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Kaiser R, Svoboda N, Waldauf P, Netuka D. The economic and psychological impact of cancellations of elective spinal surgeries in the COVID-19 era. Br J Neurosurg 2024; 38:322-326. [PMID: 33459075 DOI: 10.1080/02688697.2020.1868404] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The adoption of health care restrictions due to the COVID-19 pandemic led to the cancellation of elective surgical care. However, the impact on patients is unknown. OBJECTIVE To evaluate the psychological and economic impact of the cancellation of scheduled spinal operations. METHODS We identified 50 patients with cancelled surgeries between 16 March 2020 and 24 April 2020. Forty-nine (98%) participants were contacted, with whom the modified WES-Pi questionnaire was filled in during a telephone interview. RESULTS Of the 49 respondents, 28 (57.2%) were aged <65 years. The most often reported problem (85.7%) was an ongoing limitation in basic daily activities. At least moderate sadness was experienced by 65.3% and disappointment by 73.5% of the patients. More than 80% reported concerns about the continuation and 73.5% about the progression of their symptoms. Out of 27 employees (55.1%), 63% could not work due to severe pain or movement limitation (p < .001). The inability to work was associated with anger (p = .037). The work-related impact of the cancellation was associated with stress (p < .0001) and concerns about continuing the symptoms (p = .004). Two-third of patients would undergo immediate surgery despite the current epidemic situation. CONCLUSIONS The cancellations of elective spinal surgeries have a serious psychological impact on patients. This together with potential economic consequences is especially evident in employees unable to work due to pain or movement disability. The information is beneficial for health management. Every effort should be made to resume planned surgical treatment if the epidemiological situation allows it.
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Affiliation(s)
- Radek Kaiser
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Norbert Svoboda
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
| | - Petr Waldauf
- Department of Anesthesiology and Critical Care Medicine, Third Faculty of Medicine, Charles University and Hospital Kralovske Vinohrady, Prague, Czech Republic
| | - David Netuka
- Department of Neurosurgery and Neurooncology, First Faculty of Medicine, Charles University and Military University Hospital Prague, Prague, Czech Republic
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2
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Yang MMH, Riva-Cambrin J, Cunningham J, Casha S. Validation of the Calgary Postoperative Pain after Spine Surgery Score for Poor Postoperative Pain Control after Spine Surgery. Can J Neurol Sci 2023; 50:687-693. [PMID: 36278829 DOI: 10.1017/cjn.2022.305] [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] [Indexed: 11/07/2022]
Abstract
OBJECTIVE The Calgary Postoperative Pain after Spine Surgery (CAPPS) score was developed to identify patients at risk of experiencing poorly controlled pain after spine surgery. The goal of this study was to independently validate the CAPPS score on a prospectively collected patient sample. METHODS Poor postoperative pain control was defined as a mean numeric rating scale (NRS) for pain >4 at rest in the first 24 hours after surgery. Baseline characteristics in this study (validation cohort) were compared to those of the development cohort used to create the CAPPS score. Predictive performance of the CAPPS score was assessed by the area under the curve (AUC) and percentage misclassification for discrimination. A graphical comparison between predicted probability vs. observed incidence of poorly controlled pain was performed for calibration. RESULTS Fifty-two percent of 201 patients experienced poorly controlled pain. The validation cohort exhibited lower depression scores and a higher proportion using daily opioid medications compared to the development cohort. The AUC was 0.74 [95%CI = 0.68-0.81] in the validation cohort compared to 0.73 [95%CI = 0.69-0.76] in the development cohort for the eight-tier CAPPS score. When stratified between the low- vs. extreme-risk and low- vs. high-risk groups, the percentage misclassification was 21.2% and 30.7% in the validation cohort, compared to 29.9% and 38.0% in the development cohort, respectively. The predicted probability closely mirrored the observed incidence of poor pain control across all scores. CONCLUSIONS The CAPPS score, based on seven easily obtained and reliable prognostic variables, was validated using a prospectively collected, independent sample of patients.
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Affiliation(s)
- Michael M H Yang
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, AB, Canada
- O'Brien Institute for Public Health, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jay Riva-Cambrin
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, AB, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, AB, Canada
| | - Jonathan Cunningham
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, AB, Canada
| | - Steven Casha
- Department of Clinical Neurosciences, Section of Neurosurgery, University of Calgary, Calgary, AB, Canada
- Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada
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Ushirozako H, Suda K, Harmon SM, Komatsu M, Ota M, Shimizu T, Minami A, Takahata M, Iwasaki N, Matsuyama Y. Complications Associated with Preventive Management to Reduce the Risk of COVID-19 Spread After Surgery for Spinal Cord Injury. J Bone Joint Surg Am 2023; Publish Ahead of Print:00004623-990000000-00811. [PMID: 37216434 DOI: 10.2106/jbjs.22.00785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND Preventive management to reduce the risk of coronavirus disease-2019 (COVID-19) spread led to delays in active rehabilitation, which may have negatively impacted the outcomes of patients with traumatic spinal cord injury (SCI). Therefore, the aim of this study was to clarify the influence of preventive management on the rate of perioperative complications after surgical treatment for SCI. METHODS This single-center retrospective study examined the cases of 175 patients who had SCI surgery between 2017 and 2021. We could not continue early rehabilitation interventions starting on April 30, 2020, because of our preventive management to reduce the risk of COVID-19 spread. Using a propensity score-matched model, we adjusted for age, sex, American Spinal Injury Association impairment scale score at admission, and risk factors for perioperative complications described in previous studies. Perioperative complication rates were compared between the COVID-19 pandemic and prepandemic groups. RESULTS Of the 175 patients, 48 (the pandemic group) received preventive management. The preliminary analysis revealed significant differences between the unmatched pandemic and prepandemic groups with respect to age (75.0 versus 71.2 years, respectively; p = 0.024) and intraoperative estimated blood loss (152 versus 227 mL; p = 0.013). The pandemic group showed significant delays in visiting the rehabilitation room compared with the prepandemic group (10 versus 4 days from hospital admission; p < 0.001). There were significant differences between the pandemic and prepandemic groups with respect to the rates of pneumonia (31% versus 16%; p = 0.022), cardiopulmonary dysfunction (38% versus 18%; p = 0.007), and delirium (33% versus 13%; p = 0.003). With a propensity score-matched analysis (C-statistic = 0.90), 30 patients in the pandemic group and 60 patients in the prepandemic group were automatically selected. There were significant differences between the matched pandemic and prepandemic groups with respect to the rates of cardiopulmonary dysfunction (47% versus 23%; p = 0.024) and deep venous thrombosis (60% versus 35%; p = 0.028). CONCLUSIONS Even with early surgical intervention, late mobilization and delays in active rehabilitation during the COVID-19 pandemic increased perioperative complications after SCI surgery. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Hiroki Ushirozako
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
| | - Kota Suda
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Satoko Matsumoto Harmon
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Miki Komatsu
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Masahiro Ota
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Tomoaki Shimizu
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Akio Minami
- Department of Orthopaedic Surgery, Hokkaido Spinal Cord Injury Center, Bibai, Hokkaido, Japan
| | - Masahiko Takahata
- Department of Orthopaedic Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Norimasa Iwasaki
- Department of Orthopaedic Surgery, Hokkaido University Faculty of Medicine and Graduate School of Medicine, Sapporo, Hokkaido, Japan
| | - Yukihiro Matsuyama
- Department of Orthopaedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan
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Jayakumar N, Ferguson L, Nissen J, Holliman D. Surgical decompressions for cauda equina syndrome during COVID-19. Br J Neurosurg 2023; 37:231-233. [PMID: 33345629 DOI: 10.1080/02688697.2020.1861434] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND The novel coronarvirus disease (COVID-19) has had a major impact on provision of spinal neurosurgery across the world, especially in the UK, with a significant fall in operating and patient volumes, and elective clinical activities. It is unclear whether the pandemic has affected the volume of urgent spinal procedures in the UK, especially surgical decompressions for cauda equina syndrome (CES). METHODS Therefore, we conducted a retrospective analysis of theatre records and electronic operation notes at our institution to identify all procedures performed for CES before (December 2019 to February 2020) and during (March 2020 to May 2020) the COVID-19 pandemic. Statistical analyses were performed on SPSS v22 (IBM). RESULTS Forty-four patients underwent surgical decompressions during the study period. Over half (54.5%) were female and the median age was 45 years (range = 22-78 years). Three in four procedures were performed at L4-5 and L5-S1 levels (79.5%). There was no statistically significant difference in the number of decompressions performed each month [χ2(5)=1.818; p = 0.874]. On the other hand, the number of referrals for suspected or confirmed CES fell by 81.8% between December 2019 and April 2020. CONCLUSIONS Our results did not show any statistically significant decline in the volume of surgical decompressions performed for CES despite the considerable fall in electronic referrals for CES and degenerative spinal conditions. This suggests that patients with critical neurological symptoms continued to present and were treated appropriately despite the restrictions imposed on spinal surgeons during the pandemic.
