PMCID: PMC8559421 DOI: 10.7759/cureus.18434] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2021] [Accepted: 10/02/2021] [Indexed: 12/12/2022] Open
Abstract
In this review, we provide an overview of the current research and treatment of all types of traumatic brain injury (TBI) before illustrating the need for improved care specific to mild TBI patients. Contemporary issues pertaining to acute care of mild TBI including prognostication, neurosurgical intervention, repeat radiographic imaging, reversal of antiplatelet and anticoagulation medications, and cost savings initiatives are reviewed. Lastly, the effect of COVID-19 on TBI is addressed.
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Affiliation(s)
- Evan M Krueger
- Neurological Surgery, Carle Foundation Hospital, Urbana, USA
| | - Anthony M DiGiorgio
- Neurological Surgery, University of California San Francisco, San Francisco, USA
| | - Jonathan Jagid
- Neurological Surgery, University of Miami, Coral Gables, USA
| | | | - Hamad Farhat
- Neurological Surgery, Advocate Aurora Health Care, Downers Grove, USA
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18
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Ridwan S, Ganau M, Zoia C, Broekman M, Grote A, Clusmann H. Unequal Impact of COVID-19 on Private and Academic Neurosurgical Workforce: Results of an International Survey. Front Surg 2021; 8:749399. [PMID: 34660687 PMCID: PMC8517237 DOI: 10.3389/fsurg.2021.749399] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/06/2021] [Indexed: 12/24/2022] Open
Abstract
Background: Since the COVID-19 outbreak several manuscripts regarding neurosurgical practice during this pandemic have been published. Qualitative studies on how the pandemic affected neurosurgeons, with additional focus on their practice, are still scarce. This study's objective was to investigate the impact of COVID-19 on various aspects of the professional and private life of a homogeneous group of international neurosurgeons affiliated to the European Association of Neurosurgical Societies (EANS). Methods: Neurosurgeons from Europe and abroad were invited to participate in an online survey endorsed by the Individual Membership Committee of the EANS. The survey captured a subjective snapshot of the impact of the first wave of the COVID-19 pandemic on EANS members and was advertised through its Institutional website. In addition to departmental data, personal feeling of safety, financial security, local precautions, number of surgeries performed, changes in daily routine, and other practice-related information were inquired. Differences among practice types were closely reviewed. Results: The survey was distributed between April and May 2020: 204 neurosurgeons participated. Participants were typically active EANS members (73%), consultants (57.9%), from university hospitals (64.5%). Elective surgical practice was still ongoing only for 15% of responders, whereas 18.7% of them had already transitioned to COVID-19 and emergency medical services. While 65.7% of participants thought their institutions were adequately prepared, lack of testing for SARS-CoV-2, and scarcity of personal protective equipment were still a matter of concern for most of them. Overall surgical activity dropped by 68% (cranial by 54%, spine by 71%), and even emergencies decreased by 35%. COVID-19 prompted changes in communication in 74% of departments, 44% increased telemedicine by >50%. While most neurosurgeons had concerns about personal and families' health, financial outlook appeared to be gloomy only for private practitioners. Conclusion: The lockdown imposed in many countries by the COVID-19 outbreak called for immediate modification of working routine and resulted in a dramatic decrease of elective surgical procedures. Neurosurgeons share common concerns but were not equally exposed to the personal health and financial dangers of the ongoing pandemic.
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Affiliation(s)
- Sami Ridwan
- Department of Neurosurgery, Klinikum Ibbenbueren, Ibbenbueren, Germany
| | - Mario Ganau
- Department of Neurosurgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - Cesare Zoia
- Department of Neurosurgery, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy
| | - Marike Broekman
- Department of Neurosurgery, Haaglanden Medical Center, The Hague, Leiden University Medical Center, Leiden, Netherlands.,Department of Neurology, Massachusetts General Hospital, Boston, MA, United States
| | - Alexander Grote
- Department of Neurosurgery, Bethel Clinic, Bielefeld, Germany
| | - Hans Clusmann
- Department of Neurosurgery, RWTH Aachen University, Aachen, Germany
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19
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Chan KIP, Ignacio KHD, Omar AT, Khu KJO. Top 100 Most Cited Neurologic and Neurosurgical Articles on COVID-19: A Bibliometric Analysis. World Neurosurg 2021; 157:e137-e147. [PMID: 34619402 PMCID: PMC8489273 DOI: 10.1016/j.wneu.2021.09.118] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 09/26/2021] [Accepted: 09/27/2021] [Indexed: 02/08/2023]
Abstract
Objective With the exponential growth of literature on coronavirus disease 2019 (COVID-19), we aimed to identify and characterize the 100 most cited COVID-19–related articles in neurology and neurosurgery. Methods In March 2021, we performed a title-specific search of the Scopus database using (“neurology” or “neurologic” or “neurosurgery” or “neurosurgical”) and “COVID” as our search query term without date restrictions. The top 100 most cited English-language articles were obtained and reviewed. Results Our search yielded 9648 articles published from December 2019 to March 2021. Bibliometric analysis of the top 100 articles found that the most cited article had a citation count of 1741 and was the first to report on the detailed neurologic manifestations of the disease; Neurology had the most number of publications; the majority of the primary authors were neurologists, but 35% were from nonneuroscience specialties; the United States, Italy, the United Kingdom, China, and Germany were the top contributors, with a combined total of 77%; most of the publications were correspondence or editorial articles; and most articles discussed the neurologic manifestations and complications of patients with COVID-19. Conclusions This study identified the top 100 most cited neurologic or neurosurgical COVID-19–related articles published to date. This list can be used to identify high-impact studies that will help health care practitioners in clinical decision making and researchers in navigating key areas of study and guiding future research.
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Affiliation(s)
- Kevin Ivan P Chan
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Katrina Hannah D Ignacio
- Division of Neurology, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Abdelsimar Tan Omar
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - Kathleen Joy O Khu
- Division of Neurosurgery, Department of Neurosciences, College of Medicine and Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
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20
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A National Survey Evaluating the Impact of the COVID-19 Pandemic on Students Pursuing Careers in Neurosurgery. NEUROSCI 2021; 2:320-333. [PMID: 36091326 PMCID: PMC9457230 DOI: 10.3390/neurosci2040023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background: The COVID-19 pandemic has profoundly disrupted medical education and the residency application process. Methods: We conducted a descriptive observational study in April 2020 of medical students and foreign medical graduates considering or pursuing careers in neurosurgery in the United States to examine the impact of the pandemic. Results: A total of 379 respondents from 67 medical schools completed the survey. Across all participants, 92% (n = 347) stopped in-person didactic education, and 43% (n = 161) experienced basic science and 44% (n = 167) clinical research delays. Sixty percent (n = 227) cited a negative impact on academic productivity. Among first year students, 18% (n = 17) were less likely to pursue a career in neurosurgery. Over half of second year and third year students were likely to delay taking the United States Medical Licensing Examination Steps I and II. Among third year students, 77% (n = 91) reported indefinite postponement of sub-internships, and 43% (n = 53) were unsatisfied with communication from external programs. Many fourth-year students (50%, n = 17) were graduating early to participate in COVID-19-related patient care. Top student-requested support activities included access to student-focused educational webinars and sessions at upcoming conferences. Conclusions: Medical students pursuing careers in neurosurgery faced unique academic, career, and personal challenges secondary to the pandemic. These challenges may become opportunities for new initiatives guided by professional organizations and residency programs.
