Decompressive Surgery in the Treatment of Acute Ischemic Stroke during the First Four Waves of the COVID-19 Pandemic in Germany: A Nationwide Observational Cohort Study.

Autor:	Gheewala H; Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany.; Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany., Aldergham M; Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany.; Department of Vascular Surgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany., Rosahl S; Department of Neurosurgery, HELIOS Hospital Erfurt, Erfurt, Germany., Stoffel M; Department of Neurosurgery, HELIOS Hospital Krefeld, Krefeld, Germany., Ryang YM; Department of Neurosurgery and Center for Spine Therapy, HELIOS Hospital Berlin Buch, Berlin, Germany.; Department of Neurosurgery, Klinikum rechts der Isar, Technical University Munich, Munich, Germany., Heese O; Department of Neurosurgery and Spinal Surgery, HELIOS Hospital Schwerin - University Campus of MSH Medical School Hamburg, Schwerin, Germany., Gerlach R; Department of Neurosurgery, HELIOS Hospital Erfurt, Erfurt, Germany., Burger R; Department of Neurosurgery, HELIOS Hospital Uelzen, Uelzen, Germany., Carl B; Department of Neurosurgery, University of Marburg, Marburg, Germany.; Marburg Center for Mind, Brain and Behavior (MCMBB), Marburg, Germany.; Department of Neurosurgery, HELIOS Dr. Horst Schmidt Kliniken, Wiesbaden, Germany., Kristof RA; Department of Neurosurgery, HELIOS Hospital Meiningen, Meiningen, Germany., Westermaier T; Department of Neurosurgery, HELIOS Hospital Dachau, Dachau, Germany., Terzis J; Department of Neurosurgery, HELIOS Hospital Wuppertal, Wuppertal, Germany., Youssef F; Department of Neurosurgery, HELIOS Hospital Plauen, Plauen, Germany., Gonzalez GR; Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany.; Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany., Bold F; Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany.; Department of Anesthesiology and Intensive Care Medicine, HELIOS Hospital Bad Saarow, Bad Saarow, Germany., Allam A; Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany.; Department of Anesthesiology and Intensive Care Medicine, HELIOS Hospital Bad Saarow, Bad Saarow, Germany., Kuhlen R; HELIOS Health GmbH, Berlin, Germany., Hohenstein S; Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany., Bollmann A; Real World Evidence and Health Technology Assessment, Helios Health Institute, Berlin, Germany.; Department of Electrophysiology, Heart Center Leipzig, Leipzig, Germany., Dengler J; Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany.; Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany.
Jazyk:	angličtina
Zdroj:	Journal of neurological surgery. Part A, Central European neurosurgery [J Neurol Surg A Cent Eur Neurosurg] 2024 Sep; Vol. 85 (5), pp. 478-484. Date of Electronic Publication: 2023 Aug 18.
DOI:	10.1055/a-2156-5363
Abstrakt:	Background:  The COVID-19 pandemic has significantly affected acute ischemic stroke (AIS) care. In this study, we examined the effects of the pandemic on neurosurgical AIS care by means of decompressive surgery (DS). Methods:  In this retrospective observational study, we compared the characteristics, in-hospital processes, and in-hospital mortality rates among patients hospitalized for AIS during the first four waves of the pandemic (between January 1, 2020 and October 26, 2021) versus the corresponding periods in 2019 (prepandemic). We used administrative data from a nationwide hospital network in Germany. Results:  Of the 177 included AIS cases with DS, 60 were from 2019 and 117 from the first four pandemic waves. Compared with the prepandemic levels, there were no changes in weekly admissions for DS during the pandemic. The same was true for patient age (range: 51.7-60.4 years), the number of female patients (range: 33.3-57.1%), and the prevalence of comorbidity, as measured by the Elixhauser Comorbidity Index (range: 13.2-20.0 points). Also, no alterations were observed in transfer to the intensive care unit (range: 87.0-100%), duration of in-hospital stay (range: 14.6-22.7 days), and in-hospital mortality rates (range: 11.8-55.6%). Conclusion:  In Germany, compared with the prepandemic levels, AIS patients undergoing DS during the first four waves of the pandemic showed no changes in demographics, rates of comorbidity, and in-hospital mortality rates. This is in contrast to previous evidence on patients with less critical types of AIS not requiring DS and underlines the uniqueness of the subgroup of AIS patients requiring DS. Our findings suggests that these patients, in contrast to AIS patients in general, were unable to forgo hospitalization during the COVID-19 pandemic. Maintaining the delivery of DS is an essential aspect of AIS care during a pandemic. Competing Interests: J.D. received funding through the Helios Center for Research and Innovation via a grant (HCRI ID 2021–0431). R.K. holds shares of Fresenius AG. Y.R. is a member of DWG Commissions (Science, Education, Quality Safety, Congress Program, Scientific Advisory Board publication “Die Wirbelsäule”), and Eurospine EduCom. All other authors declare no conflict of interest. (Thieme. All rights reserved.)
Databáze:	MEDLINE
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