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Affiliation(s)
- Nithish Jayakumar
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Lucie Ferguson
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Justin Nissen
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
| | - Damian Holliman
- Department of Neurosurgery, Royal Victoria Infirmary, Newcastle upon Tyne, UK
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Idrizi A, Gordon AM, Lam A, Conway C, Saleh A. The Effect of the Coronavirus Disease 2019 (COVID-19) Pandemic on Elective Cervical Spine Surgery Utilization and Complications in the United States: A Nationwide Temporal Trends Analysis. World Neurosurg 2023; 170:e1-e8. [PMID: 35917922 PMCID: PMC9338825 DOI: 10.1016/j.wneu.2022.07.095] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 07/19/2022] [Accepted: 07/20/2022] [Indexed: 12/25/2022]
Abstract
OBJECTIVES As a result of the coronavirus disease 2019 (COVID-19) pandemic, elective surgeries nationwide were suspended. The objective was to compare temporal trends in patient demographics, case volumes, and postoperative complications of patients undergoing elective cervical spine surgery from pre-COVID-19 (2019-2020 Q1) to post-COVID-19 (2020 Q2-Q4). METHODS The 2019 to 2020 American College of Surgeon's National Surgery Quality Improvement Program database was queried for common elective cervical spine surgeries. Patients pre-COVID-19 (2019-2020 Q1) were compared with those undergoing surgery during post-COVID-19 (2020 Q2-Q4) protocols. Procedural use, patient demographics, and complications were compared. Linear regression was used to evaluate case volume changes over time. P values less than 0.05 were significant. RESULTS In total, 31,013 patients underwent elective cervical spine surgery in 2019 (N = 16,316) and 2020 (N = 14,697); an overall 10% decline. Compared with the calendar year 2019 through 2020 Q1 mean, elective surgery volume decreased by 21.6% in 2020 Q2 and never returned to prepandemic baseline. The percentage decline in case volume from 2019 to 2020 Q1 to 2020 Q2 was greatest for anterior cervical discectomy and fusion (23.3%), followed by cervical decompression (23.4%), posterior cervical fusion (15.0%), and cervical disc arthroplasty and vertebral corpectomy (13.7%). Patients undergoing surgery in 2020 Q2-Q4 had overall greater comorbidity burden (American Society of Anesthesiologists grade 3 and 4) (P < 0.001). From 2019-2020 Q1 versus 2020 Q2-Q4, there was a significant increase in total complication (5.5% vs. 6.8%, P < 0.001), reoperation (1.9% vs. 2.2%, P = 0.048), and mortality (0.25% vs. 0.37%, P = 0.049) rates. CONCLUSIONS Elective surgery declined drastically during the second quarter of 2020. Patients undergoing surgery during the pandemic had an overall greater comorbidity burden, resulting in increased total complication and mortality rates over the study period.
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Affiliation(s)
- Adem Idrizi
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA; SUNY Downstate Health Sciences University, College of Medicine, Brooklyn, New York, USA
| | - Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA.
| | - Aaron Lam
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Charles Conway
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
| | - Ahmed Saleh
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York, USA
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Schappacher R, Rapp M, Muth CM, Amrehn L, Schön M, Liener U, Bökeler U, Sander S, Dinse-Lambracht A, Fillies T. [Impact of the COVID-19 crisis in Spring 2020 on trauma case numbers of an academic teaching hospital in Stuttgart : Trauma during a pandemic]. UNFALLCHIRURGIE (HEIDELBERG, GERMANY) 2022; 125:959-966. [PMID: 34677623 PMCID: PMC8532415 DOI: 10.1007/s00113-021-01093-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 09/20/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND To cope with the COVID-19 outbreak in Germany, the government imposed a lockdown, which led to restrictions and lifestyle changes for the population. PURPOSE This study aimed to evaluate the impact of the lockdown on activities causing trauma and the consultation in emergency rooms. MATERIAL AND METHODS All consecutive trauma patients consulting the Emergency Department of the Marienhospital Stuttgart (MHS), Germany, during the 6 weeks preceding the lockdown, during and after the lockdown were included. The time and type of consultation, treatment received, Manchester triage score, type of trauma, the anatomical region of the injury as well as demographic data were reported and compared. RESULTS The study included 551 cases during lockdown, 943 cases before and 783 cases after the lockdown. We observed a reduced caseload during the lockdown of 41.6% compared to before and of 29.7% compared to after (p < 0.001). Patients were on average older in the observation group than in both control groups (before : 51.5 years, lockdown: 56.1 years, after: 51.6 years) (p < 0.001). Injuries to the head and neck were constant (25.0%, 25.4%, 25.5%). We noticed lower limb injuries decreasing (26.1%, 22.3%, 22.7%) and upper limb injuries increasing (25.5%, 31.8%, 30.1%). A decrease in sports injuries (11.1%, 5.1%, 9.1%) and work accidents (16.1%, 10.7%, 12.8%) resulted in more domestic accidents (30.4%, 52.5%, 31.8%). Self-referral decreased (67.7%, 53.2%, 60.3%) while referral via paramedics increased (28.3%, 38.7%, 35.6). Blunt trauma was the most common cause of injury (55.6%, 61.0%, 55.3%). Indications for surgery were higher (16.8%, 21.6%, 14.0%). CONCLUSION The lockdown and restrictions in personal life and daily routine had an impact on the frequency, etiology and management of trauma patients in Stuttgart.
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Affiliation(s)
- Robert Schappacher
- Klinik für Mund-Kiefer-Gesichtschirurgie, Marienhospital Stuttgart, Böheimstraße 37, 70199, Stuttgart, Deutschland.
- Klinik für Orthopädie und Unfallchirurgie, Marienhospital Stuttgart, Böheimstraße 37, 70199, Stuttgart, Deutschland.
- Klinik für Anaesthesiologie, Abteilung Notfallmedizin, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland.
| | - Matthias Rapp
- Klinik für Orthopädie und Unfallchirurgie, Marienhospital Stuttgart, Böheimstraße 37, 70199, Stuttgart, Deutschland
| | - Claus-Martin Muth
- Klinik für Anaesthesiologie, Abteilung Notfallmedizin, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland
| | - Lance Amrehn
- Klinik für Mund-Kiefer-Gesichtschirurgie, Marienhospital Stuttgart, Böheimstraße 37, 70199, Stuttgart, Deutschland
| | - Michael Schön
- Institut für Anatomie und Zellbiologie, Universität Ulm, Albert-Einstein-Allee 11, 89081, Ulm, Deutschland
| | - Ulrich Liener
- Klinik für Orthopädie und Unfallchirurgie, Marienhospital Stuttgart, Böheimstraße 37, 70199, Stuttgart, Deutschland
| | - Ulf Bökeler
- Klinik für Orthopädie und Unfallchirurgie, Marienhospital Stuttgart, Böheimstraße 37, 70199, Stuttgart, Deutschland
| | - Silvia Sander
- Institut für Epidemiologie und Medizinische Biometrie, Universität Ulm, Ulm, Deutschland
| | - Alexander Dinse-Lambracht
- Klinik für Anaesthesiologie, Abteilung Notfallmedizin, Universitätsklinikum Ulm, Prittwitzstraße 43, 89075, Ulm, Deutschland
| | - Thomas Fillies
- Klinik für Mund-Kiefer-Gesichtschirurgie, Marienhospital Stuttgart, Böheimstraße 37, 70199, Stuttgart, Deutschland
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Crawford Z, Elson NC, Kanhere A, Thomson C, Sabbagh R, Nasser R, Guanciale AF. Management and Scheduling of Spine Surgery in a Level 1 Trauma Center in the Setting of the COVID-19 Pandemic: Feasibility and Considerations for Reimplementation of Elective Spine Surgery. Geriatr Orthop Surg Rehabil 2022; 13:21514593221126020. [PMID: 36124097 PMCID: PMC9478636 DOI: 10.1177/21514593221126020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Introduction Determination of what constitutes necessary surgery in the setting of acute
hospital resource strain during the COVID-19 pandemic is an unprecedented
challenge for healthcare systems. Over the past two years during the
COVID-19 pandemic, there have been many changes in reviews of medically
necessary spine surgery. There continues to be no clear guidelines on
recommendations and further discussion is necessary to continue to provide
appropriate and high-level care during future pandemics. Significance This review critically appraises and evaluates current barriers to medically
necessary spine surgery during the COVID-19 pandemic and evaluates future
decision making to maintain spine surgery during future pandemics or
limitations in medical care. Results Multiple studies included in this review have shown that while various
orthopaedic surgeries may be considered elective, medically necessary spine
surgery will need to continue during settings of limited medical care. This
review discussed multiple methods and recommendations to limit transmission
of virus from patients to providers and providers to patients. Conclusion Continued medically necessary spine surgery in the setting of the COVID-19
pandemic and future pandemics should continue while limiting risk of
transmission to continue providing high-level medical care and allowing
hospitals to maintain financial responsibility.
