The Impact of the Coronavirus Disease 2019 Pandemic on Neurosurgical Practice and Feasibility of Safe Resumption of Elective Procedures During this Era in a Large Referral Center in Tehran, Iran: An Unmatched Case-Control Study

Autor: Kaveh Oraii Yazdani, Pooria Ahmadi, Alireza Zali, Saeed Oraee-Yazdani, Roozbeh Tavanaei
Rok vydání: 2021
Předmět:
Male
Iran
Neurosurgical Procedures
COVID-19 Testing
Postoperative Complications
Pandemic
Hospital Mortality
Prospective Studies
Young adult
Prospective cohort study
Aged
80 and over
COVID-19
Coronavirus disease 2019
IRR
Incidence rate ratio
Middle Aged
HRCT
High-resolution computed tomography
ICU
Intensive care unit
Elective Surgical Procedures
symbols
CT
Computed tomography
Original Article
Female
Neurosurgery
Adult
medicine.medical_specialty
Coronavirus disease 2019 (COVID-19)
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
Young Adult
symbols.namesake
medicine
Humans
Poisson regression
Pandemics
Aged
SARS-CoV-2
Severe acute respiratory syndrome coronavirus 2
SARS-CoV-2
CI
Confidence interval
RT-PCR
Reverse-transcriptase polymerase chain reaction
business.industry
Case-control study
COVID-19
IQR
Interquartile range
Case-Control Studies
Emergency medicine
Feasibility Studies
Surgery
Neurology (clinical)
Tomography
X-Ray Computed
business
OR
Odds ratio
Zdroj: World Neurosurgery
ISSN: 1878-8750
DOI: 10.1016/j.wneu.2021.07.047
Popis: Objective The coronavirus disease 2019 (COVID-19) pandemic has considerably affected surgical practice. The present study aimed to investigate the effects of the pandemic on neurosurgical practice and the safety of the resumption of elective procedures through implementing screening protocols in a high-volume academic public center in Iran, as one of the countries severely affected by the pandemic. Methods This unmatched case-control study compared 2 populations of patients who underwent neurosurgical procedures between June 1, 2019 and September 1, 2019 and the same period in 2020. In the prospective part of the study, patients who underwent elective procedures were tested for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection postoperatively to evaluate the viability of our screening protocol. Results Elective and emergency procedures showed significant reduction during the pandemic (59.4%, n = 168 vs. 71.3%, n = 380) and increase (28.7%, n = 153 vs. 40.6%, n = 115, respectively; P = 0.003). The proportional distribution of neurosurgical categories remained unchanged during the pandemic. Poisson regression showed that the reduction in total daily admissions and some categories, including spine, trauma, oncology, and infection were significantly correlated with the pandemic. Among patients who underwent elective procedures, 0 (0.0%) and 26 (16.25%) had positive test results on days 30 and 60 postoperatively, respectively. Overall mortality was comparable between the pre–COVID-19 and COVID-19 periods, yet patients with concurrent SARS-CoV-2 infection showed substantially higher mortality (65%). Conclusions By implementing safety and screening protocols with proper resource allocation, the emergency care capacity can be maintained and the risk minimized of hospital-acquired SARS-CoV-2 infection, complications, and mortality among neurosurgical patients during the pandemic. Similarly, for elective procedures, according to available resources, hospital beds can be allocated for patients with a higher risk of delayed hospitalization and those who are concerned about the risk of hospital-acquired infection can be reassured.
Databáze: OpenAIRE
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