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21
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Wilson CM, Brown NJ, Detchou DKE. Letter: Impact of Sub-Internship Cancellations in Neurosurgery During COVID-19. Neurosurgery 2021; 89:E201-E202. [PMID: 34192742 PMCID: PMC8344663 DOI: 10.1093/neuros/nyab232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Chidinma M Wilson
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA
| | - Nolan J Brown
- University of California, Irvine School of Medicine Irvine, California, USA
| | - Donald K E Detchou
- Perelman School of Medicine University of Pennsylvania Philadelphia, Pennsylvania, USA
- Frazier Scholar Program Department of Neurosurgery Hospital of the University of Pennsylvania Philadelphia, Pennsylvania, USA
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22
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Khurana P, Ganjoo P, Duggal S, Kiro KL, Dhanwani L, Tandon MS, Singh D, Jagetia A. Perioperative Practices and Outcome of Neurosurgery during the COVID-19 Pandemic: Institutional Experience and Retrospective Observational Analysis. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1729463] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Introduction Surgery during the coronavirus disease 2019 (COVID-19) pandemic is a major concern due to possibility of infection transmission among health care workers (HCWs) and patients, and a worsened surgical outcome; most surgeries are thus being deferred. However, we continued with emergency neurosurgeries using our own Neurosurgical Standard Operating Procedures (NS-SOPs). We describe here our institutional neurosurgical experience and observations of a retrospective analysis done to determine the incidence of workplace-acquired COVID infection among the HCWs, and the outcome of neurosurgery performed during the early phase of the on-going pandemic.
Methods Our NS-SOPs included a Screening Proforma, and protocols for the conduct of neurosurgery, starting from the preoperative period till death or postdischarge follow-up of the patients. Protocols to ensure safety and mental well-being of the HCWs were also implemented. Patient and HCW data from April 1 to August 31, 2020 was collected and analyzed for the postsurgical patient outcome and for determining the level of workplace-transmitted COVID infection.
Results Neurosurgeries were performed on 169 patients during this 5-month period. We observed a cumulative mortality of 17/169 (10.1%), with 5 patients having unexplained postoperative respiratory manifestations and rapid deterioration suggestive of COVID illness. Nineteen HCWs (8.83%), mostly nurses, were infected, but only 3 (16.7%) had workplace-acquired infection. The infections were sporadic with no cluster of infections observed.
Conclusion Implementation of standard perioperative protocols and their continuous scrutiny, evaluation, and modification is important to contain infection in HCWs and to improve the neurosurgical outcome during this pandemic.
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Affiliation(s)
- Priyanka Khurana
- Department of Anaesthesiology and Intensive Care, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Pragati Ganjoo
- Department of Anaesthesiology and Intensive Care, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Sakshi Duggal
- Department of Anaesthesiology and Intensive Care, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Kiran Lata Kiro
- Department of Anaesthesiology and Intensive Care, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Lavina Dhanwani
- Department of Anaesthesiology and Intensive Care, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Monica S. Tandon
- Department of Anaesthesiology and Intensive Care, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Daljit Singh
- Department of Neurosurgery, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
| | - Anita Jagetia
- Department of Neurosurgery, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
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23
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Maragkos GA, McNeill IT, Kessler R, Xie M, Schaefer S, Patel G, Bederson JB, Shrivastava RK. Letter: Comprehensive Neurosurgery Infection Prevention and Control Practice in the COVID-19 “Return to Operate” Era. JOURNAL OF SCIENTIFIC INNOVATION IN MEDICINE 2021. [DOI: 10.29024/jsim.95] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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24
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Analysis of Neurosurgical Cases Before and During the Coronavirus Disease 2019 Pandemic from a Tertiary-Care Centre in India. World Neurosurg 2021; 152:e635-e644. [PMID: 34129979 PMCID: PMC8197626 DOI: 10.1016/j.wneu.2021.06.019] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 12/20/2022]
Abstract
Objective We present the unique administrative issues as well as specific patient-related and surgeon-related challenges and solutions implemented while treating neurosurgical patients during the coronavirus disease 2019 (COVID-19) pandemic vis-à-vis pre-COVID-19 times at our tertiary-care center. Methods This is a retrospective study comparing the outcome of the neurosurgical patients treated from the beginning of lockdown in India on March 25, 2020 to November 30, 2020 with that of same period in the previous year, 2019. Results There were 687 neurosurgery admissions during the study period compared with 2550 admissions in 2019. The total number of surgeries performed in neurosurgery also showed a similar trend, with only 654 surgeries in 2020 compared with 3165 surgeries in 2019. During COVID-19 times, 474 patients were operated on including both trauma and nontrauma cases. Of the 50 patients with suspected/indeterminate COVID-19 who were operated on, 5 turned out to be positive for COVID-19. Significant differences were seen in the mortality (P < 0.01) and morbidity (P < 0.01) among patients with trauma on comparing COVID and pre-COVID periods. Similarly, a significant difference was observed in the mortality (P < 0.001) and morbidity (P < 0.001) in patients who did not have trauma. Conclusions The higher mortality and morbidity during the COVID pandemic is primarily attributable to poorer baseline clinical status. Our experience from this COVID period might not only help us in tackling subsequent waves but also help other institutions in the developing world to be better prepared for similar circumstances.
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25
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Delavari F, Varzaneh FN, Rezaei N. Neurologic Manifestations of COVID-19. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2021; 1318:343-353. [PMID: 33973188 DOI: 10.1007/978-3-030-63761-3_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
Neurological manifestations of novel coronavirus disease (COVID-19) are reported to occur in as much as 37% of the affected patients. These manifestations range from headache and dizziness to altered mental status and consciousness, anosmia, ageusia, sensory disturbances, and stroke. The mechanisms by which the neurological symptoms arise are not yet determined but may either proceed as an indirect consequence of systemic hyperinflammation or result from the direct invasion of the virus to neural and glial cells. The neural invasion can explain both the retrograde pathway of encephalitis and the early manifestation of anosmia by invading the olfactory bulb. Moreover, in the case of attacking the brain stem, it may take part in the early apnea manifestation reported by patients. Additionally, neurotropism of the virus could be the cause of acute hemorrhagic encephalitis. Hyperinflammation can have acute and prolonged effects in the nervous system, such as acute demyelination and predisposition to multiple sclerosis. Moreover, the pro-inflammatory state contributes to hypercoagulation, which in turn could result in cerebrovascular injuries in COVID-19 patients. This chapter would discuss that the neurologic manifestations of the COVID-19 are to be looked at as a multifactorial entangled phenomenon.
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Affiliation(s)
- Farnaz Delavari
- University of Geneva, Geneva, Switzerland.
- Interactive Research Education and Training Association (IRETA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
| | - Farnaz Najmi Varzaneh
- The Russell H. Morgan Department of Radiology and Radiological Sciences, Johns Hopkins University, Baltimore, MD, USA
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Baltimore, MD, USA
| | - Nima Rezaei
- Research Center for Immunodeficiencies, Children's Medical Center, Tehran University of Medical Sciences, Tehran, Iran.
- Department of Immunology, School of Medicine, Tehran University of Medical Sciences, Tehran, Iran.
- Network of Immunity in Infection, Malignancy and Autoimmunity (NIIMA), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
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26
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Jati Nugroho B, Soetjahjo B, Heru Nefihancoro U, Ermawan R, Darma Saputra R, Santoso Putra G, Kaldani F, Putra MDP, Rhani Lebang Z, Alberta Setiawati D. Orthopedic Department of Education Center and Service Provide During Coronavirus Disease-2019 Pandemic: An Experience from Single-Center Hospital. Open Access Maced J Med Sci 2021. [DOI: 10.3889/oamjms.2021.6027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND: In the global pandemic of the 2019 coronavirus disease (COVID-19), many countries have reported a decrease in visits to hospitals, and health-care systems around the world are reshaping health protocols. Health service and education in orthopedics are also affected although not at the frontline in dealing COVID-19.
METHODS: The data from this study collected from several official databases, including the Indonesian Ministry of Health, Central Java provincial government, general hospital, and orthopedic surgery cases.
RESULTS: Pandemic COVID-19 started in March 2020 in Indonesia. Surakarta has become one of the epicenters. Health services in the orthopedic department also experienced a decrease cases on all divisions (outpatient clinics, emergency rooms, and inpatients). Mann–Whitney non-parametric comparative test showed significance result in p value operation of orthopedic cases and inpatients (p = 0.016 and p = 0.016; p < 0.05), meanwhile, outpatient visits did not show significance result with p = 0.0509 (p > 0.05). The decrease in the number of cases being treated in the orthopedic service also has an impact on education and training programs. The digital era is one of the choices in the field of education. However, digital resources cannot substitute for direct patient exposure.