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Affiliation(s)
- Zachary Crawford
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Nora C Elson
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Arun Kanhere
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Cameron Thomson
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Ramsey Sabbagh
- College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Rani Nasser
- Department of Neurosurgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
| | - Anthony F Guanciale
- Department of Orthopaedic Surgery, College of Medicine, University of Cincinnati, Cincinnati, OH, USA
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Tanaka M, Kanayama M, Hashimoto T, Oha F, Shimamura Y, Tsujimoto T, Hasegawa Y, Nojiri H, Ishijima M. Trends of Spine Surgeries during the First COVID-19 Semi-Lockdown: Survey in a Non-Epidemic Region in Japan. Spine Surg Relat Res 2022; 6:109-114. [PMID: 35478977 PMCID: PMC8995125 DOI: 10.22603/ssrr.2021-0208] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 12/06/2021] [Indexed: 12/30/2022] Open
Abstract
Introduction Methods Results Conclusions
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Affiliation(s)
| | | | | | | | | | | | | | - Hidetoshi Nojiri
- Department of Orthopaedic Surgery, Juntendo University Graduate School of Medicine
| | - Muneaki Ishijima
- Department of Orthopaedic Surgery, Juntendo University Graduate School of Medicine
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9
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Arnold PM, Owens L, Heary RF, Webb AG, Whiting MD, Vaccaro AR, Iyer RK, Harrop JS. Lumbar Spine Surgery and What We Lost in the Era of the Coronavirus Pandemic: A Survey of the Lumbar Spine Research Society. Clin Spine Surg 2021; 34:E575-E579. [PMID: 34561353 PMCID: PMC8628851 DOI: 10.1097/bsd.0000000000001235] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2020] [Accepted: 04/14/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a survey of the surgeon members of the Lumbar Spine Research Society (LSRS). OBJECTIVE The purpose of this study was to assess trends in surgical practice and patient management involving elective and emergency surgery in the early months of the coronavirus pandemic. SUMMARY OF BACKGROUND DATA The novel coronavirus has radically disrupted medical care in the first half of 2020. Little data exists regarding the exact nature of its effect on spine care. METHODS A 53-question survey was sent to the surgeon members of the LSRS. Respondents were contacted via email 3 times over a 2-week period in late April. Questions concentrated on surgical and clinical practice patterns before and after the pandemic. Other data included elective surgical schedules and volumes, as well as which emergency cases were being performed. Surgeons were asked about the status of coronavirus disease 2019 (COVID-19) virus testing. Circumstances for performing surgical intervention on patients with and without testing as well as patients testing positive were explored. RESULTS A total of 43 completed surveys were returned of 174 sent to active surgeons in the LSRS (25%). Elective lumbar spine procedures decreased by 90% in the first 2 months of the pandemic, but emergency procedures did not change. Patients with "stable" lumbar disease had surgeries deferred indefinitely, even beyond 8 weeks if necessary. In-person outpatient visits became increasingly rare events, as telemedicine consultations accounted for 67% of all outpatient spine appointments. In total, 91% surgeons were under some type of confinement. Only 11% of surgeons tested for the coronavirus on all surgical patients. CONCLUSIONS Elective lumbar surgery was significantly decreased in the first few months of the coronavirus pandemic, and much of outpatient spine surgery was practiced via telemedicine. Despite these constraints, spine surgeons performed emergency surgery when indicated, even when the COVID-19 status of patients was unknown. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
| | - Linda Owens
- Stephens Family Clinical Research Institute, Carle Foundation Hospital, Urbana, IL
| | - Robert F. Heary
- Hackensack Meridian School of Medicine, Nutley
- Mountainside Medical Center, Montclair NJ
| | - Andrew G. Webb
- Stephens Family Clinical Research Institute, Carle Foundation Hospital, Urbana, IL
| | - Mark D. Whiting
- Stephens Family Clinical Research Institute, Carle Foundation Hospital, Urbana, IL
| | | | - Ravishankar K. Iyer
- Department of Electrical and Computer Engineering, The Grainger College of Engineering, Urbana, IL
| | - James S. Harrop
- Department of Neurosurgery, Thomas Jefferson University, Philadelphia, PA
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Abstract
The impact of the coronavirus disease (COVID-19) pandemic on healthcare services around the world has been unprecedented. Surgical specialities, in particular, had to respond rapidly and adapt to continue to meet the needs of their patients in this ever-evolving and uncertain situation. With the cancellation of elective surgery and outpatient clinics, the majority of work carried out by spinal surgeons was obliterated. It was imperative emergency spinal care continued throughout the pandemic, with the creation of guidelines to assist spinal surgeons manage patients appropriately. Alongside assisting on the frontline, spinal surgeons had to triage referrals to ensure urgent care was still provided, undertake outpatient clinics virtually and ensure educational opportunities were available for colleagues. Paediatric spinal surgery was affected by the pandemic; although the virus did not significantly impact children to the same extent, a notable consequence of the lockdown restrictions was a reduction in GP referrals into the specialist service. In the event of any future pandemics, national spinal organizations have created guidelines to assist in the prioritization and care of spinal pathologies. While a 'return to normality' is a long way off, the impact of the past year will undoubtedly change spinal surgeons and their practice forever.
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Affiliation(s)
- Sarah J Wordie
- Foundation Year Two Doctor, Royal Infirmary of Edinburgh, UK. Conflicts of interest: none declared.,Consultant Orthopaedic and Spine Surgeon, Scottish National Spine Deformity Centre, Royal Hospital for Sick Children, Edinburgh, UK. Conflicts of interest: none declared
| | - Athanasios I Tsirikos
- Foundation Year Two Doctor, Royal Infirmary of Edinburgh, UK. Conflicts of interest: none declared.,Consultant Orthopaedic and Spine Surgeon, Scottish National Spine Deformity Centre, Royal Hospital for Sick Children, Edinburgh, UK. Conflicts of interest: none declared
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11
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COVID-19: Moral and Ethical Implications for Orthopaedic Spine Surgeons. Case Rep Orthop 2021; 2021:6682705. [PMID: 34336332 PMCID: PMC8298177 DOI: 10.1155/2021/6682705] [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] [Received: 10/22/2020] [Revised: 04/26/2021] [Accepted: 06/25/2021] [Indexed: 11/18/2022] Open
Abstract
The rapid spread of COVID-19 has made a significant impact on healthcare systems worldwide, with a large influx of patients prompting the cancellation of elective surgery in order to conserve resources and prevent the risk of exposure to the novel virus. In this case report, we present a 66-year-old male patient, with a history of cerebral palsy and developmental disabilities, exhibiting an increasing loss of function over the course of 10 days amid the COVID-19 pandemic. The patient was initially refused transport to the hospital by emergency medical services and later transported per independent request from his surgeon. Upon admittance to the hospital, the patient was found to have severe spinal cord compression with myelopathic symptoms and underwent an anterior cervical discectomy and fusion. This case highlights the need for more specific guidelines regarding the evaluation of a spinal injury by EMS and the hospital system amid a national crisis.
