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Lin G, Xu X, Luan X, Qiu H, Shao S, Wu Q, Xu W, Huang G, He J, Feng L. A Longitudinal Research on the Distribution and Prognosis of Intracerebral Hemorrhage During the COVID-19 Pandemic. Front Neurol 2022; 13:873061. [PMID: 35518200 PMCID: PMC9062182 DOI: 10.3389/fneur.2022.873061] [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: 02/10/2022] [Accepted: 03/17/2022] [Indexed: 11/13/2022] Open
Abstract
Purpose Globally, intracerebral hemorrhage (ICH) is a common cerebrovascular disease. At the beginning of 2020, due to the coronavirus disease 2019 (COVID-19) pandemic, the allocation of medical resources and the patient treatment and referrals were affected to varying degrees. We aimed to determine the characteristics and prognoses and associated factors of patients with ICH. Patients and Methods The baseline demographic characteristics and ICH outcomes were compared between patients diagnosed with ICH between January and June 2020 (the 2020 group) and between January and June 2019 (the 2019 group). COVID-19 positive patients were excluded from the study. A 30-day data from patients in the 2019 and 2020 groups were analyzed to create survival curves for these patients. We also used regression models to identify the significant determinants of poor outcomes [modified Rankin score (mRS): 3-6] and death. Results The number of patients diagnosed with ICH was slightly lower in the 2020 group (n = 707) than in the 2019 group (n = 719). During the lockdown period (February 2020), the admission rates for ICH decreased greatly by 35.1%. The distribution of the patients' domicile (P = 0.002) and the mRS (P < 0.001) differed significantly between the years. The survival curve revealed that the highest risk of death was in the acute stage (especially in the first 5 days) of ICH. At 30 days, mortality was 19.8% in February 2019 and 29.4% in February 2020 (P = 0.119). Multivariate analysis revealed age, baseline mRS, postoperative complications, massive brainstem hemorrhage, and creatinine as factors significantly associated with poor outcomes and death following ICH. Neurosurgery and massive supratentorial hemorrhage were only correlated with the risk of death. Conclusion During the lockdown period, the COVID-19 pandemic caused a decrease in the admission rates and severe conditions at admission due to strict traffic constraints for infection control. This led to high mortality and disability in patients with ICH. It is necessary to ensure an effective green channel and allocate adequate medical resources for patients to receive timely treatment and neurosurgery.
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Affiliation(s)
- Gangqiang Lin
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xueqian Xu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Xiaoqian Luan
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Huihua Qiu
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Shengfang Shao
- Department of Emergency, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Qingsong Wu
- Medical Record Room, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Wei Xu
- Outpatient Office, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Teaching and Research Section of Epidemiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Guiqian Huang
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Jincai He
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Liang Feng
- Department of Neurology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China.,Teaching and Research Section of Epidemiology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
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Hessheimer AJ, Trapero-Bertran M, Borin A, Butori E, Curell A, Espinoza AS, Jensen J, Turrado V, Morales X, de Lacy AM, Fondevila C. Resource utilization and outcomes in emergency general surgery during the COVID19 pandemic: An observational cost analysis. PLoS One 2021; 16:e0252919. [PMID: 34143802 PMCID: PMC8213049 DOI: 10.1371/journal.pone.0252919] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 05/25/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND Over the course of the COVID19 pandemic, global healthcare delivery has declined. Surgery is one of the most resource-intensive area of medicine; loss of surgical care has had untold health and economic consequences. Herein, we evaluate resource utilization, outcomes, and healthcare costs associated with unplanned surgery admissions during the height of the pandemic in 2020 versus the same period in 2019. METHODS Retrospective analysis on patients ≥18 years admitted from the emergency department to General & Digestive and Gastrointestinal Surgery Services between February and May 2019 and 2020 at our center; clinical outcomes and unadjusted and adjusted per-person healthcare costs were analyzed. RESULTS Consults and admissions to surgery declined between February and May 2020 by 37% and 19%, respectively, relative to the same period in 2019, with even greater relative decline during late March and early April. Time between onset of symptoms to diagnosis increased from 2±3 days 2019 to 5±22 days 2020 (P = 0.01). Overall hospital stay was two days less in 2020 (P = 0.19). Complications (Comprehensive Complication Index 10.3±23.7 2019 vs. 13.9±25.5 2020, P = 0.10) and mortality rates (3% vs. 4%, respectively, P = 0.58) did not vary. Mean unadjusted per-person costs for patients in the 2019 and 2020 cohorts were 5,886.72€±12,576.33€ and 5,287.62±7,220.16€, respectively (P = 0.43). Following multivariate analysis, costs remained similar (4,656.89€±390.53€ 2019 vs. 4,938.54±406.55€ 2020, P = 0.28). CONCLUSIONS Healthcare delivery and spending for unplanned general surgery admissions declined considerably due to COVID19. These results provide a small yet relevant illustration of clinical and economic ramifications of this healthcare crisis.
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Affiliation(s)
- Amelia J. Hessheimer
- General & Digestive Surgery, Institut de Malaties Digestives i Metabòliques (ICMDM), Hospital Clínic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
| | - Marta Trapero-Bertran
- Basic Sciences Department, University Institute for Patient Care, Universitat Internacional de Catalunya Barcelona, Barcelona, Spain
| | - Alex Borin
- General & Digestive Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Eugenia Butori
- General & Digestive Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Anna Curell
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Arlena Sofía Espinoza
- General & Digestive Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Joaquín Jensen
- General & Digestive Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Víctor Turrado
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | - Xavier Morales
- Gastrointestinal Surgery, ICMDM, Hospital Clínic Barcelona, Barcelona, Spain
| | | | - Constantino Fondevila
- General & Digestive Surgery, Institut de Malaties Digestives i Metabòliques (ICMDM), Hospital Clínic Barcelona, IDIBAPS, CIBERehd, University of Barcelona, Barcelona, Spain
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