CONCLUSION: The average number of orthopedic patients during the pandemic period from January to December 2020 decreased compared to visits in the same period in 2019 so that orthopedic services at tertiary and academic referral hospitals experienced a significant decrease in cases. The education and services department must adapt to the policy on educational activities for residents and medical students. The education department and hospital institutions restructured and reorganized resident doctors to continue providing services. The digital era is an option that supports the education process during a pandemic.
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27
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Toombs CS, Boody BS, Bronson WH, Girasole GJ, Russo GS. Safe Spine Surgery During the COVID-19 Pandemic. Clin Spine Surg 2021; 34:87-91. [PMID: 33027092 PMCID: PMC8132561 DOI: 10.1097/bsd.0000000000001084] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 08/19/2020] [Indexed: 12/24/2022]
Abstract
Safe spine surgery is possible during the COVID-19 pandemic. Certain urgent procedures must still be performed during this challenging time to prevent permanent long-term disability or death for patients. Precautions must be taken in the operating room to optimize safety, including the use of personal protective equipment and appropriate room setup and anesthesia and equipment optimization. Evidence-based guidelines to create a safe operative paradigm for use in future viral outbreaks are paramount.
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Affiliation(s)
| | - Barrett S. Boody
- Department of Orthopaedic Surgery, Indiana University Hospital, IN
| | - Wesley H. Bronson
- Department of Orthopaedic Surgery, Mount Sinai Hospital, New York, NY
| | - Gerard J. Girasole
- Connecticut Orthopaedics
- Department of Surgery, Frank H. Netter School of Medicine, Quinnipiac University, Hamden
- St. Vincent’s Medical Center, Bridgeport, CT
| | - Glenn S. Russo
- Connecticut Orthopaedics
- Department of Surgery, Frank H. Netter School of Medicine, Quinnipiac University, Hamden
- St. Vincent’s Medical Center, Bridgeport, CT
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28
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Amruta N, Chastain WH, Paz M, Solch RJ, Murray-Brown IC, Befeler JB, Gressett TE, Longo MT, Engler-Chiurazzi EB, Bix G. SARS-CoV-2 mediated neuroinflammation and the impact of COVID-19 in neurological disorders. Cytokine Growth Factor Rev 2021; 58:1-15. [PMID: 33674185 PMCID: PMC7894219 DOI: 10.1016/j.cytogfr.2021.02.002] [Citation(s) in RCA: 71] [Impact Index Per Article: 23.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 02/16/2021] [Indexed: 12/11/2022]
Abstract
SARS-CoV-2 is a novel coronavirus that severely affects the respiratory system, is the cause of the COVID-19 pandemic, and is projected to result in the deaths of 2 million people worldwide. Recent reports suggest that SARS-CoV-2 also affects the central nervous system along with other organs. COVID-19-associated complications are observed in older people with underlying neurological conditions like stroke, Alzheimer's disease, and Parkinson's disease. Hence, we discuss SARS-CoV-2 viral replication and its inflammation-mediated infection. This review also focuses on COVID-19 associated neurological complications in individuals with those complications as well as other groups of people. Finally, we also briefly discuss the current therapies available to treat patients, as well as ongoing available treatments and vaccines for effective cures with a special focus on the therapeutic potential of a small 5 amino acid peptide (PHSCN), ATN-161, that inhibits SARS-CoV-2 spike protein binding to both integrin α5β1 and α5β1/hACE2.
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Affiliation(s)
- Narayanappa Amruta
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Wesley H Chastain
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Meshi Paz
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Rebecca J Solch
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Isabel C Murray-Brown
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Jaime B Befeler
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Timothy E Gressett
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA
| | - Michele T Longo
- Department of Neurology, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Tulane Brain Institute, Tulane University, New Orleans, LA, 70112, USA
| | - Elizabeth B Engler-Chiurazzi
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Tulane Brain Institute, Tulane University, New Orleans, LA, 70112, USA
| | - Gregory Bix
- Department of Neurosurgery, Clinical Neuroscience Research Center, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Department of Neurology, Tulane University School of Medicine, New Orleans, LA, 70112, USA; Tulane Brain Institute, Tulane University, New Orleans, LA, 70112, USA.
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29
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Zou Y, Zhang J, Zhang T, Feng Y, Xiong Z, Xu C, Gong P, Si J, Chen J. Characteristics and operation outcomes of neuro-oncology patients after COVID-19 pandemic - A case series. INTERDISCIPLINARY NEUROSURGERY-ADVANCED TECHNIQUES AND CASE MANAGEMENT 2021; 25:101172. [PMID: 33754122 PMCID: PMC7955585 DOI: 10.1016/j.inat.2021.101172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 02/04/2021] [Accepted: 02/28/2021] [Indexed: 12/24/2022]
Abstract
Background COVID-19 has been spreading worldwide at hitherto unknown speed, and the treatment of neuro-oncology patients without COVID-19 has been greatly affected. Methods To compare the medical records and surgical results of surgical patients before and after the pandemic. We collected a total of 80 patients form April 2020 to May 2020 after pandemic and from April 2019 to May 2019 before pandemic. The patient's demographics, past medical history, comorbidities, imaging, pathology, laboratory teat, and Karnofsky Performance Score (KPS) were analyzed. Results The most common presenting symptom was intracranial hypertension and neurological deficit. Hypertension and diabetes were the most common comorbid diseases. The pre-operation KPS were 83.21 ± 15.60, 80 ± 14.77, 78.57 ± 12.83 and 74.14 ± 12.72, respectively. The post-operation KPS were 94.64 ± 8.65, 95.45 ± 6.56, 91.43 ± 10.82 and 84.21 ± 22.55, respectively. The tumor volume was larger and the midline shift distance was greater after the pandemic than before. For pathological grade, meningiomas were mostly grade I, while gliomas were mainly grade III and IV. Conclusion Although affected by the COVID-19 pandemic, patients with glioma should be operated as soon as possible to obtain better surgical results, however, for patients with meningiomas, their operation can be postponed slightly when the patients are tolerable.
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Affiliation(s)
- Yichun Zou
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jiangjiang Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Tingbao Zhang
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Yu Feng
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Zhongwei Xiong
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Chengshi Xu
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Pian Gong
- Department of Neurosurgery, Renmin Hospital of Wuhan University, Wuhan, Hubei 430060, China
| | - Jichun Si
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
| | - Jincao Chen
- Department of Neurosurgery, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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Fleseriu M. Pituitary Disorders and COVID-19, Reimagining Care: The Pandemic A Year and Counting. Front Endocrinol (Lausanne) 2021; 12:656025. [PMID: 33776943 PMCID: PMC7996050 DOI: 10.3389/fendo.2021.656025] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 02/15/2021] [Indexed: 12/15/2022] Open
Affiliation(s)
- Maria Fleseriu
- Pituitary Center, and Departments of Medicine (Endocrinology, Diabetes and Clinical Nutrition), and Neurological Surgery, Oregon Health & Science University, Portland, OR, United States
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Arimappamagan A, Vilanilam G, Pandey P. Is Elective Neurosurgery Justified During COVID-19 Pandemic? Neurol India 2021; 69:21-25. [PMID: 33642265 DOI: 10.4103/0028-3886.310113] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Background As the world faces a new viral pandemic, which has spread very rapidly, initial response from most countries was to suspend nonemergent health services so that available resources can be diverted to handle the large numbers of patients with COVID-19 infection. Many societies issued guidelines to suspend or postpone nonemergent surgeries. Methods We reviewed the emerging evidence regarding the impact of COVID-19 infection in neurosurgery and the postponement of elective surgeries. Results and Observations COVID-19 infection poses serious threat in hospitals in the form of cross-infection, hospital staff falling sick, with potential risk to overwhelm or paralyze the healthcare. In addition, we have come to realize the significant perioperative morbidity and mortality secondary to active COVID-19 infection. All these strongly favor suspension of elective neurosurgical services. However, these have to be weighed against the fallout due to prolonged postponement of neurosurgical treatment for conditions, which can progress and cause neurological deterioration. Conclusion This article discusses the contemporary published literature regarding the perioperative risk of COVID-19 infection, impact of postponed surgeries, challenges, risk assessment and guidelines for elective neurosurgery at this point of time.