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Sewell M, Rasul F, Vachhani K, Sedra F, Aftab S, Pushpananthan S, Bull J, Ranganathan A, Montgomery A. Does Coronavirus Disease 2019 (COVID-19) Affect Perioperative Morbidity and Mortality for Patients Requiring Emergency Instrumented Spinal Surgery? A Single-Center Cohort Study. World Neurosurg 2021; 152:e603-e609. [PMID: 34144165 PMCID: PMC8205544 DOI: 10.1016/j.wneu.2021.06.046] [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: 01/22/2021] [Revised: 06/03/2021] [Accepted: 06/04/2021] [Indexed: 12/18/2022]
Abstract
Background The coronavirus disease 2019 (COVID-19) pandemic sent shockwaves through health services worldwide. Resources were reallocated. Patients with COVID-19 still required instrumented spinal surgery for emergencies. Clinical outcomes for these patients are not known. The objective of this study was to evaluate the effects of COVID-19 on perioperative morbidity and mortality for patients undergoing emergency instrumented spinal surgery and to determine risk factors for increased morbidity/mortality. Methods This retrospective cohort study included 11 patients who were negative for COVID-19 and 8 patients who were positive for COVID-19 who underwent emergency instrumented spinal surgery in 1 hospital in the United Kingdom during the pandemic peak. Data collection was performed through case note review. Patients in both treatment groups were comparable for age, sex, body mass index (BMI), comorbidities, surgical indication, and preoperative neurologic status. Predefined perioperative outcomes were recorded within a 30-day postoperative period. Univariable analysis was used to identify risk factors for increased morbidity. Results There were no mortalities in either treatment group. Four patients positive for COVID-19 (50%) developed a complication compared with 6 (55%) in the COVID-19–negative group (P > 0.05). The commonest complication in both groups was respiratory infection. Three patients positive for COVID-19 (37.5%) required intensive care unit admission, compared with 4 (36%) in the COVID-19–negative group (P > 0.05). The average time between surgery and discharge was 19 and 10 days in COVID-19–positive and –negative groups, respectively (P = 0.02). In the COVID-19 positive group, smoking, abnormal BMI, preoperative oxygen requirement, presence of fever, and oxygen saturations <95% correlated with increased risk of complications. Conclusions Emergency instrumented spinal surgery in patients positive for COVID-19 was associated with increased length of hospital stay. There was no difference in occurrence of complications or intensive care unit admission. Risk factors for increased morbidity in patients with COVID-19 included smoking, abnormal BMI, preoperative oxygen requirement, fever and saturations <95%.
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Affiliation(s)
- Mathew Sewell
- Department of Spinal Surgery, Royal London Hospital, London, United Kingdom.
| | - Fahid Rasul
- Department of Spinal Surgery, Royal London Hospital, London, United Kingdom
| | | | - Fady Sedra
- Department of Spinal Surgery, Royal London Hospital, London, United Kingdom
| | - Syed Aftab
- Department of Spinal Surgery, Royal London Hospital, London, United Kingdom
| | | | - Jonathan Bull
- Department of Spinal Surgery, Royal London Hospital, London, United Kingdom
| | - Arun Ranganathan
- Department of Spinal Surgery, Royal London Hospital, London, United Kingdom
| | - Alex Montgomery
- Department of Spinal Surgery, Royal London Hospital, London, United Kingdom
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BALESTRINO ALBERTO, ANANIA PASQUALE, CERAUDO MARCO, TRUFFELLI MONICA, SBAFFI PIERFILIPPO, MELLONI ILARIA, GRATAROLA ANGELO, ZONA GIANLUIGI, FIASCHI PIETRO. [Not Available]. JOURNAL OF PREVENTIVE MEDICINE AND HYGIENE 2021; 62:E46-E49. [PMID: 34622083 PMCID: PMC8452282 DOI: 10.15167/2421-4248/jpmh2021.62.1s3.1913] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/10/2020] [Accepted: 03/15/2021] [Indexed: 12/02/2022]
Abstract
Introduction During the COVID-19 pandemic emergency, all non-urgent surgical procedures including elective spine surgery were performed. Now many countries have passed over the epidemic peak and the time to organize re-opening of non-essential activities has come. After the emergency phase of the COVID-19 pandemic, the viral outbreak is supposed to reduce but will not reasonably disappear until a vaccine is available. Resuming elective spine surgery while ensuring safety for patients and healthcare workers has become an issue of critical importance. We propose a simple algorithm with the aim to help worldwide spine surgeons in management of elective spine surgery cases after the COVID-19 emergency ensuring safety for patients and healthcare workers. Methods An expert panel composed by Spine Surgeons, Neurosurgeons, Anesthesiologists and Intensivists with direct experience in COVID-19 management developed an algorithm for management of elective spine surgery based on evidence-based indications. The algorithm has been used for management of hospital admissions of undelayable spine surgery cases during the COVID-19 emergency period. Data regarding COVID-19 nosocomial transmission on patients and healthcare workers have been retrospectively reviewed and reported. Results Hospital admissions of 159 patients have been managed according to the proposed algorithm. Since the application of the protocol, we have not reported COVID-19 nosocomial transmission in our department. Conclusions According to our preliminary results, we think that the proposed algorithm may successfully help management of spinal elective surgical patients in the post-COVID-19 emergency era, avoiding unnecessary risks for patients and healthcare workers.
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Affiliation(s)
- ALBERTO BALESTRINO
- Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Correspondence: Alberto Balestrino, Division of Neurosurgery, Department of Neuroscience, Ospedale Policlinico San Martino-IST, University of Genoa, largo Rosanna Benzi 10, 16132 Genoa, Italy - Tel.: +393405836354 - E-mail:
| | - PASQUALE ANANIA
- Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - MARCO CERAUDO
- Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - MONICA TRUFFELLI
- Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - PIER FILIPPO SBAFFI
- Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - ILARIA MELLONI
- Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
| | - ANGELO GRATAROLA
- Division of Anesthesia and Intensive Care, San Martino Policlinic Hospital, IRCCS for Oncology, Genoa, Italy
| | - GIANLUIGI ZONA
- Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze materno infantili (DINOGMI), IRCCS Ospedale Policlinico San Martino, Università di Genova, Genoa, Italy
| | - PIETRO FIASCHI
- Division of Neurosurgery, Department of Neurosciences (DINOGMI), IRCCS Ospedale Policlinico San Martino, Genoa, Italy
- Dipartimento di Neuroscienze, Riabilitazione, Oftalmologia, Genetica e Scienze materno infantili (DINOGMI), IRCCS Ospedale Policlinico San Martino, Università di Genova, Genoa, Italy
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14
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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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15
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Ramey WL, Hurlbert RJ. COVID Contingencies: Resource Rationing on a Global Scale. World Neurosurg 2021; 145:368-369. [PMID: 32992059 PMCID: PMC7521349 DOI: 10.1016/j.wneu.2020.08.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 08/12/2020] [Indexed: 11/20/2022]
Affiliation(s)
- Wyatt L Ramey
- Department of Neurosurgery, Banner University of Arizona Medical Center, Tucson, Arizona, USA
| | - R John Hurlbert
- Department of Neurosurgery, Banner University of Arizona Medical Center, Tucson, Arizona, USA.
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16
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Wang VTJ, Odani T, Ito M. Considerations and Strategies for Restarting Elective Spine Surgery in the Midst of a Pandemic of COVID-19. Spine Surg Relat Res 2020; 5:52-60. [PMID: 33842710 PMCID: PMC8026206 DOI: 10.22603/ssrr.2020-0154] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 09/01/2020] [Indexed: 02/06/2023] Open
Abstract
The 2019 coronavirus disease (COVID-19) pandemic outbreak has rapidly spread to the globe, causing severe global socioeconomic disruption on an unprecedented scale. As the first wave of COVID-19 pandemic is now going to settle down, many medical organizations are in the process of reopening surgical services. This paper describes a few key factors that spine surgeons should consider prior to resuming elective spine services namely, local outbreak situations, availability of hospital resources, manpower and personal protective equipment (PPE). Spine surgeons should prioritize their operating list based on clinical indications and likely benefits from surgical intervention so as to make optimum use of hospital resources and operating room listings. International organizations have published on general principles and recommendations on how to restart elective surgery. However, with different regions at varying phases of the outbreak and unpredictable nature of the COVID-19 pandemic, a general set of practice guidelines may not be applicable. This paper also proposes, on top of peri-operative precautionary measures already in place, clearly-defined risk stratification algorithms for hospital visitors, as well as a disease-testing protocol for patients planned for elective surgery. It is of critical importance for surgeons to define key areas of concern and assimilate these principles into clearly-defined algorithms which can be applied to the field of spine surgery so as to help re-establish continuity of care for patients.
