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1.
World Neurosurg ; 148: e689-e694, 2021 04.
Article in English | MEDLINE | ID: covidwho-1062634

ABSTRACT

BACKGROUND: Cessation of elective procedures and lower bed capacity during the COVID-19 pandemic have led to a rise in the waiting lists for surgery, but it is unclear if workload has recovered sufficiently to account for this backlog. We describe the change in neurosurgical workload at a tertiary neurosciences center in the United Kingdom after the first pandemic wave in comparison with the months before and during the first wave. METHODS: A retrospective review of theatre records and electronic referrals-between December 1, 2019, and August 31, 2020-was performed. The months of December 2019-February 2020 were designated as pre-COVID months and March-May 2020 were designated as COVID months. The time period from June to August 2020 was designated as post-wave months. Statistical analyses were performed on SPSS v22 (IBM). RESULTS: Referrals declined from 572 in January to a nadir of 352 in April before a steady rise to August. Referral volumes for degenerative spinal disease and traumatic brain injuries showed a statistically significant change during the year. On average, 212 procedures per month were performed in the pre-COVID months, 167 procedures per month during COVID months, and 232 procedures per month in the post-wave months. The number of patients on the waiting list for scheduled operations rose from March (785 patients) onward to a peak of 997 patients in July. CONCLUSIONS: In the aftermath of COVID-19, higher referral volumes and operative procedures were apparent in the post-wave months as services returned to normal. With the expectation of a second wave of infections, it is unclear whether this will be sustainable.


Subject(s)
COVID-19/epidemiology , Neurosurgical Procedures/trends , Workload , Brain Injuries, Traumatic/surgery , Brain Neoplasms/surgery , Female , Hemorrhagic Stroke/surgery , Humans , Ischemic Stroke/surgery , Male , Middle Aged , Referral and Consultation/trends , Retrospective Studies , SARS-CoV-2 , Spinal Diseases/surgery , Spinal Neoplasms/surgery , Subarachnoid Hemorrhage/surgery , Tertiary Care Centers , United Kingdom/epidemiology , Waiting Lists
3.
World Neurosurg ; 148: e209-e217, 2021 04.
Article in English | MEDLINE | ID: covidwho-1003130

ABSTRACT

BACKGROUND: The occurrence of coronavirus disease 2019 (COVID-19) has overwhelmed the blood supply chain worldwide and severely influenced clinical procedures with potential massive blood loss, such as clipping surgery for aneurysmal subarachnoid hemorrhage (aSAH). Whether acute normovolemic hemodilution (ANH) is safe and effective in aneurysm clipping remains largely unknown. METHODS: Patients with aSAH who underwent clipping surgery within 72 hours from bleeding were included. The patients in the ANH group received 400 mL autologous blood collection, and the blood was returned as needed during surgery. The relationships between ANH and perioperative allogeneic blood transfusion, postoperative outcome, and complications were analyzed. RESULTS: Sixty-two patients with aSAH were included between December 2019 and June 2020 (20 in the ANH group and 42 in the non-ANH group). ANH did not reduce the need of perioperative blood transfusion (3 [15%] vs. 5 [11.9%]; P = 0.734). However, ANH significantly increased serum hemoglobin levels on postoperative day 1 (11.5 ± 2.5 g/dL vs. 10.3 ± 2.0 g/dL; P = 0.045) and day 3 (12.1 ± 2.0 g/dL vs. 10.7 ± 1.3 g/dL; P = 0.002). Multivariable analysis indicated that serum hemoglobin level on postoperative day 1 (odds ratio, 0.895; 95% confidence interval, 0.822-0.973; P = 0.010) was an independent risk factor for unfavorable outcome, and receiver operating characteristic curve analysis showed that it had a comparable predictive power to World Federation of Neurosurgical Societies grade (Z = 0.275; P > 0.05). CONCLUSIONS: ANH significantly increased postoperative hemoglobin levels, and it may hold the potential to improve patients' outcomes. Routine use of ANH should be considered in aneurysm clipping surgery.


Subject(s)
Aneurysm, Ruptured/surgery , Blood Transfusion, Autologous/methods , Bloodless Medical and Surgical Procedures/methods , Hemodilution/methods , Intracranial Aneurysm/surgery , Neurosurgical Procedures/methods , Subarachnoid Hemorrhage/surgery , Adult , Aged , Blood Transfusion/statistics & numerical data , COVID-19 , Female , Hemoglobins/metabolism , Humans , Male , Middle Aged , Perioperative Care , SARS-CoV-2 , Surgical Instruments
4.
Acta Neurochir (Wien) ; 162(8): 1795-1801, 2020 08.
Article in English | MEDLINE | ID: covidwho-574636

