1Neurosurgery, Department of Medical and Surgical Specialties, Radiological Sciences and Public Health, University of Brescia.
2Biostatistics, Department of Molecular and Translational Medicine, University of Brescia.
Neurosurg Focus. 2020 Dec;49(6):E19. doi: 10.3171/2020.9.FOCUS20681.
The COVID-19 pandemic has forced many countries into lockdown and has led to the postponement of nonurgent neurosurgical procedures. Although stress has been investigated during this pandemic, there are no reports on anxiety in neurosurgical patients undergoing nonurgent surgical procedures.
Neurosurgical patients admitted to hospitals in eastern Lombardy for nonurgent surgery after the lockdown prospectively completed a pre- and postoperative structured questionnaire. Recorded data included demographics, pathology, time on surgical waiting list, anxiety related to COVID-19, primary pathology and surgery, safety perception during hospital admission before and after surgery, and surgical outcomes. Anxiety was measured with the State-Trait Anxiety Inventory. Descriptive statistics were computed on the different variables and data were stratified according to pathology (oncological vs nononcological). Three different models were used to investigate which variables had the greatest impact on anxiety, oncological patients, and safety perception, respectively. Because the variables (Xs) were of a different nature (qualitative and quantitative), mostly asymmetrical, and related to outcome (Y) by nonlinear relationships, a machine learning approach composed of three steps (1, random forest growing; 2, relative variable importance measure; and 3, partial dependence plots) was chosen.
One hundred twenty-three patients from 10 different hospitals were included in the study. None of the patients developed COVID-19 after surgery. State and trait anxiety were reported by 30.3% and 18.9% of patients, respectively. Higher values of state anxiety were documented in oncological compared to nononcological patients (46.7% vs 25%; p = 0.055). Anxiety was strongly associated with worry about primary pathology, surgery, disease worsening, and with stress during waiting time, as expected. Worry about positivity to SARS-CoV-2, however, was the strongest factor associated with anxiety, even though none of the patients were infected. Neuro-oncological disease was associated with state anxiety and with worry about surgery and COVID-19. Increased bed distance and availability of hand sanitizer were associated with a feeling of safety.
These data underline the importance of psychological support, especially for neuro-oncological patients, during a pandemic.
COVID-19 大流行迫使许多国家进入封锁状态，并导致非紧急神经外科手术的推迟。尽管在此期间已经研究了压力，但尚无关于接受非紧急手术的神经外科患者焦虑的报道。
封锁后，东部伦巴第大区医院收治的非紧急手术神经外科患者前瞻性地完成了术前和术后的结构化问卷。记录的数据包括人口统计学、病理学、手术等候名单上的时间、与 COVID-19 相关的焦虑、主要病理学和手术、手术前后住院期间的安全感知以及手术结果。使用状态-特质焦虑量表测量焦虑。对不同变量进行描述性统计，并根据病理学（肿瘤与非肿瘤）对数据进行分层。使用三种不同的模型分别调查哪些变量对焦虑、肿瘤患者和安全感知的影响最大。由于变量（X）具有不同的性质（定性和定量），大多数是非对称的，并且通过非线性关系与结果（Y）相关，因此选择了由三个步骤组成的机器学习方法（1，随机森林生长；2，相对变量重要性度量；3，偏依赖图）。
研究纳入了来自 10 家不同医院的 123 名患者。手术后没有患者感染 COVID-19。分别有 30.3%和 18.9%的患者报告出现状态和特质焦虑。与非肿瘤患者相比，肿瘤患者的状态焦虑值更高（46.7%比 25%；p = 0.055）。焦虑与对主要病理学、手术、疾病恶化的担忧以及等待时间的压力密切相关，这在意料之中。然而，对 SARS-CoV-2 阳性的担忧是与焦虑最相关的因素，尽管没有患者感染。神经肿瘤疾病与状态焦虑以及对手术和 COVID-19 的担忧有关。增加床位距离和提供洗手液与安全感有关。
这些数据强调了在大流行期间提供心理支持的重要性，特别是对神经肿瘤患者。