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Affiliation(s)
- Victor Tzong-Jing Wang
- Department of Orthopaedic Surgery, the National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Toshio Odani
- Department of Rheumatology, the National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Manabu Ito
- Department of Orthopaedic Surgery, the National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
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Dash C, Venkataram T, Goyal N, Chaturvedi J, Raheja A, Singla R, Sardhara J, Gupta R. Neurosurgery training in India during the COVID-19 pandemic: straight from the horse's mouth. Neurosurg Focus 2020; 49:E16. [PMID: 33260120 DOI: 10.3171/2020.9.focus20537] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Accepted: 09/24/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The COVID-19 pandemic has forced medical professionals throughout the world to adapt to the changing medical scenario. The objective of this survey was to assess the change in neurosurgical training in India following the COVID-19 pandemic. METHODS Between May 7, 2020, and May 16, 2020, a validated questionnaire was circulated among neurosurgical residents across India by social media, regarding changes in the department's functioning, patient interaction, surgical exposure, changes in academics, and fears and apprehensions associated with the pandemic. The responses were kept anonymous and were analyzed for changes during the COVID-19 pandemic compared to before the pandemic. RESULTS A total of 118 residents from 29 neurosurgical training programs across 17 states/union territories of the country gave their responses to the survey questionnaire. The survey revealed that the surgical exposure of neurosurgical residents has drastically reduced since the onset of the COVID-19 pandemic, from an average of 39.86 surgeries performed/assisted per month (median 30) to 12.31 per month (median 10), representing a decrease of 67.50%. The number of academic sessions has fallen from a median of 5 per week to 2 per week. The survey uncovered the lack of universal guidelines and homogeneity regarding preoperative COVID-19 testing. The survey also reveals reluctance toward detailed patient examinations since the COVID-19 outbreak. The majority of respondents felt that the COVID-19 pandemic will hamper their operative and clinical skills. Fear of rescheduling or deferring of licensing examinations was significantly higher among those closest to the examination (p = 0.002). CONCLUSIONS The adverse impact of the pandemic on neurosurgical training needs to be addressed. While ensuring the safety of the residents, institutes and neurosurgical societies/bodies must take it upon themselves to ensure that their residents continue to learn and develop neurosurgical skills during these difficult times.
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Affiliation(s)
- Chinmaya Dash
- 1Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneshwar, Orissa
| | - Tejas Venkataram
- 2Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
| | - Nishant Goyal
- 2Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
| | - Jitender Chaturvedi
- 2Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand
| | - Amol Raheja
- 3Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi
| | - Raghav Singla
- 4Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh
| | - Jayesh Sardhara
- 5Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow; and
| | - Ravi Gupta
- 6Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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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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19
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Nolte MT, Harada GK, Louie PK, McCarthy MH, Sayari AJ, Mallow GM, Siyaji Z, Germscheid N, Cheung JPY, Neva MH, El‐Sharkawi M, Valacco M, Sciubba DM, Chutkan NB, An HS, Samartzis D. COVID-19: Current and future challenges in spine care and education - a worldwide study. JOR Spine 2020; 3:e1122. [PMID: 33392457 PMCID: PMC7770197 DOI: 10.1002/jsp2.1122] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2020] [Revised: 07/31/2020] [Accepted: 08/14/2020] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has impacted spine care around the globe. Much uncertainty remains regarding the immediate and long-term future of spine care and education in this COVID-19 era. STUDY DESIGN Cross-sectional, international study of spine surgeons. METHODS A multi-dimensional survey was distributed to spine surgeons around the world. A total of 73 questions were asked regarding demographics, COVID-19 observations, personal impact, effect on education, adoption of telemedicine, and anticipated challenges moving forward. Multivariate analysis was performed to assess factors related to likelihood of future conference attendance, future online education, and changes in surgical indications. RESULTS A total of 902 spine surgeons from seven global regions completed the survey. Respondents reported a mean level of overall concern of 3.7 on a scale of one to five. 84.0% reported a decrease in clinical duties, and 67.0% reported a loss in personal income. The 82.5% reported being interested in continuing a high level of online education moving forward. Respondents who personally knew someone who tested positive for COVID-19 were more likely to be unwilling to attend a medical conference 1 year from now (OR: 0.61, 95% CI: [0.39, 0.95], P = .029). The 20.0% reported they plan to pursue an increased degree of nonoperative measures prior to surgery 1 year from now, and respondents with a spouse at home (OR: 3.55, 95% CI: [1.14, 11.08], P = .029) or who spend a large percentage of their time teaching (OR: 1.45, 95% CI: [1.02, 2.07], P = .040) were more likely to adopt this practice. CONCLUSIONS The COVID-19 pandemic has had an adverse effect on surgeon teaching, clinical volume, and personal income. In the future, surgeons with family and those personally affected by COVID-19 may be more willing to alter surgical indications and change education and conference plans. Anticipating these changes may help the spine community appropriately plan for future challenges.
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Affiliation(s)
- Michael T. Nolte
- Department of Orthopaedic SurgeryRush University Medical CenterChicagoIllinoisUSA
- The International Spine Research and Innovation InitiativeRUSH University Medical CenterChicagoUSA
| | - Garrett K. Harada
- Department of Orthopaedic SurgeryRush University Medical CenterChicagoIllinoisUSA
- The International Spine Research and Innovation InitiativeRUSH University Medical CenterChicagoUSA
| | - Philip K. Louie
- Department of Orthopaedic SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Michael H. McCarthy
- Department of Orthopaedic SurgeryHospital for Special SurgeryNew YorkNew YorkUSA
| | - Arash J. Sayari
- Department of Orthopaedic SurgeryRush University Medical CenterChicagoIllinoisUSA
- The International Spine Research and Innovation InitiativeRUSH University Medical CenterChicagoUSA
| | - G. Michael Mallow
- Department of Orthopaedic SurgeryRush University Medical CenterChicagoIllinoisUSA
- The International Spine Research and Innovation InitiativeRUSH University Medical CenterChicagoUSA
| | - Zakariah Siyaji
- Department of Orthopaedic SurgeryRush University Medical CenterChicagoIllinoisUSA
- The International Spine Research and Innovation InitiativeRUSH University Medical CenterChicagoUSA
| | | | - Jason PY Cheung
- Department of Orthopaedics and TraumatologyThe University of Hong KongHong Kong
| | - Marko H. Neva
- Department of Orthopaedic and Trauma SurgeryTampere University HospitalTampereFinland
| | - Mohammad El‐Sharkawi
- Department of Orthopaedic and Trauma SurgeryAssiut University Medical SchoolAssiutEgypt
| | - Marcelo Valacco
- Department of OrthopaedicsChurruca Hospital de Buenos AiresBuenos AiresArgentina
| | - Daniel M. Sciubba
- Department of NeurosurgeryJohn Hopkins UniversityBaltimoreMarylandUSA
| | - Norman B. Chutkan
- Department of Orthopaedic SurgeryUniversity of Arizona College of MedicinePhoenixArizonaUSA
| | - Howard S. An
- Department of Orthopaedic SurgeryRush University Medical CenterChicagoIllinoisUSA
- The International Spine Research and Innovation InitiativeRUSH University Medical CenterChicagoUSA
| | - Dino Samartzis
- Department of Orthopaedic SurgeryRush University Medical CenterChicagoIllinoisUSA
- The International Spine Research and Innovation InitiativeRUSH University Medical CenterChicagoUSA
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21
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Spine surgery in Atlantic Canada in the COVID-19 era: lessons learned so far. Spine J 2020; 20:1379-1380. [PMID: 32389734 PMCID: PMC7204752 DOI: 10.1016/j.spinee.2020.04.027] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 04/28/2020] [Accepted: 04/28/2020] [Indexed: 02/03/2023]
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Khattab MF, Abou-Madawi AM. Current effect of COVID-19 global pandemic on the professional and life profiles of the Egyptian spine surgeons. SICOT J 2020; 6:31. [PMID: 32819456 PMCID: PMC7441017 DOI: 10.1051/sicotj/2020029] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/09/2020] [Accepted: 07/30/2020] [Indexed: 11/14/2022] Open
Abstract
Introduction: During the recent decade, many outbreaks of infectious diseases have been reported at increasing scales and frequency. The novel COVID-19 is the most recent lethal virus and has been declared to be a pandemic disease on March 11th, 2020. It has spread from China to most of the countries around the world causing a great burden on individuals and communities. The socioeconomic and professional profiles have been affected seriously by this pandemic. The aim of this study was to assess the short-term effects of COVID-19 on the socioeconomic profile of spinal surgeons in Egypt. Methods: We conducted a cross-sectional online survey study to address the effect of COVID-19 global pandemic on spine surgeons in Egypt, discussing the short-term socioeconomic effect of COVID-19 global pandemic on the professional and social profiles of the Egyptian spine surgeons. A SurveyMonkey® questionnaire was sent to 190 spine surgeons registered in the Egyptian spine association database. Results: Ninety male surgeons responded to our four-day survey. The responders included the following: 4 residents, 16 fellows, and 70 consultants working in different Egyptian hospitals. The partial country lockdown was associated with drop in monthly income and in number of both elective and emergency operations. Most surgeons either stopped surgery or limited the number of either elective or emergency surgeries as well as outpatient clinics. Most of them were not in the COVID-19 team or did not receive any training, working under immense physical and psychological stress of being exposed to transmission of infection. Discussion: COVID-19 global pandemic negatively affected spine surgeons in Egypt socioeconomically. The Health Authority and the community have to work jointly to help the health care professionals in overcoming this crisis.
