西班牙 COVID-19 大流行第一波期间接受神经外科疾病手术的患者：一项多中心队列研究。

Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study.

机构信息

Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain

Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain.

出版信息

BMJ Open. 2022 Aug 17;12(8):e061208. doi: 10.1136/bmjopen-2022-061208.

DOI:10.1136/bmjopen-2022-061208

PMID:35977759

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC9388715/

Abstract

OBJECTIVES

The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery.

DESIGN

This was an observational retrospective study.

SETTINGS

A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020.

PARTICIPANTS

A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease.

PRIMARY AND SECONDARY OUTCOME MEASURES

The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection.

RESULTS

More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p<0.001), degenerative spine (OR=0.296, p=0.027) and expedited indications (OR=6.095, p<0.001) were independent factors for being operated on during the pandemic.

CONCLUSIONS

Patients awaiting neurosurgery experienced significant collateral damage even when they were considered for scheduled procedures.

摘要

目的

大量需要机械通气的感染患者导致 COVID-19 大流行第一波期间推迟了计划中的神经外科手术。本研究的目的是探讨影响推迟计划中的神经外科手术的因素，并评估西班牙应对 COVID-19 大流行第一波时限制择期手术对等待手术患者结局的影响。

设计

这是一项观察性回顾性研究。

地点

2020 年 3 月 1 日至 6 月 30 日期间进行的三级多中心神经外科活动研究。

参与者

共纳入 680 例等待任何计划中的神经外科手术的患者。470 例患者（69.1%）因脊柱退行性疾病接受手术，86 例患者（12.6%）因功能障碍，58 例患者（8.5%）因脑或脊柱肿瘤，25 例患者（3.7%）因脑脊髓液（CSF）障碍和 17 例患者（2.5%）因脑血管病。

主要和次要结局测量

主要结局是任何原因导致的死亡率和特定神经外科状况的任何恶化。其次，我们分析了确诊的 SARS-CoV-2 感染率。

结果

超过四分之一的患者出现临床或影像学恶化。功能障碍（39.5%）或 CSF 障碍（40%）患者的恶化率更高。两名患者在等待期间死亡（0.4%），均因合并疾病所致。我们进行了多变量逻辑回归分析，以确定与维持手术适应证相关的独立协变量。我们发现社区 SARS-CoV-2 发病率（OR=1.011，p<0.001）、退行性脊柱疾病（OR=0.296，p=0.027）和紧急手术适应证（OR=6.095，p<0.001）是大流行期间手术的独立因素。