Department of Neurosurgery, Rigshospitalet, Blegdamsvej 9, 2100, Copenhagen, Denmark.
Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
Acta Neurochir (Wien). 2020 Sep;162(9):2221-2233. doi: 10.1007/s00701-020-04482-8. Epub 2020 Jul 8.
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19), which began as an epidemic in China and spread globally as a pandemic, has necessitated resource management to meet emergency needs of Covid-19 patients and other emergent cases. We have conducted a survey to analyze caseload and measures to adapt indications for a perception of crisis.
We constructed a questionnaire to survey a snapshot of neurosurgical activity, resources, and indications during 1 week with usual activity in December 2019 and 1 week during SARS-CoV-2 pandemic in March 2020. The questionnaire was sent to 34 neurosurgical departments in Europe; 25 departments returned responses within 5 days.
We found unexpectedly large differences in resources and indications already before the pandemic. Differences were also large in how much practice and resources changed during the pandemic. Neurosurgical beds and neuro-intensive care beds were significantly decreased from December 2019 to March 2020. The utilization of resources decreased via less demand for care of brain injuries and subarachnoid hemorrhage, postponing surgery and changed surgical indications as a method of rationing resources. Twenty departments (80%) reduced activity extensively, and the same proportion stated that they were no longer able to provide care according to legitimate medical needs.
Neurosurgical centers responded swiftly and effectively to a sudden decrease of neurosurgical capacity due to relocation of resources to pandemic care. The pandemic led to rationing of neurosurgical care in 80% of responding centers. We saw a relation between resources before the pandemic and ability to uphold neurosurgical services. The observation of extensive differences of available beds provided an opportunity to show how resources that had been restricted already under normal conditions translated to rationing of care that may not be acceptable to the public of seemingly affluent European countries.
严重急性呼吸综合征冠状病毒 2（SARS-CoV-2 或 COVID-19）在中国开始流行，并作为大流行病在全球范围内传播，这需要进行资源管理，以满足 COVID-19 患者和其他紧急病例的紧急需求。我们进行了一项调查，以分析病例数和适应危机意识的措施。
我们构建了一个问卷，以调查 2019 年 12 月正常活动期间的 1 周和 2020 年 3 月 SARS-CoV-2 大流行期间的 1 周的神经外科活动、资源和适应症的快照。该问卷发送给了欧洲的 34 个神经外科部门；25 个部门在 5 天内回复了。
我们发现，在大流行之前，资源和适应症已经存在很大差异。在大流行期间，实践和资源的变化也很大。神经外科病床和神经重症监护病床数量从 2019 年 12 月到 2020 年 3 月显著减少。通过减少对脑损伤和蛛网膜下腔出血的护理需求，推迟手术以及改变手术适应症作为资源配给的方法，资源利用率降低。20 个部门（80%）广泛减少活动，同样比例的部门表示，根据合法的医疗需求，他们不再能够提供护理。
神经外科中心迅速有效地应对由于资源转移到大流行护理而导致的神经外科能力突然下降。80%的参与中心实行神经外科护理配给。我们看到了大流行前资源与维持神经外科服务能力之间的关系。在正常情况下已经受到限制的资源观察到广泛的差异，为表明在看似富裕的欧洲国家，公众可能无法接受的护理配给提供了机会。