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Affiliation(s)
- Arivazhagan Arimappamagan
- Department of Neurosurgery, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Paritosh Pandey
- Department of Neurosurgery, Manipal Hospitals, Bengaluru, Karnataka, India
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Singh SK, Abhijit V, Jha VC. Modification of neurosurgical practice during corona pandemic: Our experience at AIIMS patna and long term guidelines. INTERDISCIPLINARY NEUROSURGERY : ADVANCED TECHNIQUES AND CASE MANAGEMENT 2021; 23:100895. [PMID: 32929400 PMCID: PMC7481068 DOI: 10.1016/j.inat.2020.100895] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2020] [Accepted: 09/05/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND First case of covid-19 was confirmed on 30th January 2020 in India. Our state, Bihar reported its first confirmed case of covid on 22nd march 2020 at AIIMS Patna. For safety, Electives surgeries and outpatient department was suspended temporary since 25th March. Standard operating procedure (SOP) was framed for covid suspected, covid positive and negative patients. Neurosurgery department formulated their own strategy for successful and covid free management of neurosurgical patients along with zero transmission rate among doctors and staff. METHODS All Neurosurgical patients who got attended, admitted and operated from 25th March to 30th June 2020 (Period of lockdown) were taken in this study. Categorizations of the patients were done according to the urgency and elective nature of pathology after corona screening and RT-PCR testing of covid-19. A proper training to all neurosurgical staff and residents were given for management of patients (admission to operation to discharge). RESULTS Total 133 patients were attended and 90 were admitted. We operated 76 cases (major - 52, minor - 24) during the lockdown period. Out of this 2 were corona positive (both eventually succumbed) and rest 74 was corona negative. One patient who was operated with corona negative report became positive after 10 days of surgery inward. All the residents, faculty and nursing staff remain asymptomatic throughout the lockdown period with zero infection rate and zero transmission rate. CONCLUSION Following a properly made standard operating procedure and strictly implementing it can avoid any type of misadventure in neurosurgery during corona pandemic.
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Epilepsy and COVID-19: Updated evidence and narrative review. Epilepsy Behav 2021; 116:107785. [PMID: 33515934 PMCID: PMC7805398 DOI: 10.1016/j.yebeh.2021.107785] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 12/31/2020] [Accepted: 12/31/2020] [Indexed: 01/08/2023]
Abstract
The coronavirus disease 2019 (COVID-19) outbreak started in Wuhan, China, in late 2019 and rapidly spread globally. Vaccines have recently been developed and are being administered in some countries, but their widespread use is not yet sufficient; the battle against COVID-19 is protracted and people need to adapt to living under the influence of this disease. Epilepsy is a common chronic neurological condition characterized by spontaneous recurrence of unprovoked seizures. Various effects of COVID-19 on epilepsy have been studied in recent months. As clinicians, we need to keep up with daily updates in the evidence regarding interactions between COVID-19 and epilepsy. This review article summarizes the current evidence. Prospective studies on epilepsy and COVID-19 remain lacking. Most articles have comprised case reports, case series, retrospective studies, and recommendations/opinions that do not include data. However, summarizing these articles can identify the demands for research into COVID-19 and epilepsy by clarifying what is known and what remains unclear from current research.
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Alimohammadi E, Eden SV, Anand SK, Ahadi P, Bostani A, Bagheri SR. The impact of coronavirus 2019 (COVID-19) on neurosurgical practice and training: a review article. Br J Neurosurg 2021; 36:569-573. [PMID: 33612023 DOI: 10.1080/02688697.2021.1888874] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
The 2019 coronavirus pandemic (COVID-19) has affected all of society at different levels. Similarly, COVID-19 has significantly impacted every medical field, including neurosurgery. By exposing scarcities in the healthcare industry and requiring the reallocation of available resources towards the priority setting and away from elective surgeries and outpatient visits, the pandemic posed new, unprecedented challenges to the medical community. Despite the redistribution of resources towards COVID-19 patients and away from elective surgeries, urgent and emergent surgeries for life-threatening conditions needed to be continued. The neurosurgical community, like other specialties not directly involved in the care of COVID-19 patients, initially struggled to balance the needs of COVID-19 patients with those of neurosurgical patients, residents, and researchers. Several articles describing the effect of COVID-19 on neurosurgical practice and training have been published throughout the COVID-19 pandemic. This article aims to provide a focused review of the impact COVID-19 has had on neurosurgical practice and training as well as describe neurological manifestations of the disease.
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Affiliation(s)
- Ehsan Alimohammadi
- Neurosurgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Sonia V Eden
- Wayne State University School of Medicine, Detroit, MI, USA
| | | | - Paniz Ahadi
- Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Arash Bostani
- Neurology, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Seyed Reza Bagheri
- Neurosurgery, Imam Reza Hospital, Kermanshah University of Medical Sciences, Kermanshah, Iran
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Rosyidi RM, Wisnu Wardhana DP, Apriawan T, Al Fauzi A, Priyanto B, Gunawan K, Nugroho SW, Prihastomo KT, Nasution MD, Ihwan A. Algorithm of traumatic brain injury management at Indonesia in the COVID 19 pandemic ERA. Retrospective cohort study. Ann Med Surg (Lond) 2021; 62:98-103. [PMID: 33520203 PMCID: PMC7819803 DOI: 10.1016/j.amsu.2021.01.008] [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: 11/22/2020] [Revised: 01/05/2021] [Accepted: 01/08/2021] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES COVID-19, a global pandemic, affects neurosurgical care in Indonesia. This study has objective to propose guideline and algorithm recommendation for the management of TBI patients during this pandemic, which can be used flexibly at neurosurgery centers, both in Indonesia and throughout the world. METHODS We performed retrospective Cohort analysis from TBI database at tertiary public general hospitals. All neurotrauma cases from mid-February until mid-August 2020 was included in this study. The chronology of COVID-19 pandemics impact in Indonesia was defined by early period from mid-February until end of May 2020, and late period are latter. All subjects undergone the screening and perioperative measures that based on our proposes scoring system and algorithm as follows. RESULTS There are many guidelines that explain screening methods in neurosurgery patients in general, as well as neurotrauma in particular. But here, we proposed our own scoring and screening algorithm that has been developed based on conditions in Indonesia. In total of 757 neurotrauma cases data were collected from the pandemic starts in Indonesia. DISCUSSION Screening is a crucial initial step in this pandemic period, not only for COVID patients, but also all patients who enter the emergency room. The use of PPE is a necessity in several neurosurgery centers, especially with high COVID-19 case rates. CONCLUSION The management of neurotrauma patients with suspected and confirmed COVID-19 requires special attention, starting from admission of the patient in ER. Rapid scoring and screening are important and the highest level of PPE is mandatory during patient care.
