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Neurosurgery in times of a pandemic: a survey of neurosurgical services during the COVID-19 outbreak in the Veneto region in Italy.
Raneri, Fabio; Rustemi, Oriela; Zambon, Giampaolo; Del Moro, Giulia; Magrini, Salima; Ceccaroni, Yuri; Basso, Elisabetta; Volpin, Francesco; Cappelletti, Martina; Lardani, Jacopo; Ferraresi, Stefano; Guida, Franco; Chioffi, Franco; Pinna, Giampietro; Canova, Giuseppe; d'Avella, Domenico; Sala, Francesco; Volpin, Lorenzo.
  • Raneri F; 1Azienda ULSS 8 Berica, Ospedale San Botolo, Vicenza.
  • Rustemi O; 1Azienda ULSS 8 Berica, Ospedale San Botolo, Vicenza.
  • Zambon G; 1Azienda ULSS 8 Berica, Ospedale San Botolo, Vicenza.
  • Del Moro G; 2Azienda ULSS Marca Trevigiana, Ospedale Cà Foncello, Treviso.
  • Magrini S; 3Azienda ULSS 3 Serenissima, Ospedale dell'Angelo, Mestre.
  • Ceccaroni Y; 3Azienda ULSS 3 Serenissima, Ospedale dell'Angelo, Mestre.
  • Basso E; 4Azienda ULSS 18 Rovigo, Ospedale Santa Maria della Misericordia, Rovigo.
  • Volpin F; 5Università degli Studi di Padova, Azienda Ospedaliera di Padova, Padua.
  • Cappelletti M; 2Azienda ULSS Marca Trevigiana, Ospedale Cà Foncello, Treviso.
  • Lardani J; 6Università degli Studi di Verona, Azienda Ospedaliera Universitaria Integrata, Verona; and.
  • Ferraresi S; 4Azienda ULSS 18 Rovigo, Ospedale Santa Maria della Misericordia, Rovigo.
  • Guida F; 3Azienda ULSS 3 Serenissima, Ospedale dell'Angelo, Mestre.
  • Chioffi F; 5Università degli Studi di Padova, Azienda Ospedaliera di Padova, Padua.
  • Pinna G; 6Università degli Studi di Verona, Azienda Ospedaliera Universitaria Integrata, Verona; and.
  • Canova G; 2Azienda ULSS Marca Trevigiana, Ospedale Cà Foncello, Treviso.
  • d'Avella D; 5Università degli Studi di Padova, Azienda Ospedaliera di Padova, Padua.
  • Sala F; 7Academic Neurosurgery, Department of Neurosciences, University of Padua Medical School, Padua, Italy.
  • Volpin L; 6Università degli Studi di Verona, Azienda Ospedaliera Universitaria Integrata, Verona; and.
Neurosurg Focus ; 49(6): E9, 2020 12.
Article in English | MEDLINE | ID: covidwho-953489
ABSTRACT

OBJECTIVE:

The purpose of this study was to analyze the effect of the coronavirus disease 2019 (COVID-19) outbreak and of the subsequent lockdown on the neurosurgical services of the Veneto region in Italy compared to the previous 4 years.

METHODS:

A survey was conducted in all 6 neurosurgical departments in the Veneto region to collect data about surgical, inpatient care and endovascular procedures during the month of March for each year from 2016 to 2020. Safety measures to avoid infection from SARS-CoV-2 and any COVID-19 cases reported among neurosurgical patients or staff members were considered.

RESULTS:

The mean number of neurosurgical admissions for the month of March over the 2016-2019 period was 663, whereas in March 2020 admissions decreased by 42%. Emergency admissions decreased by 23%. The average number of neurosurgical procedures was 697, and declined by 30% (range -10% to -51% in individual centers). Emergency procedures decreased in the same period by 23%. Subarachnoid hemorrhage and spontaneous intracerebral hemorrhage both decreased in Veneto-by 25% and 22%, respectively. Coiling for unruptured aneurysm, coiling for ruptured aneurysm, and surgery for ruptured aneurysm or arteriovenous malformation diminished by 49%, 27%, and 78%, respectively. Endovascular procedures for acute ischemic stroke (AIS) increased by 33% in 2020 (28 procedures in total). There was a slight decrease (8%) in brain tumor surgeries. Neurosurgical admissions decreased by 25% and 35% for head trauma and spinal trauma, respectively, while surgical procedures for head trauma diminished by 19% and procedures for spinal trauma declined by 26%. Admissions and surgical treatments for degenerative spine were halved. Eleven healthcare workers and 8 patients were infected in the acute phase of the pandemic.

CONCLUSIONS:

This multicenter study describes the effects of a COVID-19 outbreak on neurosurgical activities in a vast region in Italy. Remodulation of neurosurgical activities has resulted in a significant reduction of elective and emergency surgeries compared to previous years. Most likely this is a combined result of cancellation of elective and postponable surgeries, increase of conservative management, increase in social restrictions, and in patients' fear of accessing hospitals. Curiously, only endovascular procedures for AIS have increased, possibly due to reduced physical activity or increased thrombosis in SARS-CoV-2. The confounding effect of thrombectomy increase over time cannot be excluded. No conclusion can be drawn on AIS incidence. Active monitoring with nasopharyngeal swabs, wearing face masks, and using separate pathways for infected patients reduce the risk of infection.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Disease Outbreaks / Surveys and Questionnaires / Health Personnel / Neurosurgical Procedures / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Country/Region as subject: Europa Language: English Journal: Neurosurg Focus Journal subject: Neurosurgery Year: 2020 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Disease Outbreaks / Surveys and Questionnaires / Health Personnel / Neurosurgical Procedures / COVID-19 Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Humans Country/Region as subject: Europa Language: English Journal: Neurosurg Focus Journal subject: Neurosurgery Year: 2020 Document Type: Article