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Collateral damage caused by COVID-19: Change in volume and spectrum of neurosurgery patients. J Clin Neurosci 2020; 80:156-161. [PMID: 33099339 PMCID: PMC7438073 DOI: 10.1016/j.jocn.2020.07.055] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 07/19/2020] [Indexed: 01/13/2023]
Abstract
BACKGROUND There has been a dramatic change in the pattern of patients being seen in hospitals and surgeries performed during the ongoing COVID-19 pandemic. The objective of this study is to study the change in the volume and spectrum of surgeries performed during the ongoing COVID-19 pandemic compared to pre-COVID-19 era. METHODS Details of all patients who were operated under department of neurosurgery at our institute since the onset of COVID-19 pandemic in India were collected and compared to the same time period last year. The demographic profile, diagnosis, surgery performed, type of surgery (routine/emergency, cranial/spinal and major/minor) in these two groups were compared. They were further categorized into various categories [neuro-oncology (brain and spine tumors), neuro-trauma (head injury and spinal trauma), congenital cases, degenerative spine, neuro-vascular, CSF diversion procedures, etc.] and compared between the two groups. RESULTS Our study showed a drastic fall (52.2%) in the number of surgeries performed during the pandemic compared to pre-COVID era. 11.3% of patients operated during COVID-19 pandemic were non-emergent surgeries compared to 57.7% earlier (p = 0.000). There was increase in proportion of minor cases from 28.8% to 41.5% (p = 0.106). The proportion of spinal cases decreased from 27.9% to 11.3% during the COVID-19 pandemic (p = 0.043). CONCLUSIONS The drastic decrease in the number of surgeries performed will result in large backlog of patients waiting for 'elective' surgery. There is a risk of these patients presenting at a later stage with progressed disease and the best way forward would be to resume work with necessary precautions and universal effective COVID-19 testing.
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Sivakanthan S, Pan J, Kim L, Ellenbogen R, Saigal R. Economic Impact of COVID-19 on a High-Volume Academic Neurosurgical Practice. World Neurosurg 2020; 143:e561-e566. [PMID: 32791222 PMCID: PMC7416742 DOI: 10.1016/j.wneu.2020.08.028] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 08/03/2020] [Indexed: 11/10/2022]
Abstract
Background Coronavirus disease-2019 (COVID-19) is a novel disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) that rapidly spread around the globe. The dramatic increase in the number of cases and deaths have placed tremendous strain on health care systems worldwide. As health care workers and society adjust to focus treatment and prevention of COVID-19, other facets of the health care enterprise are affected, particularly surgical volume and revenue. The purpose of this study was to describe the financial impact of COVID-19 on an academic neurosurgery department. Methods A retrospective review of weekly average daily work relative value units (wRVUs) were compared before and after COVID-19 in the fiscal year 2020. A comparative time period of the same months in the year prior was also included for review. We also review strategies for triaging neurosurgical disease as needing emergent, urgent, or routine operative treatment. Results Daily average wRVU after COVID-19 dropped significantly with losses in all weeks examined. Of the 7 weeks in the current post-COVID period, the weekly daily average wRVU was 173 (range, 128–363). The mean decline was 51.4% compared with the pre-COVID era. Both inpatient and outpatient revenue was affected. Conclusions COVID-19 had a profound detrimental effect on surgical productivity and revenue generation.
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Affiliation(s)
- Sananthan Sivakanthan
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA.
| | - James Pan
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Louis Kim
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Richard Ellenbogen
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
| | - Rajiv Saigal
- Department of Neurological Surgery, University of Washington, Seattle, Washington, USA
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Viswanathan VK, Subramanian S, Rao AK. Principles for Managing Patients with Spinal Ailments in the Coronavirus Disease 2019 Era: What Do We Know So Far? An Evidence-Based, Narrative Review. Asian Spine J 2020; 14:572-580. [PMID: 32493004 PMCID: PMC7435302 DOI: 10.31616/asj.2020.0248] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 05/21/2020] [Indexed: 01/08/2023] Open
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has significantly affected all specialty practices in medicine, including the field of spinal surgery. Spinal surgery is unique in that the procedures include not only fully elective and fully emergent interventions, but also involve a separate group of semi-emergent surgeries, where delayed intervention may lead to permanent neurological deficits. Here, we present an evidence-based review on the impact of the COVID-19 pandemic on spinal surgery and our current knowledge about this issue. We conducted a thorough search of the PubMed, Medline, and Google Scholar databases using the keywords, "COVID-19," "COVID-19 impact on spine surgery," "coronavirus impact on spine surgery," "COVID-19 impact on neurosurgery," "coronavirus impact on neurosurgery," "COVID-19 impact on spine surgeons," and "coronavirus impact on spine surgeons" on May 6, 2020. A total of 8,322 articles were identified in the initial search. Articles that were duplicated, those that did not pertain to COVID-19 or spine surgeries, those with details not pertaining to the current topic of interest, and those published in languages other than English were excluded from our analyses. After complete screening, six articles were included in this review. During the previous few weeks, the COVID pandemic has significantly influenced all major aspects of spine surgery across the world. Outpatient care has been gradually shifted from physical visits to tele-health and online consultations. General recommendations have favored the conservative approach over surgeries, although no patient should be deprived of standard care owing to concerns about COVID. The general principles followed by spine surgeons should include early detection of COVID symptomatology; triaging of patients based on underlying spinal pathology; prescription of appropriate investigations to confirm the COVID status; isolation, as needed; selection of optimal management method as per the guidelines; adherence to best intraoperative practices; and ensuring protective measures for non-infected patients, family members, fellow heath care providers, and themselves against the disease.
