Department of Neurosurgery, T. Marciniak Lower Silesian Specialist Hospital - Emergency Medicine Centre, Wrocław, Poland.
Institute of Medicine, University of Opole, Poland.
Adv Clin Exp Med. 2023 Nov;32(11):1299-1309. doi: 10.17219/acem/161726.
The coronavirus disease (COVID-19) pandemic has greatly affected the treatment of most medical conditions. In particular, the treatment of seriously ill patients had to be adjusted due to the limited availability of in-hospital procedures.
The aim of this study was to evaluate the effects of COVID-19-related changes on neuro-oncological surgeries in the Polish medical system.
Data from the period of 2010-2020 were collected from National Health Insurance database for 2 diagnosis-related groups: A11 (complex intracranial procedures) and A12 (large intracranial procedures). The total number of procedures and diagnoses per year, trend changes and changes in procedures grouped by medical type were analyzed, including resections/biopsies, malignant/stable (nonmalignant) lesions, elective/acute procedures, and length of stay.
Mean yearly numbers of 7177 (standard deviation (SD) = 760) procedures and 5934 (SD = 1185) diagnoses were recorded. Both numbers were growing up to 9.1% per year until 2018. From 2018, a 3.1% decrease in the number of procedures was observed, with a significantly larger decrease of 10.5% observed in 2020 (p < 0.001). The number of diagnoses decreased in 2019 by 2.7%, and by 9.2% in 2020 (p = 0.706), with a statistically significant change in the annual growth rate (p = 0.044). The number of resections decreased by 11.5% in 2020 (p = 0.204), with a significant change in the annual growth rate (p < 0.001). The number of biopsies decreased by 2.5% in 2020 (p = 0.018), with the annual decrement in 2019/2020 also being significant (p = 0.004). Decreases were observed in 2019 and 2020 for the number of malignant (0.5% and 6.3%, respectively) and nonmalignant (5.4% and 12.9%, respectively) tumors (p = 0.233 and p = 0.682 for absolute values, and p = 0.008 and p = 0.004 for the annual growth rates, respectively). The number of acute procedures in 2020 further decreased by 9.8% from 5.5% decrease in 2019 (p = 0.004), and the number of elective procedures decreased by 11.8% (p = 0.009). The annual growth rates for both acute and elective procedures were statistically significant (p < 0.001 and p < 0.001).
The decrease in the number of neuro-oncological surgeries appeared to be much lower than the 20% decrease observed for general oncological surgeries in Poland during the COVID-19 pandemic. This seems to have resulted from postponing the treatment of less critical cases (i.e., nonmalignant and elective) and focusing on the treatment of the most precarious patients.
冠状病毒病（COVID-19）大流行极大地影响了大多数医疗条件的治疗。特别是，由于医院内程序的可用性有限，严重患者的治疗必须进行调整。
本研究旨在评估 COVID-19 相关变化对波兰医疗系统神经肿瘤学手术的影响。
从国家健康保险数据库中收集了 2010-2020 年期间与两个诊断相关组（A11[复杂颅内手术]和 A12[大型颅内手术]）相关的数据。分析了每年的总手术次数和诊断次数、趋势变化以及按医疗类型分组的手术变化，包括切除/活检、恶性/稳定（非恶性）病变、择期/急症手术以及住院时间。
记录了平均每年 7177 例（标准差[SD] = 760）手术和 5934 例（SD = 1185）诊断。这两个数字每年都以 9.1%的速度增长，直到 2018 年。自 2018 年以来，手术数量下降了 3.1%，2020 年的降幅明显更大，为 10.5%（p < 0.001）。2019 年诊断数量下降了 2.7%，2020 年下降了 9.2%（p = 0.706），年度增长率的变化具有统计学意义（p = 0.044）。2020 年切除术的数量减少了 11.5%（p = 0.204），年度增长率的变化也具有统计学意义（p < 0.001）。2020 年活检数量减少了 2.5%（p = 0.018），2019/2020 年的年度递减也具有统计学意义（p = 0.004）。2019 年和 2020 年恶性（分别为 0.5%和 6.3%）和非恶性（分别为 5.4%和 12.9%）肿瘤的数量均有所减少（绝对值分别为 p = 0.233 和 p = 0.682，年度增长率分别为 p = 0.008 和 p = 0.004）。2020 年急症手术数量进一步减少了 9.8%，而 2019 年减少了 5.5%（p = 0.004），择期手术数量减少了 11.8%（p = 0.009）。急症和择期手术的年度增长率均具有统计学意义（p < 0.001 和 p < 0.001）。
神经肿瘤学手术数量的减少似乎远低于波兰 COVID-19 大流行期间一般肿瘤学手术减少的 20%。这似乎是由于推迟了对非关键病例（即非恶性和择期）的治疗，并专注于治疗最不稳定的患者。