ABSTRACT

BACKGROUND: To investigate whether patients with critical emergency conditions are seeking or receiving the medical care that they require, we characterized the reality of care for patients presenting with neuro-emergencies during the first phase of the COVID-19 pandemic. METHODS: In this observational, longitudinal cohort study, all neurosurgical admissions that presented to our department between February 1 and April 15 during the COVID-19 pandemic and during the same time period in 2019 were identified and categorized according to the presence of a neuro-emergency, the route of admission, management, and the category of disease. Further, the clinical course of patients with aneurysmal subarachnoid hemorrhage (aSAH) and chronic subdural hematoma (cSDH) was investigated representatively for severe vascular and semi-urgent traumatic conditions that present with a wide variety of symptoms. RESULTS: During the pandemic, the percentage of neuro-emergencies among all neurosurgical admissions remained similar but a larger proportion presented through the emergency department than through the outpatient clinic or by referral (*p = 0.009). The total number of neuro-emergencies was significantly reduced (*p = 0.0007) across all types of disease, particularly in vascular (*p = 0.036) but also in spinal (*p = 0.007) and hydrocephalus (*p = 0.048) emergencies. Patients with spinal emergencies presented 48 h later (*p = 0.001) despite comparable symptom severity. For aSAH, the number of cases, aSAH grade, aneurysm localization, and treatment modality did not change but strikingly, elderly patients with cSDH presented less frequently, with more severe symptoms (*p = 0.046), and were less likely to reach favorable outcome (*p = 0.003) at discharge compared with previous years. CONCLUSIONS: Despite pandemic-related restrictive measures and reallocation of resources, patients with neuro-emergencies should be encouraged to present regardless of the severity of symptoms because deferred presentation may result in adverse outcome. Thus, conservation of critical healthcare resources remains essential in spite of fighting COVID-19.


Subject(s)
Brain Diseases/surgery , Coronavirus Infections/epidemiology , Emergencies , Neurosurgical Procedures , Pneumonia, Viral/epidemiology , Spinal Cord Diseases/surgery , Spinal Injuries/surgery , Adult , Aged , Aged, 80 and over , Betacoronavirus , COVID-19 , Cohort Studies , Female , Hematoma, Subdural, Chronic/surgery , Humans , Longitudinal Studies , Male , Middle Aged , Pandemics , SARS-CoV-2 , Subarachnoid Hemorrhage/surgery , Young Adult
5.
World Neurosurg ; 138: e955-e960, 2020 06.
Article in English | MEDLINE | ID: covidwho-274866

ABSTRACT

OBJECTIVE: The novel coronavirus disease 2019 (COVID-19) pandemic poses a substantial threat to the health of health care personnel on the front line of caring for patients with COVID-19. The Centers for Medicare and Medicaid Services have announced that all nonessential planned surgeries and procedures should be postponed until further notice and only urgent procedures should proceed. Neurologic surgeries and procedures should not be delayed under the circumstance in which it is essential at saving a life or preserving functioning of the central nervous system. METHODS: With the intent to advise the neurosurgery team on how to adequately prepare and safely perform neurosurgical procedures on confirmed and suspected patients with COVID-19, we discuss considerations and recommendations based on the lessons and experience shared by neurosurgeons in China. RESULTS: Perioperative and intraoperative strategies, considerations, as well as challenges arisen under the specific circumstance have been discussed. In addition, a case of a ruptured aneurysm in a suspected patient with COVID-19 is reported. It is advised that all health care personnel who immediately participate in neurosurgical surgeries and procedures for confirmed and suspected patients with COVID-19 should take airborne precautions and wear enhanced personal protective equipment. CONCLUSIONS: Following the proposed guidance, urgent neurosurgical surgeries and procedures can be safely performed for the benefit of critical patients with or suspected for COVID-19.


Subject(s)
Aneurysm, Ruptured/surgery , Coronavirus Infections/diagnosis , Infection Control/methods , Infectious Disease Transmission, Patient-to-Professional/prevention & control , Intracranial Aneurysm/surgery , Neurosurgical Procedures/methods , Pneumonia, Viral/diagnosis , Subarachnoid Hemorrhage/surgery , Air Filters , Aneurysm, Ruptured/complications , Aneurysm, Ruptured/diagnostic imaging , Betacoronavirus , COVID-19 , COVID-19 Testing , China , Clinical Laboratory Techniques , Computed Tomography Angiography , Coronavirus Infections/complications , Craniotomy/methods , Drainage , Emergencies , Hematoma/complications , Hematoma/diagnostic imaging , Hematoma/surgery , Humans , Intracranial Aneurysm/complications , Intracranial Aneurysm/diagnostic imaging , Intracranial Pressure , Intraoperative Care , Lung/diagnostic imaging , Monitoring, Physiologic , Operating Rooms , Pandemics , Perioperative Care , Personal Protective Equipment , Pneumonia, Viral/complications , Practice Guidelines as Topic , SARS-CoV-2 , Subarachnoid Hemorrhage/complications , Subarachnoid Hemorrhage/diagnostic imaging , Tomography, X-Ray Computed , United States
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