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Affiliation(s)
| | | | - Arthi K. Rao
- Division of Clinical Microbiology, Department of Laboratory Services, MIOT International, Chennai, India
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26
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Rasouli JJ, Shin JH, Than KD, Gibbs WN, Baum GR, Baaj AA. Virtual Spine: A Novel, International Teleconferencing Program Developed to Increase the Accessibility of Spine Education During the COVID-19 Pandemic. World Neurosurg 2020; 140:e367-e372. [PMID: 32474104 PMCID: PMC7255710 DOI: 10.1016/j.wneu.2020.05.191] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 05/19/2020] [Accepted: 05/20/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND The coronavirus identified in 2019 (COVID-19) pandemic effectively ended all major spine educational conferences in the first half of 2020. In response, the authors formed a "virtual" case-based conference series directed at delivering spine education to health care providers around the world. We herein share the technical logistics, early participant feedback, and future direction of this initiative. METHODS The Virtual Global Spine Conference (VGSC) was created in April 2020 by a multiinstitutional team of spinal neurosurgeons and a neuroradiologist. Biweekly virtual meetings were established wherein invited national and international spine care providers would deliver case-based presentations on spine and spine surgery-related conditions via teleconferencing. Promotion was coordinated through social media platforms such as Twitter. RESULTS VGSC recruited more than 1000 surgeons, trainees, and other specialists, with 50-100 new registrants per week thereafter. An early survey to the participants, with 168 responders, indicated that 92% viewed the content as highly valuable to their practice and 94% would continue participating post COVID-19. Participants from the United States (29%), Middle East (16%), and Europe (12%) comprised the majority of the audience. Approximately 52% were neurosurgeons, 18% orthopedic surgeons, and 6% neuroradiologists. A majority of participants were physicians (55%) and residents/fellows (21%). CONCLUSIONS The early success of the VGSC reflects a strong interest in spine education despite the COVID-19 pandemic and social distancing guidelines. There is widespread opinion, backed by our own survey results, that many clinicians and trainees want to see "virtual" education continue post COVID-19.
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Affiliation(s)
| | - John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Khoi D Than
- Department of Neurosurgery, Duke University Hospital, Durham, North Carolina, USA
| | - Wende N Gibbs
- Department of Radiology, Mayo Clinic Scottsdale, Scottsdale, Arizona, USA
| | - Griffin R Baum
- Department of Neurosurgery, Lenox Hill Hospital, New York, New York, USA
| | - Ali A Baaj
- Department of Neurological Surgery, Weill Cornell Medicine, New York, New York, USA
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27
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Venkataram T, Goyal N, Dash C, Chandra PP, Chaturvedi J, Raheja A, Singla R, Sardhara J, Singh B, Gupta R. Impact of the COVID-19 Pandemic on Neurosurgical Practice in India: Results of an Anonymized National Survey. Neurol India 2020; 68:595-602. [PMID: 32643671 DOI: 10.4103/0028-3886.289004] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Background The COVID-19 pandemic has created an unprecedented challenge for medical professionals throughout the world to tackle the rapidly changing scenario. The objective of this survey was to analyze the change in neurosurgical practice in India following the COVID-19 outbreak and assess its impact on practising neurosurgeons. Materials and Methods Between May 7th and 23rd, 2020, a validated questionnaire was circulated amongst practising neurosurgeons across the country by social media and e-mails, regarding changes in the patterns of patients seen, adaptations made in their practice, effect on surgeries performed, financial burden, and impact on their personal lives. The responses were kept anonymous and were analyzed for correlations between the changes observed and independent factors such as hospital affiliations, teaching professions, and neurosurgical experience. Results Our survey showed a drastic fall in the number of neurosurgical patients seen in the outpatient department (OPD) as well as the number of surgeries performed. A drop of 76.25% was seen in OPD patients (P = 0.000) and that of 70.59% in surgeries performed (P = 0.000). There was no uniformity among the neurosurgeons in the number of COVID-19 tests being done before elective/emergency surgery and in the use of protective gear while examining patients. Private practitioners were more affected financially as compared to those in the government sector. The pandemic has affected the research work of 53.23% of all respondents, with those in the teaching profession (70.96%) more affected than those in the non-teaching profession (24.67%). Conclusions Evidence-based policies, screening COVID-19 tests with better sensitivity, and better-quality personal protective equipment kits in adequate numbers are required to protect our medical professionals from COVID-19. Mental health issues among neurosurgeons may also be an issue, this being a high risk speciality and should be closely watched for.
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Affiliation(s)
- Tejas Venkataram
- 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
| | - Chinmaya Dash
- Department of Neurosurgery, All India Institute of Medical Sciences, Bhubaneshwar, Orissa, India
| | - Prarthana P Chandra
- Department of Neurosurgery, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Jitender Chaturvedi
- Department of Neurosurgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
| | - Amol Raheja
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Raghav Singla
- Department of Neurosurgery, Post Graduate Institute of Medical Education and Research, Chandigarh, India
| | - Jayesh Sardhara
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Bhoopendra Singh
- Department of Neurosurgery, Hamdard Institute of Medical Sciences and Research, New Delhi, India
| | - Ravi Gupta
- Department of Psychiatry, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India
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28
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Abdelnasser MK, Morsy M, Osman AE, AbdelKawi AF, Ibrahim MF, Eisa A, Fadle AA, Hatem A, Anter Abdelhameed M, Hassan AAA, Shawky Abdelgawaad A. COVID-19. An update for orthopedic surgeons. SICOT J 2020; 6:24. [PMID: 32609085 PMCID: PMC7328530 DOI: 10.1051/sicotj/2020022] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 06/13/2020] [Indexed: 12/19/2022] Open
Abstract
The COVID-19 pandemic has affected our world in a short period of time, and the orthopedic surgery practice was not an exclusion. Elective care was deferred in most health care facilities and emergency care was continued with strict precautions. With rapid progression of the pandemic, the response of the medical community is also rapidly changing in all aspects of delivering care. This led to a large number of publications with reports, guidelines, measures, ways to react to the crisis, and post-pandemic predictions and speculations. In this review we aimed at summarizing all the relevant information to the orthopedic surgery community. To do this, a comprehensive search was performed with all related terms on two scientific search engines, PubMed and SCOPUS, and the results were filtered by the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. The result was 72 articles that were further reduced to 33 articles after full text reading. The resultant information was organized under 5 main headings; the impact of pandemic on the orthopedic practice, COVID-19 and the trauma patient, elective and emergency surgeries during the pandemic, peri-operative management of the patient with COVID-19, Miscellaneous effects of the pandemic such as those on training programs and the evolution of telemedicine. This review represents the most up to date information published in the literature that is a must-know to every orthopedic surgeon.
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Affiliation(s)
| | - Mohamed Morsy
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | - Ahmed E. Osman
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | | | | | - Amr Eisa
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | - Amr A. Fadle
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | - Amr Hatem
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
| | | | | | - Ahmed Shawky Abdelgawaad
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Orthopedic Department, Assiut University Hospitals Assiut 71515 Egypt
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Spine center, Helios Klinikum Erfurt Nordhaeuser street 74 88089 Erfurt Germany
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29
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Giorgi PD, Schirò GR, Capitani D, D'Aliberti G, Gallazzi E. Vertebral compression fractures in multiple myeloma: redefining the priorities during the COVID-19 pandemic. Aging Clin Exp Res 2020; 32:1203-1206. [PMID: 32410167 PMCID: PMC7224162 DOI: 10.1007/s40520-020-01590-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Accepted: 05/02/2020] [Indexed: 11/28/2022]
Affiliation(s)
- P D Giorgi
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
| | - G R Schirò
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
| | - D Capitani
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy
| | - G D'Aliberti
- Neurosurgery Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Milan, Italy
| | - E Gallazzi
- Orthopedics and Traumatology Unit, Emergency and Urgency Department, A.S.S.T. Grande Ospedale Metropolitano Niguarda, Piazza dell'Ospedale Maggiore 3, Milan, Italy.
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30
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Khattab MF, Kannan TMA, Morsi A, Al-Sabbagh Q, Hadidi F, Al-Sabbagh MQ, M Taha M, Bourghli A, Obeid I. The short-term impact of COVID-19 pandemic on spine surgeons: a cross-sectional global study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2020; 29:1806-1812. [PMID: 32591880 PMCID: PMC7317075 DOI: 10.1007/s00586-020-06517-1] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 05/29/2020] [Accepted: 06/18/2020] [Indexed: 01/08/2023]
Abstract
Purpose The outbreak of COVID-19 erupted in December 2019 in Wuhan, China. In a few weeks, it progressed rapidly into a global pandemic which resulted in an overwhelming burden on health care systems, medical resources and staff. Spine surgeons as health care providers are no exception. In this study, we try to highlight the impact of the crisis on spine surgeons in terms of knowledge, attitude, practice and socioeconomic burden.