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Affiliation(s)
- Rohadi Muhammad Rosyidi
- Department of Neurosurgery, Medical Faculty of Mataram University, West Nusa Tenggara General Hospital, Mataram, Indonesia
| | - Dewa Putu Wisnu Wardhana
- Department of Neurosurgery,Udayana University Hospital, Medical Faculty of Udayana University, Bali, Indonesia
| | - Tedy Apriawan
- Department of Neurosurgery, Medical Faculty of Airlangga University, Dr. Soetomo General Hospital Medical Center, Surabaya, East Java, Indonesia
| | - Asra Al Fauzi
- Department of Neurosurgery, Medical Faculty of Airlangga University, Dr. Soetomo General Hospital Medical Center, Surabaya, East Java, Indonesia
| | - Bambang Priyanto
- Department of Neurosurgery, Medical Faculty of Mataram University, West Nusa Tenggara General Hospital, Mataram, Indonesia
| | - Kevin Gunawan
- Department of Neurosurgery, Medical Faculty of Indonesia University, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Setyo Widi Nugroho
- Department of Neurosurgery, Medical Faculty of Indonesia University, Cipto Mangunkusumo National General Hospital, Jakarta, Indonesia
| | - Krisna Tsaniadi Prihastomo
- Department of Neurosurgery, Dr. Kariadi General Hospital Medical Center, Semarang, Center Java, Indonesia
| | - Muhammad Deni Nasution
- Department of Neurosurgery, Medical Faculty of Sumatera Utara University, Medan, North Sumatera, Indonesia
| | - Andi Ihwan
- Department of Neurosurgery, Medical Faculty of Hasanuddin University, Makassar, South Sulawesi, Indonesia
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Hameed NUF, Ma Y, Zhen Z, Wu S, Feng R, Li W, Huang G, Wu J, Chen Z. Impact of a pandemic on surgical neuro-oncology-maintaining functionality in the early phase of crisis. BMC Surg 2021; 21:40. [PMID: 33461509 PMCID: PMC7812331 DOI: 10.1186/s12893-021-01055-z] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Accepted: 01/07/2021] [Indexed: 02/06/2023] Open
Abstract
Background The Coronavirus disease 2019 (COVID-19) pandemic has extraordinarily impacted global healthcare. Neuro-oncological surgery units have peculiar features that make them highly relevant in the strategic reaction to the pandemic. In this Chinese Society of Neuro-Oncology (CSNO) initiated survey, we appraise the changes implemented in neuro-oncological surgery hospitals across different Asian countries and provide expert recommendations for responses at different stages of the pandemic. Methods We performed a 42-question survey of the early experience of neuro-oncological surgery practice in hospitals across different Asian countries on April 1, 2020, with responses closed on April 18, 2020. Results 144 hospitals completed the questionnaire. Most were in WHO post-peak phase of the pandemic and reported a median reduction in neuro-oncological surgery volume of 25–50%. Most (67.4%) resumed elective surgery in only COVID-19 negative patients;11.1% performed only emergency cases irrespective of COVID-19 status;2.1% suspended all surgical activity. Ninety-one (63.2%) relocated personnel from neurosurgery to other departments. Fifty-two (36.1%) hospitals suspended post-operative adjuvant therapy and 94 (65.2%) instituted different measures to administer post-operative adjuvant therapy. Majority (59.0%) of the hospitals suspended research activity. Most (70%) respondents anticipate that current neurosurgery restrictions will continue to remain for > 1 month. Conclusions Majority of the respondents to our survey reported reduced neuro-oncological surgery activity, policy modification, personnel reallocation, and curtailment of educational/research activities in response to the COVID-19 pandemic. The persistent widespread interruption of surgical neuro-oncology in even post-peak phases of the pandemic raises serious concerns about the long-term impact of the pandemic on neuro-oncological patients and highlights the essence of timely measures for pandemic preparedness, patient triage, and workforce protection.
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Affiliation(s)
- N U Farrukh Hameed
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 201206, China
| | - Yixin Ma
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 201206, China
| | - Zili Zhen
- Department of General Surgery, Jinshan Hospital, Fudan University, Shanghai, 201206, China
| | - Shuai Wu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 201206, China
| | - Rui Feng
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 201206, China
| | - Weiping Li
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China
| | - Guodong Huang
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China
| | - Jinsong Wu
- Department of Neurosurgery, Huashan Hospital, Fudan University, Shanghai, 201206, China
| | - Zhongping Chen
- Department of Neurosurgery, The First Affiliated Hospital of Shenzhen University, Shenzhen, 518035, China.
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The effects of COVID-19 pandemic on pediatric neurosurgery practice and training in a developing country. Childs Nerv Syst 2021; 37:1313-1317. [PMID: 33130919 PMCID: PMC7603429 DOI: 10.1007/s00381-020-04953-4] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 10/27/2020] [Indexed: 11/23/2022]
Abstract
PURPOSE COVID-19 pandemic has influenced all aspects of societies, with the healthcare being the most affected field. All specialties including neurosurgery are involved, and due to resource limitations, the number of elective surgeries in subspecialized filed has substantially decreased. Herein, we report our practice experience in pediatric neurosurgery in a tertiary hospital during pandemic, and the effects of pandemic on educational issues. METHODS All the patients on whom any kind of neurosurgical operation was performed from March to June 2020 were retrospectively collected, and also from the same period in the previous year. RESULTS A total of 111 patients underwent surgery in this period. This figure was 159 patients during the same period in 2019. The total number of surgical cases reduced by 31% compared to the last year. While ventriculoperitoneal shunts and supratentorial tumor were more frequent, there was a considerable reduction in subspecialized educational surgeries like neural tube defects and craniosynostoses. CONCLUSION CVID-19 pandemic changed all scopes of medical practice and training. Considering the limitation in the available resources, the number of educational cases may decrease in subspecialized disciplines like pediatric neurosurgery. If pandemic continues, alternative measures should be taken to compensate for the shortcoming in technical and practical training.
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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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Farahbakhsh F, Rostami M, Khoshnevisan A, Naderian N, Ghorbani M, Fehlings MG, Rahimi-Movaghar V. The Management and Outcomes of Coronavirus Disease 2019 Infection in a Series of Neurosurgical Patients. Asian J Neurosurg 2021; 16:78-83. [PMID: 34211871 PMCID: PMC8202364 DOI: 10.4103/ajns.ajns_187_20] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 06/06/2020] [Accepted: 10/30/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has impacted neurosurgical practice worldwide. In Iran, hospitals have halted their routine activities, and most hospital beds have been assigned to COVID-19 patients. Here, we share our experience with 10 neurosurgical cases with confirmed COVID-19. MATERIALS AND METHODS From February 24, 2020 to April 20, 2020, we were able to obtain clinical data on ten neurosurgical patients with COVID-19 through a predefined electronic form. RESULTS Of the 10 patients with COVID-19 on neurosurgical units, eight underwent surgical interventions. The age of the patients ranged from 21 to 75 years and 70% were males. The diagnosis of COVID-19 was based on chest imaging findings and reverse transcriptase-polymerase chain reaction for coronavirus and an infectious disease specialist and a pulmonologist confirmed the diagnoses. In two cases, there was a significant decrease in O2 saturation intraoperatively. Three patients in this series died during the assessment period. One death was due to respiratory failure induced by the coronavirus infection. The cause of death in other two patients was cardiovascular failure not related to COVID-19. CONCLUSIONS We hope we can provide a reference for future studies and help develop a clearer understanding of neurosurgical practice and outcomes in patients with COVID-19. In the time of COVID-19 pandemic when dealing with neurosurgical emergencies, a conservative approach is recommended. Using committed personal protective equipment, short-time operating procedures or minimally invasive surgery must be considered in the management of emergent patients. Resuming elective surgeries need defining measures needed to ensure patients and health-care providers' safety. Reorganizing the health-care system for telemonitoring released patients can lessen hospital visits.
