SARS-CoV-2 大流行第一波对神经外科患者结局的影响：西班牙全国性研究。
Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: a nationwide study in Spain.
机构信息
Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain.
出版信息
BMJ Open. 2021 Dec 10;11(12):e053983. doi: 10.1136/bmjopen-2021-053983.
OBJECTIVE
To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain.
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/10 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/10 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/10 people/week) was a statistically independent predictor of mortality.
TRIAL REGISTRATION NUMBER
CEIM 20/217.
目的
评估 SARS-CoV-2 大流行第一波对西班牙神经外科患者结局的影响。
背景
COVID-19 患者的最初浪潮使医疗体系不堪重负。采取了不同的措施来应对这种负担过重的情况。这些措施对神经外科患者的影响，以及 COVID-19 本身的影响，尚未得到彻底研究。
参与者
这是一项多中心、全国性、观察性回顾性研究，纳入了 2020 年 3 月至 7 月期间接受任何神经外科手术的患者。
干预措施
进行探索性因子分析以选择样本中最相关的变量。
主要和次要结果测量
进行单变量和多变量分析以确定死亡率和术后 SARS-CoV-2 感染的独立预测因素。
结果
16 家医院登记了 1677 例手术患者。总死亡率为 6.4%，2.9%（44 例）发生围手术期 SARS-CoV-2 感染。其中 24 例术后确诊。年龄（OR 1.05）、围手术期 SARS-CoV-2 感染（OR 4.7）、社区 COVID-19 发病率（每 10 人/周的病例数）（OR 1.006）、术后神经功能恶化（OR 5.9）、术后需要气道支持（OR 5.38）、ASA 分级≥3（OR 2.5）和术前 GCS 3-8（OR 2.82）与死亡率独立相关。对于 SARS-CoV-2 术后感染，术前 72 小时内筛查拭子检测（OR 0.76）、社区 COVID-19 发病率（每 10 人/周的病例数）（OR 1.011）、术前认知障碍（OR 2.784）、术后脓毒症（OR 3.807）和无术后并发症（OR 0.188）与死亡率独立相关。
结论
神经外科患者围手术期 SARS-CoV-2 感染与死亡率增加近五倍相关。社区 COVID-19 发病率（每 10 人/周的病例数）是死亡率的统计学独立预测因素。
临床试验注册号
CEIM 20/217。
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