Methods This was global, multicentric cross-sectional study on 781 spine surgeons that utilized an Internet-based validated questionnaire to evaluate knowledge about COVID-19, availability of personal protective equipment, future perceptions, effect of this crisis on practice and psychological distress. Univariate and multivariate ordinal logistic regression analyses were used to evaluate the predictors for the degree of COVID-19 effect on practice.
Results Overall, 20.2%, 52% and 27.8% of the participants were affected minimally, intermediately and hugely by COVID-19, respectively. Older ages (β = 0.33, 95% CI 0.11–0.56), orthopedic spine surgeons (β = 0.30, 95% CI 0.01–0.61) and those who work in the private sector (β = 0.05, 95% CI 0.19–0.61) were the most affected by COVID-19. Those who work in university hospitals (β = − 0.36, 95% CI 0.00 to − 0.71) were affected the least. The availability of N95 masks (47%) and disposable eye protectors or face shields (39.4%) was significantly associated with lower psychological stress (p = 0.01). Only 6.9%, 3.7% and 5% had mild, moderate and severe mental distress, respectively.
Conclusion While it is important to recognize the short-term impact of COVID-19 pandemic on the practice of spine surgery, predicting where we will be standing in 6–12 months remains difficult and unknown. The COVID-19 crisis will probably have an unexpected long-term impact on lives and economies.
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Affiliation(s)
- Mohamed Fawzy Khattab
- Orthopedic Surgery Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Tareq M A Kannan
- Spine Unit, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Ahmed Morsi
- Orthopedic Surgery Department, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Qussay Al-Sabbagh
- Spine Unit, Jordan University Hospital, University of Jordan, Amman, Jordan
| | - Fadi Hadidi
- Spine Unit, Jordan University Hospital, University of Jordan, Amman, Jordan
| | | | - Muzahem M Taha
- Orthopaedic Surgery Department, Kirkuk University, Kirkuk, Iraq
| | - Anouar Bourghli
- Orthopedic and Spine Surgery Department, Kingdom Hospital, Riyadh, Saudi Arabia
| | - Ibrahim Obeid
- Spine Surgery Unit, Elsan Group Jean Villar Private Hospital, Bruges-Bordeaux, France.
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31
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Spinal surgery in COVID-19 pandemic era: One trauma hub center experience in central-southern Italy. J Orthop 2020; 22:291-293. [PMID: 32616990 PMCID: PMC7322226 DOI: 10.1016/j.jor.2020.06.014] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 06/14/2020] [Indexed: 11/22/2022] Open
Abstract
The aim of the study is to analyze and report the results of the surgical activity in a spinal unit of a trauma hub in central Italy during COVID-19 pandemic. Surgical activity was compared between COVID 19 pandemic and the same period of time in 2019 at our institution. A 50% reduction of surgical procedures during the last three months was observed compared with the same period of time in 2019. The compliance with the containment rules for the spread of the infection, were sufficient to allow safe surgical activity for the medical teams and patients.
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32
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Thomas JG, Gandhi S, White TG, Jocelyn C, Soo TM, Eisenberg M, Schulder M, Narayan RK. Letter: A Guide to the Prioritization of Neurosurgical Cases After the COVID-19 Pandemic. Neurosurgery 2020; 87:E411-E416. [PMID: 32504465 PMCID: PMC7313802 DOI: 10.1093/neuros/nyaa251] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Justin G Thomas
- Division of Neurosurgery Michigan State University College of Human Medicine Ascension Providence Hospital Southfield, Michigan
| | - Shashank Gandhi
- Department of Neurosurgery The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell North Shore University Hospital Manhasset, New York
| | - Timothy G White
- Department of Neurosurgery The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell North Shore University Hospital Manhasset, New York
| | - Christian Jocelyn
- Department of Neurosurgery The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell North Shore University Hospital Manhasset, New York
| | - Teck M Soo
- Division of Neurosurgery Michigan State University College of Human Medicine Ascension Providence Hospital Southfield, Michigan
| | - Mark Eisenberg
- Department of Neurosurgery The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell North Shore University Hospital Manhasset, New York
| | - Michael Schulder
- Department of Neurosurgery The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell North Shore University Hospital Manhasset, New York
| | - Raj K Narayan
- Department of Neurosurgery The Donald and Barbara Zucker School of Medicine at Hofstra/Northwell North Shore University Hospital Manhasset, New York
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33
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Wang TJV, Ito M. Spine Surgery: Precautions and Strategies to Minimize Perioperative Risks Amid COVID-19 Outbreak. Spine Surg Relat Res 2020; 4:192-198. [PMID: 32864484 PMCID: PMC7447339 DOI: 10.22603/ssrr.2020-0076] [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: 04/26/2020] [Accepted: 05/06/2020] [Indexed: 12/12/2022] Open
Abstract
Coronavirus disease 2019 (COVID-19) outbreak is an ongoing pandemic that has shocked the world. It has brought severe socioeconomic disruptions on a global scale that is unprecedented. On the frontline, the medical world is facing mounting pressure and challenges to clinical work. During this escalating worldwide crisis, spine care providers around the world are needing accurate and precise information on how surgical safety for themselves and the patients can be ensured. With the ultimate objective of formulating a standardized work process for spine practices, this article aimed to summarize some key principles from various international recommendations/consensus and combined evidence- and experience-based practice from medical communities around the world.
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Affiliation(s)
- Tzong-Jing Victor Wang
- Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
| | - Manabu Ito
- Department of Orthopaedic Surgery, National Hospital Organization Hokkaido Medical Center, Sapporo, Japan
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34
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Pichard R, Kopel L, Lejeune Q, Masmoudi R, Masmejean EH. Impact of the COronaVIrus Disease 2019 lockdown on hand and upper limb emergencies: experience of a referred university trauma hand centre in Paris, France. INTERNATIONAL ORTHOPAEDICS 2020; 44:1497-1501. [PMID: 32488564 PMCID: PMC7264483 DOI: 10.1007/s00264-020-04654-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Accepted: 05/26/2020] [Indexed: 01/08/2023]
Abstract
Purpose The lockdown imposed in France to cope with the COronaVIrus Disease 2019 (COVID-19) outbreak has led to major changes in the lifestyle of French citizens. The aim of our study was to study its impact on activity related to emergencies in hand and upper limb trauma in comparison to the same reference period in 2019. Material and methods All consecutive patients consulting for upper limb injury requiring urgent care at Georges-Pompidou European Hospital (HEGP), France, during the lockdown period (case group) and the equivalent period in 2019 (control group) were included. In each group, the type of accident, the anatomical location of the injury, and the treatment were reported and compared. Results Two hundred seventy-five patients were included in the case group in comparison to 784 patients in the control group. We observed a two-third decrease in the rate of upper limb emergencies (− 64.9%) in particular a drastic drop in the rate of road, work, and leisure accidents (10.4% vs 14.3%, p = 0.1151; 10.0% vs 22.6%, p < 0.0001; 13.1% vs 30.8%, p < 0.0001, respectively), and a clear increase in domestic accidents (66.5% vs 32.3%, p < 0.0001). The aetiologies were more dominated by lacerations of soft tissues (48.4%, vs 38.3%, p = 0.0034) and infections (8.7% vs 5.1%, p = 0.0299) with an increase in the indications for surgical management (51.2% vs 36.9%, p < 0.0001). Conversely, we observed fewer consultations for joint injuries (20.7% vs 30.7%, p = 0.0015) and fractures (22.2% vs 25.9%, p = 0.2210). Conclusion The lockdown imposed in France has changes the etiologies and the management of hand and upper limb emergencies.
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Affiliation(s)
- Rémy Pichard
- Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), 20 rue Leblanc, 75015, Paris, France. .,University of Paris, Paris, France.
| | - Luc Kopel
- Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), 20 rue Leblanc, 75015, Paris, France
| | - Quentin Lejeune
- Emergency Unit, Georges-Pompidou European Hospital (HEGP), Paris, France
| | - Rafik Masmoudi
- Emergency Unit, Georges-Pompidou European Hospital (HEGP), Paris, France
| | - Emmanuel H Masmejean
- Hand, Upper Limb and Peripheral Nerve Surgery, Georges-Pompidou European Hospital (HEGP), 20 rue Leblanc, 75015, Paris, France.,University of Paris, Paris, France.,Clinique Blomet, Research Unit, Paris, France
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