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Affiliation(s)
- Farzin Farahbakhsh
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Mohsen Rostami
- Sports Medicine Research Center, Neuroscience Institute, Tehran University of Medical Sciences, Tehran, Iran
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Alireza Khoshnevisan
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Negin Naderian
- Department of Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Mohammad Ghorbani
- Division of Vascular and Endovascular Neurosurgery, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
| | - Michael G Fehlings
- Department of Surgery, Division of Neurosurgery, University of Toronto, Toronto, Ontario, Canada
- Krembil Research Institute, University Health Network, Toronto, Ontario, Canada
| | - Vafa Rahimi-Movaghar
- Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Sina Trauma and Surgery Research Center, Tehran University of Medical Sciences, Tehran, Iran
- Brain and Spinal Cord Injury Research Center, Neurosciences Institute, Tehran University of Medical Sciences, Tehran, Iran
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Aljuboori ZS, Young CC, Srinivasan VM, Kellogg RT, Quon JL, Alshareef MA, Chen SH, Ivan M, Grant GA, McEvoy SD, Davanzo JR, Majid S, Durfy S, Levitt MR, Sieg EP, Ellenbogen RG, Nauta HJ. Early Effects of COVID-19 Pandemic on Neurosurgical Training in the United States: A Case Volume Analysis of 8 Programs. World Neurosurg 2021; 145:e202-e208. [PMID: 33065350 PMCID: PMC7550889 DOI: 10.1016/j.wneu.2020.10.016] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 10/02/2020] [Accepted: 10/03/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVE To determine the impact of the 2019 novel coronavirus disease (COVID-19) pandemic on operative case volume in 8 U.S. neurosurgical residency training programs in early 2020 and to survey these programs regarding training activities during this period. METHODS A retrospective review was conducted of monthly operative case volumes and types for 8 residency programs for 2019 and January through April 2020. Cases were grouped as elective cranial, elective spine, and nonelective emergent cases. Programs were surveyed regarding residents' perceptions of the impact of COVID-19 on surgical training, didactics, and research participation. Data were analyzed for individual programs and pooled across programs. RESULTS Across programs, the 2019 monthly mean ± SD case volume was 211 ± 82; 2020 mean ± SD case volumes for January, February, March, and April were 228 ± 93, 214 ± 84, 180 ± 73, and 107 ± 45. Compared with 2019, March and April 2020 mean cases declined 15% (P = 0.003) and 49% (P = 0.002), respectively. COVID-19 affected surgical case volume for all programs; 75% reported didactics negatively affected, and 90% reported COVID-19 resulted in increased research time. Several neurosurgery residents required COVID-19 testing; however, to our knowledge, only 1 resident from the participating programs tested positive. CONCLUSIONS This study documents a significant reduction in operative volume in 8 neurosurgery residency training programs in early 2020. During this time, neurosurgery residents engaged in online didactics and research-related activities, reporting increased research productivity. Residency programs should collect data to determine the educational impact of the COVID-19 pandemic on residents' operative case volumes, identify deficiencies, and develop plans to mitigate any effects.
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Affiliation(s)
- Zaid S Aljuboori
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA.
| | - Christopher C Young
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | | | - Ryan T Kellogg
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Jennifer L Quon
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Mohammed A Alshareef
- Department of Neurosurgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Stephanie H Chen
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Michael Ivan
- Department of Neurological Surgery, University of Miami, Miami, Florida, USA
| | - Gerald A Grant
- Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA
| | - Sean D McEvoy
- Department of Neurological Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri, USA
| | - Justin R Davanzo
- Department of Neurological Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Sonia Majid
- Department of Neurological Surgery, Penn State College of Medicine, Hershey, Pennsylvania, USA
| | - Sharon Durfy
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Michael R Levitt
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Emily P Sieg
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
| | - Richard G Ellenbogen
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Haring J Nauta
- Department of Neurosurgery, University of Louisville, Louisville, Kentucky, USA
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Mummaneni PV, Burke JF, Chan AK, Sosa JA, Lobo EP, Mummaneni VP, Antrum S, Berven SH, Conte MS, Doernberg SB, Goldberg AN, Hess CP, Hetts SW, Josephson SA, Kohi MP, Ma CB, Mahadevan VS, Molinaro AM, Murr AH, Narayana S, Roberts JP, Stoller ML, Theodosopoulos PV, Vail TP, Wienholz S, Gropper MA, Green A, Berger MS. Consensus-based perioperative protocols during the COVID-19 pandemic. J Neurosurg Spine 2021; 34:13-21. [PMID: 33007752 DOI: 10.3171/2020.6.spine20777] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2020] [Accepted: 06/01/2020] [Indexed: 01/08/2023]
Abstract
OBJECTIVE During the COVID-19 pandemic, quaternary-care facilities continue to provide care for patients in need of urgent and emergent invasive procedures. Perioperative protocols are needed to streamline care for these patients notwithstanding capacity and resource constraints. METHODS A multidisciplinary panel was assembled at the University of California, San Francisco, with 26 leaders across 10 academic departments, including 7 department chairpersons, the chief medical officer, the chief operating officer, infection control officers, nursing leaders, and resident house staff champions. An epidemiologist, an ethicist, and a statistician were also consulted. A modified two-round, blinded Delphi method based on 18 agree/disagree statements was used to build consensus. Significant disagreement for each statement was tested using a one-sided exact binomial test against an expected outcome of 95% consensus using a significance threshold of p < 0.05. Final triage protocols were developed with unblinded group-level discussion. RESULTS Overall, 15 of 18 statements achieved consensus in the first round of the Delphi method; the 3 statements with significant disagreement (p < 0.01) were modified and iteratively resubmitted to the expert panel to achieve consensus. Consensus-based protocols were developed using unblinded multidisciplinary panel discussions. The final algorithms 1) quantified outbreak level, 2) triaged patients based on acuity, 3) provided a checklist for urgent/emergent invasive procedures, and 4) created a novel scoring system for the allocation of personal protective equipment. In particular, the authors modified the American College of Surgeons three-tiered triage system to incorporate more urgent cases, as are often encountered in neurosurgery and spine surgery. CONCLUSIONS Urgent and emergent invasive procedures need to be performed during the COVID-19 pandemic. The consensus-based protocols in this study may assist healthcare providers to optimize perioperative care during the pandemic.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | - Steven W Hetts
- 9Radiology and Biomedical Imaging
- 10Interventional Neuroradiology
| | | | - Maureen P Kohi
- 9Radiology and Biomedical Imaging
- 12Vascular and Interventional Radiology, and
| | | | | | | | | | | | | | | | | | | | - Sandra Wienholz
- 16Perioperative Care, University of California, San Francisco, California
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42
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Chen Y, Chen X, Ma L, Deng X, Li Z, Ye X, Wang H, Kang S, Zhang Y, Wang R, Zhang D, Cao Y, Zhao Y, Wang S, Zhao J. Management protocol for emergency aneurysm craniotomy clipping in non-major COVID-19 epidemic areas in Beijing, China. Chin Neurosurg J 2020; 6:38. [PMID: 33349249 PMCID: PMC7752522 DOI: 10.1186/s41016-020-00217-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 11/13/2020] [Indexed: 12/15/2022] Open
Abstract
Background An epidemic of COVID-19 broke out in Wuhan, China, since December 2019. The ordinary medical services were hindered. However, the emergency cases, including aneurysmal subarachnoid hemorrhage (aSAH), still required timely intervention. Thus, it provoked challenges to the routine management protocol. In this study, we summarized our experience in the emergency management of aSAH (Beijing Tiantan Protocol, BTP) in Beijing, China. Methods Demographic, clinical, and imaging data of consecutive emergency aSAH patients who underwent craniotomy clipping during the COVID-19 epidemic season were reviewed and compared with the retrospective period last year. Subgroup analysis was further performed to assess the outcomes of different screening results and several detailed protocols. Neurological outcomes were evaluated by the modified Rankin Scale (mRS). Results A total of 127 aSAH were referred to our emergency department, and 42 (33.1%) underwent craniotomy clipping between January 20, 2020, and March 25, 2020. The incidence of preoperative hospitalized adverse events and the perioperative outcomes were similar (− 0.1, 95% CI − 1.0 to 0.8, P = 0.779) to the retrospective period last year (January 2019–March 2019). After the propensity score matching (PSM), there were still no statistical differences in prognostic parameters between the two groups. Eight (19.0%) of the 42 individuals were initially screened as preliminary undetermined COVID-19 cases, in which 2 of them underwent craniotomy clipping in the negative pressure operating room (OR). The prognosis of patients with varied COVID-19 screening results was similar (F(2, 39) = 0.393, P = 0.678). Since February 28, 12 cases (28.6%) received COVID-19 nucleic acid testing (NAT) upon admission, and all showed negative. The false-negative rate was 0.0%. The preoperative hospitalized adverse events and postoperative prognosis were still similar between patients with and without COVID-19 NAT (− 0.3, 95% CI − 1.4 to 0.9, P = 0.653). Conclusions Our emergency surgery management protocol (BTP) is reliable for scheduling emergency aneurysm craniotomy clipping in non-major epidemic areas.
