Departments of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
Departments of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
World Neurosurg. 2022 Oct;166:e915-e923. doi: 10.1016/j.wneu.2022.07.137. Epub 2022 Aug 6.
Interfacility transfers represent a large proportion of neurosurgical admissions to tertiary care centers each year. In this study, the authors examined the impact of the COVID-19 pandemic on the number of transfers, timing of transfers, demographic profile of transfer patients, and clinical outcomes including rates of surgical intervention.
A retrospective review of neurosurgical transfer patients at a single tertiary center was performed. Patients transferred from April to November 2020 (the "COVID Era") were compared with an institutional database of transfer patients collected before the COVID-19 pandemic (the "Pre-COVID Era"). During the COVID Era, both emergent and nonemergent neurosurgical services had resumed. A comparison of demographic and clinical factors between the 2 cohorts was performed.
A total of 674 patients were included in the study (331 Pre-COVID and 343 COVID-Era patients). Overall, there was no change in the average monthly number of transfers (P = 0.66) or in the catchment area of referral hospitals. However, COVID-Era patients were more likely to be uninsured (1% vs. 4%), had longer transfer times (COVID vs. Pre-COVID Era: 18 vs. 9 hours; P < 0.001), required higher rates of surgical intervention (63% vs. 50%, P = 0.001), had higher rates of spine pathology (17% vs. 10%), and less frequently were admitted to the intensive care unit (34% vs. 52%, P < 0.001). Overall, COVID-Era patients did not experience delays to surgical intervention (3.1 days vs. 3.6 days, P = 0.2). When analyzing the subgroup of COVID-Era patients, COVID infection status did not impact the time of transfer or rates of operation, although COVID-infected patients experienced a longer time to surgery after admission (14 vs. 2.9 days, P < 0.001).
The COVID-19 pandemic did not reduce the number of monthly transfers, operation rates, or catchment area for transfer patients. Transfer rates of uninsured patients increased during the COVID Era, potentially reflecting changes in access to community neurosurgery care. Shorter time to surgery seen in COVID-Era patients possibly reflects institutional policies that improved operating room efficiency to compensate for surgical backlogs. COVID status affeted time to surgery, reflecting the preoperative care that these patients require before intervention.
每年，医疗机构间的转院都在神经外科的住院病人中占很大比例。在这项研究中，作者研究了 COVID-19 大流行对转院人数、转院时间、转院患者的人口统计学特征以及包括手术干预率在内的临床结果的影响。
对一家三级中心的神经外科转院患者进行了回顾性研究。将 2020 年 4 月至 11 月（“COVID 时代”）转入的患者与 COVID-19 大流行前机构数据库中收集的转院患者（“Pre-COVID 时代”）进行比较。在 COVID 时代，紧急和非紧急神经外科服务都已恢复。对两组患者的人口统计学和临床因素进行了比较。
共有 674 名患者入组研究（Pre-COVID 时代 331 例，COVID 时代 343 例）。总体而言，每月转院的平均人数（P=0.66）或转诊医院的服务范围没有变化。然而，COVID 时代的患者更有可能没有保险（1%比 4%），转院时间更长（COVID 比 Pre-COVID 时代：18 比 9 小时；P<0.001），需要更高的手术干预率（63%比 50%，P=0.001），脊柱疾病的发生率更高（17%比 10%），入住重症监护病房的比例更低（34%比 52%，P<0.001）。总体而言，COVID 时代的患者并未延迟手术干预（3.1 天比 3.6 天，P=0.2）。在分析 COVID 时代患者的亚组时，COVID 感染状态并未影响转院时间或手术率，尽管 COVID 感染患者在入院后接受手术的时间更长（14 天比 2.9 天，P<0.001）。
COVID-19 大流行并未减少每月的转院次数、手术率或转院患者的服务范围。在 COVID 时代，未参保患者的转院率增加，这可能反映了社区神经外科护理服务获取方面的变化。COVID 时代的患者手术时间更短，这可能反映了机构为弥补手术积压而提高手术室效率的政策。COVID 状态影响手术时间，反映了这些患者在干预前需要的术前护理。
