Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: a nationwide study in Spain.
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Paredes Igor, Castaño Leon Ana Maria, Lagares Alfonso, Jimenez Roldan Luis, Perez-Nuñez Angel, González-Leon Pedro, Delgado-Fernandez Juan, Eiriz Carla, García-Pérez Daniel, Moreno-Gomez Luis Miguel, Esteban-Sinovas Olga, Delgado-López Pedro, Martín-Alonso Javier, Kaen Ariel, Tirado-Caballero Jorge, Ordóñez Carmona Marta, Arteaga Romero Francisco, Gonzalez Pombo Marta, Alén José F, Gil-Simoes Ricardo, Torres Cristina V, Navas Garcia Marta, Blasco Guillermo, Frade-Porto Natalia, González-Tarno Patricia, Martin Segura Adrian, Gelabert-Gonzalez Miguel, Menendez Cortezon Beatriz, Rodriguez Botana Brais, Pérez-Alfayate Rebeca, Fernandez Garcia Carla, Ferrandez Pujante Borja, Vargas-Jiménez Andres, Cotúa Carlos, de la Lama Adolfo, Calero Lourdes, Ruiz-Juretschke Fernando, Garcia Leal Roberto, Valera Mele Marc, Casitas Hernando Vicente, Rivero Martín Belén, Orduna Javier, Casado Pellejero Juan, Fustero De Miguel David, Diaz-Molina Jorge, Moles Herbera Jesus, Castello Ruiz Maria Jose, Gomar Alba Mario, Garcia Perez Fernando, Hernandez Garcia Borja Jesus, Villaseñor Ledezma Javier, Otero Rodríguez Álvaro, Ailagas Juan José, Goncalves-Estella Jesús, Sousa Casasnovas Pablo, Pascual Argente Daniel, Ruiz Martín Laura, Roa Montes de Oca Juan Carlos, Arandia Guzmán Daniel, García Martín Andoni, Torres Carretero Luis, Garrido Ruíz Patricia Alejandra, Calvo Marta, Miranda-Lloret Pablo, Rodriguez-Cadarso Suarez-Vence Miguel, Anotn Oltra Joan, Roca Barber Amparo, Quiroz Tejada Arnold, Carbayo Lozano Guillermo, Bermudez Vilar Garazi, Paternain Martin Clara, Dela FuenteVilla Pablo, Fidalgo De la Rosa Marina, Sistiaga García Íñigo L, Zabalo San Juan Gorka
Аннотация
SETTINGS: The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied.
PARTICIPANTS: This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020.
INTERVENTIONS: An exploratory factorial analysis was performed to select the most relevant variables of the sample.
PRIMARY AND SECONDARY OUTCOME MEASURES: Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection.
RESULTS: Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/105 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade ≥3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/105 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated.
CONCLUSIONS: Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/105 people/week) was a statistically independent predictor of mortality.
TRIAL REGISTRATION NUMBER: CEIM 20/217.