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Affiliation(s)
- Yu Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xiaolin Chen
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Li Ma
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xiaofeng Deng
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Zelin Li
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Xun Ye
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China
| | - Hao Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Shuai Kang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yan Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Rong Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China.,Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China
| | - Dong Zhang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yong Cao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China
| | - Yuanli Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China. .,Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Stroke Center, Beijing Institute for Brain Disorders, Beijing, China. .,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China. .,Beijing Translational Engineering Enter for 3D Printer in Clinical Neuroscience, Beijing, China.
| | - Shuo Wang
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China. .,Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Stroke Center, Beijing Institute for Brain Disorders, Beijing, China. .,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China. .,Beijing Translational Engineering Enter for 3D Printer in Clinical Neuroscience, Beijing, China.
| | - Jizong Zhao
- Department of Neurosurgery, Beijing Tiantan Hospital, Capital Medical University, Beijing, 100070, China. .,Department of Neurosurgery, Peking University International Hospital, Peking University, Beijing, China. .,China National Clinical Research Center for Neurological Diseases, Beijing, China. .,Stroke Center, Beijing Institute for Brain Disorders, Beijing, China. .,Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease, Beijing, China. .,Beijing Translational Engineering Enter for 3D Printer in Clinical Neuroscience, Beijing, China.
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43
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Raheja A, Agarwal N, Mohapatra S, Tandon V, Borkar SA, Chandra PS, Kale SS, Suri A. Preparedness and guidelines for neurosurgery in the COVID-19 era: Indian perspective from a tertiary care referral hospital. Neurosurg Focus 2020; 49:E3. [PMID: 33260133 DOI: 10.3171/2020.9.focus20564] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Accepted: 09/24/2020] [Indexed: 11/06/2022]
Abstract
The COVID-19 pandemic has severely impacted healthcare systems globally. The need of the hour is the development of effective strategies for protecting the lives of healthcare providers (HCPs) and judicious triage for optimal utilization of human and hospital resources. During this pandemic, neurosurgery, like other specialties, must transform, innovate, and adopt new guidelines and safety protocols for reducing the risk of cross-infection of HCPs without compromising patient care. In this article, the authors discuss the current neurosurgical practice guidelines at a high-volume tertiary care referral hospital in India and compare them with international guidelines and global consensus for neurosurgery practice in the COVID-19 era. Additionally, the authors highlight some of the modifications incorporated into their clinical practice, including those for stratification of neurosurgical cases, patient triaging based on COVID-19 testing, optimal manpower management, infrastructure reorganization, evolving modules for resident training, and innovations in operating guidelines. The authors recommend the use of their blueprint for stratification of neurosurgical cases, including their protocol for algorithmic patient triage and management and their template for manpower allocation to COVID-19 duty, as a replicable model for efficient healthcare delivery.
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Affiliation(s)
| | | | - Sarita Mohapatra
- 2Microbiology, All India Institute of Medical Sciences, New Delhi, India
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44
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Díaz-Bello S, Hernández-Hernández A, Guinto-Nishimura GY, Mondragón-Soto MG, Lem-Carrillo M, González-Aguilar A, Calleja-Castillo JM, Leyva-Rendón A, León-Ortiz P, Chávez-Piña CM, Pando-Tarín GA, Mejía-Pérez SI, Taboada-Barajas J, Zavala-Álvarez ED, Soto-Hernández JL, Cárdenas G, Gómez-Amador JL. Reconversion of neurosurgical practice in times of the SARS-CoV-2 pandemic: a narrative review of the literature and guideline implementation in a Mexican neurosurgical referral center. Neurosurg Focus 2020; 49:E4. [PMID: 33260129 DOI: 10.3171/2020.9.focus20553] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Accepted: 09/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The coronavirus disease 2019 (COVID-19) pandemic has forced the modification of surgical practice worldwide. Medical centers have been adapted to provide an efficient arrangement of their economic and human resources. Although neurosurgeons are not in the first line of management and treatment of COVID-19 patients, they take care of patients with neurological pathology and potential severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. Here, the authors describe their institutional actions against the pandemic and compare these actions with those in peer-reviewed publications. METHODS The authors conducted a search using the MEDLINE, PubMed, and Google Scholar databases from the beginning of the pandemic until July 11, 2020, using the following terms: "Neurosurgery," "COVID-19/SARS-CoV-2," "reconversion/modification," "practice," "academy," and "teaching." Then, they created operational guidelines tailored for their institution to maximize resource efficiency and minimize risk for the healthcare personnel. RESULTS According to the reviewed literature, the authors defined the following three changes that have had the greatest impact in neurosurgical practice during the COVID-19 pandemic: 1) changes in clinical practices; 2) changes in the medical care setting, including modifications of perioperative care; and 3) changes in the academic teaching methodology. CONCLUSIONS The Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez" is one of the major referral centers for treating highly complex neurosurgical pathologies in Mexico. Its clinical and neurosurgical practices have been modified with the implementation of specific interventions against the spread of COVID-19. These practical and simple actions are remarkably relevant in the context of the pandemic and can be adopted and suited by other healthcare centers according to their available resources to better prepare for the next event.
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Affiliation(s)
- Sergio Díaz-Bello
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Alan Hernández-Hernández
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Gerardo Y Guinto-Nishimura
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Michel G Mondragón-Soto
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Monica Lem-Carrillo
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Alberto González-Aguilar
- 2Neurological Emergencies.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Juan M Calleja-Castillo
- 2Neurological Emergencies.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Adolfo Leyva-Rendón
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Pablo León-Ortiz
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
| | - Carmen M Chávez-Piña
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,4Neuroanesthesiology
| | - Gustavo A Pando-Tarín
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,4Neuroanesthesiology
| | - Sonia I Mejía-Pérez
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,5Medical Education
| | - Jesús Taboada-Barajas
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,6Neuroradiology, and
| | - Elsa D Zavala-Álvarez
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - José L Soto-Hernández
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - Graciela Cárdenas
- 3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico.,7Neuro-Infectious Diseases
| | - Juan L Gómez-Amador
- Departments of1Neurosurgery.,3Instituto Nacional de Neurología y Neurocirugía "Manuel Velasco Suárez," Mexico City, Mexico
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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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Suryaningtyas W, Wahyuhadi J, Turchan A, Subagio EA, Parenrengi MA, Apriawan T, Al Fauzi A, Bajamal AH. Neurosurgery at the epicenter of the COVID-19 pandemic in Indonesia: experience from a Surabaya academic tertiary hospital. Neurosurg Focus 2020; 49:E5. [PMID: 33260130 DOI: 10.3171/2020.9.focus20559] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2020] [Accepted: 09/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Global outbreak of the novel coronavirus disease 2019 (COVID-19) has forced healthcare systems worldwide to reshape their facilities and protocols. Although not considered the frontline specialty in managing COVID-19 patients, neurosurgical service and training were also significantly affected. This article focuses on the impact of the COVID-19 outbreak at a low- and/or middle-income country (LMIC) academic tertiary referral hospital, the university and hospital policies and actions for the neurosurgical service and training program during the outbreak, and the contingency plan for future reference on preparedness for service and education. METHODS The authors collected data from several official databases, including the Indonesian Ministry of Health database, East Java provincial government database, hospital database, and neurosurgery operative case log. Policies and regulations information was obtained from stakeholders, including the Indonesian Society of Neurological Surgeons, the hospital board of directors, and the dean's office. RESULTS The curve of confirmed COVID-19 cases in Indonesia had not flattened by the 2nd week of June 2020. Surabaya, the second-largest city in Indonesia, became the epicenter of the COVID-19 outbreak in Indonesia. The neurosurgical service experienced a significant drop in cases (50% of cases from normal days) along all lines (outpatient clinic, emergency room, and surgical ward). Despite a strict preadmission screening, postoperative COVID-19 infection cases were detected during the treatment course of neurosurgical patients, and those with a positive COVID-19 infection had a high mortality rate. The reduction in the overall number of cases treated in the neurosurgical service had an impact on the educational and training program. The digital environment found popularity in the educational term; however, digital resources could not replace direct exposure to real patients. The education stakeholders adjusted the undergraduate students' clinical postings and residents' working schemes for safety reasons. CONCLUSIONS The neurosurgery service at an academic tertiary referral hospital in an LMIC experienced a significant reduction in cases. The university and program directors had to adapt to an off-campus and off-hospital policy for neurosurgical residents and undergraduate students. The hospital instituted a reorganization of residents for service. The digital environment found popularity during the outbreak to support the educational process.
