Department of Neurosurgery, Chung-Ang University College of Medicine, Seoul, Korea.
Division of Infectious Diseases, Department of Internal Medicine, Chung-Ang University College of Medicine, Seoul, Korea.
J Korean Med Sci. 2021 Jan 11;36(2):e16. doi: 10.3346/jkms.2021.36.e16.
One of the challenges neurosurgeons are facing in the global public health crisis caused by the coronavirus disease 2019 (COVID-19) pandemic is to balance COVID-19 screening with timely surgery. We described a clinical pathway for patients who needed emergency brain surgery and determined whether differences in the surgery preparation process caused by COVID-19 screening affected clinical outcomes.
During the COVID-19 period, patients in need of emergency brain surgery in our institution were managed using a novel standardized pathway designed for COVID-19 screening. We conducted a retrospective review of patients who were hospitalized through the emergency room and underwent emergency brain surgery. A total of 32 patients who underwent emergency brain surgery from February 1 to June 30, 2020 were included in the COVID-19 group, and 65 patients who underwent surgery from February 1 to June 30, 2019 were included in the pre-COVID-19 group. The baseline characteristics, disease severity indicators, time intervals of emergency processes, and clinical outcomes of the two groups were compared. Subgroup analysis was performed between the immediate surgery group and the semi-elective surgery group during the COVID-19 period.
There were no significant differences in baseline characteristics and severity indicators between the pre-COVID-19 group and COVID-19 group. The time interval to skin incision was significantly increased in the COVID-19 group ( = 0.027). However, there were no significant differences in the clinical outcomes between the two groups. In subgroup comparison, the time interval to skin incision was shorter in the immediate surgery group during the COVID-19 period compared with the pre-COVID-19 group ( = 0.040). The screening process did not significantly increase the time interval to classification and admission for immediate surgery. The time interval to surgery initiation was longer in the COVID-19 period due to the increased time interval in the semi-elective surgery group ( < 0.001).
We proposed a clinical pathway for the preoperative screening of COVID-19 in patients requiring emergency brain surgery. No significant differences were observed in the clinical outcomes before and after the COVID-19 pandemic. The protocol we described showed acceptable results during this pandemic.
在由 2019 年冠状病毒病（COVID-19）大流行引起的全球公共卫生危机中，神经外科医生面临的挑战之一是平衡 COVID-19 筛查与及时手术。我们描述了一种适用于需要紧急脑部手术的患者的临床路径，并确定 COVID-19 筛查过程中手术准备过程的差异是否会影响临床结果。
在 COVID-19 期间，我们机构中需要紧急脑部手术的患者采用了一种针对 COVID-19 筛查而设计的新型标准化途径进行管理。我们对通过急诊室住院并接受紧急脑部手术的患者进行了回顾性研究。共有 32 名在 2020 年 2 月 1 日至 6 月 30 日期间接受紧急脑部手术的患者被纳入 COVID-19 组，65 名在 2019 年 2 月 1 日至 6 月 30 日期间接受手术的患者被纳入 COVID-19 组。比较两组患者的基线特征、疾病严重程度指标、急诊流程时间间隔和临床结局。在 COVID-19 期间对立即手术组和半择期手术组进行了亚组分析。
COVID-19 组与 COVID-19 组在基线特征和严重程度指标方面无显著差异。COVID-19 组的切口至皮肤时间间隔显著增加（ = 0.027）。然而，两组的临床结局无显著差异。在亚组比较中，COVID-19 期间立即手术组的切口至皮肤时间间隔较 COVID-19 组更短（ = 0.040）。筛查过程并未显著增加立即手术的分类和入院时间间隔。由于半择期手术组的手术启动时间间隔延长，COVID-19 期间的手术启动时间间隔延长（ < 0.001）。
我们提出了一种针对需要紧急脑部手术的患者进行 COVID-19 术前筛查的临床路径。在 COVID-19 大流行前后，临床结局无显著差异。在大流行期间，我们描述的方案取得了可以接受的结果。
