ABSTRACT
BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic is an unprecedented challenge. Different models of reorganization have been described aiming to preserve resources and ensure optimal medical care. Limited clinical neurosurgical experience with patients with COVID-19 has been reported. We share organizational experience, attitudes, and preliminary data of patients treated at our institution. METHODS: Institutional guidelines and patient workflow are described and visualized. A cohort of all neurosurgical patients managed during the lockdown period is presented and analyzed, assessing suspected nosocomial infection risk factors. A comparative surgical subcohort from the previous year was used to investigate the impact on surgical activity. RESULTS: A total of 176 patients were admitted in 66 days, 20 of whom tested positive for COVID-19. Patients initially admitted to the neurosurgical ward were less likely to be suspected for a COVID-19 infection compared with patients admitted for critical emergencies, particularly with neurovascular and stroke-related diseases. The mortality of patients with COVID-19 was remarkably high (45%), and even higher in patients who underwent surgical intervention (77%). In addition to the expected decrease in surgical activity (-53%), a decrease in traumatic emergencies was noted. CONCLUSIONS: By applying infection prevention and resource-sparing logistics measures shared by the international medical community, we were able to maintain essential neurosurgical care in a pandemic with controlled nosocomial infection risk. Special consideration should be given to medical management and surgical indications in patients infected with severe acute respiratory syndrome coronavirus 2, because they seem to show a problematic hemostatic profile that might result in an unfavorable clinical and surgical outcome.
Subject(s)
Academic Medical Centers , COVID-19/prevention & control , Central Nervous System Diseases/surgery , Cross Infection/prevention & control , Neurosurgery , Organizational Policy , Workflow , Acute Disease , Adolescent , Adult , Aged , Aged, 80 and over , Belgium/epidemiology , COVID-19/complications , COVID-19/epidemiology , COVID-19 Testing , Cerebrovascular Disorders/complications , Cerebrovascular Disorders/surgery , Child , Child, Preschool , Craniocerebral Trauma/surgery , Decompressive Craniectomy , Elective Surgical Procedures , Emergencies , Female , Humans , Hydrocephalus/surgery , Infant , Infant, Newborn , Infection Control , Intracranial Hemorrhages/surgery , Male , Mass Screening , Middle Aged , Neuroendoscopy , Neurosurgical Procedures/methods , Neurosurgical Procedures/statistics & numerical data , Personal Protective Equipment , Personnel Staffing and Scheduling , Retrospective Studies , Spinal Injuries/surgery , Telemedicine , Thrombectomy , Vascular Surgical Procedures , Young AdultABSTRACT
Since December 2019, an outbreak of coronavirus disease 2019 (COVID-19) has posed significant threats to the public health and life in China. Unlike the other 6 identified coronaviruses, the SARS-Cov-2 has a high infectious rate, a long incubation period and a variety of manifestations. In the absence of effective treatments for the virus, it becomes extremely urgent to develop scientific and standardized proposals for prevention and control of virus transmission. Hereby we focused on the surgical practice in Neurosurgery Department, Tongji Hospital, Wuhan, and drafted several recommendations based on the latest relevant guidelines and our experience. These recommendations have helped us until now to achieve 'zero infection' of doctors and nurses in our department, we would like to share them with other medical staff of neurosurgery to fight 2019-nCoV infection.