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Affiliation(s)
- Wihasto Suryaningtyas
- 1Department of Neurosurgery, Universitas Airlangga Faculty of Medicine-Dr. Soetomo Academic General Hospital, Surabaya; and
| | - Joni Wahyuhadi
- 1Department of Neurosurgery, Universitas Airlangga Faculty of Medicine-Dr. Soetomo Academic General Hospital, Surabaya; and.,2The COVID-19 Curative Taskforce for The East Java Region, East Java Provincial Government, Surabaya, Indonesia
| | - Agus Turchan
- 1Department of Neurosurgery, Universitas Airlangga Faculty of Medicine-Dr. Soetomo Academic General Hospital, Surabaya; and
| | - Eko Agus Subagio
- 1Department of Neurosurgery, Universitas Airlangga Faculty of Medicine-Dr. Soetomo Academic General Hospital, Surabaya; and
| | - Muhammad Arifin Parenrengi
- 1Department of Neurosurgery, Universitas Airlangga Faculty of Medicine-Dr. Soetomo Academic General Hospital, Surabaya; and
| | - Tedy Apriawan
- 1Department of Neurosurgery, Universitas Airlangga Faculty of Medicine-Dr. Soetomo Academic General Hospital, Surabaya; and
| | - Asra Al Fauzi
- 1Department of Neurosurgery, Universitas Airlangga Faculty of Medicine-Dr. Soetomo Academic General Hospital, Surabaya; and
| | - Abdul Hafid Bajamal
- 1Department of Neurosurgery, Universitas Airlangga Faculty of Medicine-Dr. Soetomo Academic General Hospital, Surabaya; and
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Letter to the Editor Regarding “COVID-19's Impact on Neurosurgical Training in Southeast Asia”. World Neurosurg 2020; 144:331. [DOI: 10.1016/j.wneu.2020.08.190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2020] [Accepted: 08/25/2020] [Indexed: 11/18/2022]
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Wittayanakorn N, Nga VDW, Sobana M, Bahuri NFA, Baticulon RE. Impact of COVID-19 on Neurosurgical Training in Southeast Asia. World Neurosurg 2020; 144:e164-e177. [PMID: 32805466 PMCID: PMC7428452 DOI: 10.1016/j.wneu.2020.08.073] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/10/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE Neurosurgery departments worldwide have been forced to restructure their training programs because of the coronavirus disease 2019 (COVID-19) pandemic. In this study, we describe the impact of COVID-19 on neurosurgical training in Southeast Asia. METHODS We conducted an online survey among neurosurgery residents in Indonesia, Malaysia, Philippines, Singapore, and Thailand from May 22 to 31, 2020 using Google Forms. The 33-item questionnaire collected data on elective and emergency neurosurgical operations, ongoing learning activities, and health worker safety. RESULTS A total of 298 of 470 neurosurgery residents completed the survey, equivalent to a 63% response rate. The decrease in elective neurosurgical operations in Indonesia and in the Philippines (median, 100% for both) was significantly greater compared with other countries (P < 0.001). For emergency operations, trainees in Indonesia and Malaysia had a significantly greater reduction in their caseload (median, 80% and 70%, respectively) compared with trainees in Singapore and Thailand (median, 20% and 50%, respectively; P < 0.001). Neurosurgery residents were most concerned about the decrease in their hands-on surgical experience, uncertainty in their career advancement, and occupational safety in the workplace. Most of the residents (n = 221, 74%) believed that the COVID-19 crisis will have a negative impact on their neurosurgical training overall. CONCLUSIONS An effective national strategy to control COVID-19 is crucial to sustain neurosurgical training and to provide essential neurosurgical services. Training programs in Southeast Asia should consider developing online learning modules and setting up simulation laboratories to allow trainees to systematically acquire knowledge and develop practical skills during these challenging times.
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Affiliation(s)
- Nunthasiri Wittayanakorn
- Division of Neurosurgery, Department of Surgery, Queen Sirikit National Institute of Child Health, Bangkok, Thailand
| | | | - Mirna Sobana
- Division of Pediatric Neurosurgery, Hasan Sadikin Hospital/Padjadjaran University, Bandung, West Java, Indonesia
| | | | - Ronnie E Baticulon
- Division of Neurosurgery, Philippine General Hospital, and Department of Anatomy, College of Medicine, University of the Philippines Manila, Manila, Philippines.
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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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50
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Ceraudo M, Balestrino A, Cama A, Macrina G, Piatelli G, Consales A. Pediatric Neurosurgery After the COVID-19 Pandemic: Management Strategies from a Single Pediatric Hospital in Italy. World Neurosurg 2020; 146:e1079-e1082. [PMID: 33242667 PMCID: PMC7683296 DOI: 10.1016/j.wneu.2020.11.088] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Revised: 11/14/2020] [Accepted: 11/16/2020] [Indexed: 12/31/2022]
Abstract
BACKGROUND Coronavirus disease-2019 (COVID-19) pandemic had a great impact over all elective neurosurgical activity and important implications in management of neurosurgical urgencies. During the pandemic, some pediatric hospitals reported their experiences. After the emergency phase of the COVID-19 pandemic, the health care system needs to be reorganized to again manage all nonurgent activities, while ensuring safety of both patients and health care workers. METHODS We developed preventive measures to limit any possibility of COVID-19 spread, according to the principles of epidemiologic prevention and suggestions from recent literature. To evaluate the efficacy of these measures, we retrospectively reviewed the neurosurgical activity at our institution from May 4 to July 15, 2020. RESULTS One hundred nineteen patients were admitted to the neurosurgical ward, and 80 surgical procedures were performed. Furthermore, 130 outpatient clinics were scheduled. A total of 258 nasopharyngeal swabs and 249 specific interviews were performed. In our series, no cases of positivity for severe acute respiratory syndrome coronavirus-2 infection were found, and no surgical cases were postponed. DISCUSSION We present the management of the neurosurgical activity after the emergency phase at the Neurosurgical Department of Giannina Gaslini Children's Hospital in Genoa, Italy. CONCLUSIONS The Italian health care system is undertaking a process of reorganization of resources, in an attempt to restore all nonurgent activities while ensuring safety. After the emergency phase, we are learning to live together with COVID-19 and, although epidemiologic data are encouraging, we must be prepared for an eventual second peak.
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Affiliation(s)
- Marco Ceraudo
- Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Policlinico San Martino-IRCCS Hospital, Genoa, Italy.
| | - Alberto Balestrino
- Division of Neurosurgery, Department of Neurosciences, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Policlinico San Martino-IRCCS Hospital, Genoa, Italy
| | - Armando Cama
- Division of Neurosurgery, Department of Neurosciences, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Gianni Macrina
- Health Management Service, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Gianluca Piatelli
- Division of Neurosurgery, Department of Neurosciences, Giannina Gaslini Children's Hospital, Genoa, Italy
| | - Alessandro Consales
- Division of Neurosurgery, Department of Neurosciences, Giannina Gaslini Children's Hospital, Genoa, Italy
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