Faculty of Health Sciences Brandenburg, Brandenburg Medical School Theodor Fontane, Campus Bad Saarow, Bad Saarow, Germany.
Department of Neurosurgery, HELIOS Hospital Bad Saarow, Bad Saarow, Germany.
J Neurol Surg A Cent Eur Neurosurg. 2024 Sep;85(5):478-484. doi: 10.1055/a-2156-5363. Epub 2023 Aug 18.
The COVID-19 pandemic has significantly affected acute ischemic stroke (AIS) care. In this study, we examined the effects of the pandemic on neurosurgical AIS care by means of decompressive surgery (DS).
In this retrospective observational study, we compared the characteristics, in-hospital processes, and in-hospital mortality rates among patients hospitalized for AIS during the first four waves of the pandemic (between January 1, 2020 and October 26, 2021) versus the corresponding periods in 2019 (prepandemic). We used administrative data from a nationwide hospital network in Germany.
Of the 177 included AIS cases with DS, 60 were from 2019 and 117 from the first four pandemic waves. Compared with the prepandemic levels, there were no changes in weekly admissions for DS during the pandemic. The same was true for patient age (range: 51.7-60.4 years), the number of female patients (range: 33.3-57.1%), and the prevalence of comorbidity, as measured by the Elixhauser Comorbidity Index (range: 13.2-20.0 points). Also, no alterations were observed in transfer to the intensive care unit (range: 87.0-100%), duration of in-hospital stay (range: 14.6-22.7 days), and in-hospital mortality rates (range: 11.8-55.6%).
In Germany, compared with the prepandemic levels, AIS patients undergoing DS during the first four waves of the pandemic showed no changes in demographics, rates of comorbidity, and in-hospital mortality rates. This is in contrast to previous evidence on patients with less critical types of AIS not requiring DS and underlines the uniqueness of the subgroup of AIS patients requiring DS. Our findings suggests that these patients, in contrast to AIS patients in general, were unable to forgo hospitalization during the COVID-19 pandemic. Maintaining the delivery of DS is an essential aspect of AIS care during a pandemic.
COVID-19 大流行对急性缺血性脑卒中（AIS）的治疗产生了重大影响。在这项研究中，我们通过去骨瓣减压术（DS）来研究大流行对神经外科 AIS 治疗的影响。
在这项回顾性观察性研究中，我们比较了大流行的前四个波次（2020 年 1 月 1 日至 2021 年 10 月 26 日）与 2019 年同期（大流行前）期间因 AIS 住院的患者的特征、住院过程和住院死亡率。我们使用了德国一个全国性医院网络的行政数据。
在纳入的 177 例接受 DS 的 AIS 病例中，60 例来自 2019 年，117 例来自前四个大流行波次。与大流行前水平相比，DS 的每周入院人数在大流行期间没有变化。患者年龄（范围：51.7-60.4 岁）、女性患者数量（范围：33.3-57.1%）和 Elixhauser 合并症指数（范围：13.2-20.0 分）所衡量的合并症患病率也没有变化。同样，没有观察到转入重症监护病房的比例（范围：87.0-100%）、住院时间（范围：14.6-22.7 天）和住院死亡率（范围：11.8-55.6%）的变化。
与大流行前水平相比，在大流行的前四个波次期间接受 DS 的 AIS 患者在人口统计学特征、合并症患病率和住院死亡率方面没有变化。这与不需要 DS 的不太严重类型的 AIS 患者的先前证据形成对比，突显了需要 DS 的 AIS 患者亚组的独特性。我们的研究结果表明，与一般的 AIS 患者相比，这些患者在 COVID-19 大流行期间无法避免住院治疗。维持 DS 的实施是 AIS 治疗在大流行期间的一个重要方面。
