ABSTRACT
BACKGROUND: COVID-19 has had a significant impact on the economy, health care, and society as a whole. To prevent the spread of infection, local governments across the United States issued mandatory lockdowns and stay-at-home orders. In the surgical world, elective cases ceased to help "flatten the curve" and prevent the infection from spreading to hospital staff and patients. We explored the effect of the cancellation of these procedures on trainee operative experience at our high-volume, multihospital neurosurgical practice. METHODS: Our department cancelled all elective cases starting March 16, 2020, and resumed elective surgical and endovascular procedures on May 11, 2020. We retrospectively reviewed case volumes for 54 days prelockdown and 54 days postlockdown to evaluate the extent of the decrease in surgical volume at our institution. Procedure data were collected and then divided into cranial, spine, functional, peripheral nerve, pediatrics, and endovascular categories. RESULTS: Mean total cases per day in the prelockdown group were 12.26 ± 7.7, whereas in the postlockdown group, this dropped to 7.78 ± 5.5 (P = 0.01). In the spine category, mean cases per day in the prelockdown group were 3.13 ± 2.63; in the postlockdown group, this dropped to 0.96 ± 1.36 (P < 0.001). In the functional category, mean cases per day in the prelockdown group were 1.31 ± 1.51, whereas in the postlockdown group, this dropped to 0.11 ± 0.42 (P < 0.001). For cranial (P = 0.245), peripheral nerve (P = 0.16), pediatrics (P = 0.34), and endovascular (P = 0.48) cases, the volumes dropped but were not statistically significant decreases. CONCLUSION: The impact of this outbreak on operative training does appear to be significant based solely on statistics. Although the drop in case volumes during this time can be accounted for by the pandemic, it is important to understand that this is a multifactorial effect. Further studies are needed for these results to be generalizable and to fully understand the effect this pandemic has had on trainee operative experience.
ABSTRACT
INTRODUCTION Neurointerventional procedures have traditionally been performed via transfemoral access. However, according to interventional cardiology literature, transradial access can have decreased access site complications and possibly decreased mortality compared to transfemoral access. Reported limitations for wide adoption of transradial access in neurointerventional procedures include the learning curve. METHODS All neurointerventional procedures performed at a single institution with a transradial first approach were identified from Aug 2017 to January 2020. Demographic and clinical information were identified. Access site complications were recorded. Univariate analysis was performed to identify predictors of transradial failure. Covariates with P < .15 were inputted into a multivariate model with statistical significance set at P < .05. RESULTS A total of 350 transradial neurointerventional procedures were performed in 313 patients. The mean age was 68.2 years and 51% female. Most procedures (95%) used 6F radial sheaths for access. Biaxial system (e.g. microcatheter and microwire) was used in most procedures (61%). There were 81 aneurysm interventions, 73 embolization procedures, 69 angioplasty/stenting procedures, 116 mechanical thrombectomies including 93 involving the anterior circulation, and 11 vasospasm treatments. There was a remarkably high procedure completion rate with a transradial approach (96%, 335/350). Thirteen procedures were converted to transfemoral access (3.7%), 1 procedure converted to transbrachial access, and 1 procedure aborted completely. On multivariate analysis, decreasing age, female gender, and left-sided target artery were predictive of transradial failure. Radial access site complications were extremely rare (0.6%, 2/350 - 1 forearm hematoma, 1 radial artery occlusion). CONCLUSION In a high-volume endovascular center, transradial approach to a wide variety of neurointerventional procedures is both safe and feasible. Predictors of transradial failure include decreasing age, female gender, and left-sided target artery.
ABSTRACT
BACKGROUND: Academic physicians aim to provide clinical and surgical care to their patients while actively contributing to a growing body of scientific literature. The coronavirus disease 2019 (COVID-19) pandemic has resulted in procedural-based specialties across the United States witnessing a sharp decline in their clinical volume and surgical cases. OBJECTIVE: To assess the impact of COVID-19 on neurosurgical, stroke neurology, and neurointerventional academic productivity. METHODS: The study compared the neurosurgical, stroke neurology, and neurointerventional academic output during the pandemic lockdown with the same time period in previous years. Editors from a sample of neurosurgical, stroke neurology, and neurointerventional journals provided the total number of original manuscript submissions, broken down by months, from the year 2016 to 2020. Manuscript submission was used as a surrogate metric for academic productivity. RESULTS: 8 journals were represented. The aggregated data from all eight journals as a whole showed that a combined average increase of 42.3% was observed on original submissions for 2020. As the average yearly percent increase using the 2016-2019 data for each journal exhibited a combined average increase of 11.2%, the rise in the yearly increase for 2020 in comparison was nearly fourfold. For the same journals in the same time period, the average percent of COVID-19 related publications from January to June of 2020 was 6.87%. CONCLUSION: There was a momentous increase in the number of original submissions for the year 2020, and its effects were uniformly experienced across all of our represented journals.