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Neurosurgery and coronavirus: impact and challenges-lessons learnt from the first wave of a global pandemic.
Acta Neurochir (Wien). 2021 02; 163(2):317-329.AN

Abstract

INTRODUCTION AND OBJECTIVES

The novel severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has had drastic effects on global healthcare with the UK amongst the countries most severely impacted. The aim of this study was to examine how COVID-19 challenged the neurosurgical delivery of care in a busy tertiary unit serving a socio-economically diverse population.

METHODS

A prospective single-centre cohort study including all patients referred to the acute neurosurgical service or the subspecialty multidisciplinary teams (MDT) as well as all emergency and elective admissions during COVID-19 (18th March 2020-15th May 2020) compared to pre-COVID-19 (18th of January 2020-17th March 2020). Data on demographics, diagnosis, operation, and treatment recommendation/outcome were collected and analysed.

RESULTS

Overall, there was a reduction in neurosurgical emergency referrals by 33.6% and operations by 55.6% during the course of COVID-19. There was a significant increase in the proportion of emergency operations performed during COVID-19 (75.2% of total, n=155) when compared to pre-COVID-19 (n = 198, 43.7% of total, p < 0.00001). In contrast to other published series, the 30-day perioperative mortality remained low (2.0%) with the majority of post-operative COVID-19-infected patients (n = 13) having underlying medical co-morbidities and/or suffering from post-operative complications.

CONCLUSION

The capacity to safely treat patients requiring urgent or emergency neurosurgical care was maintained at all times. Strategies adopted to enable this included proactively approaching the referrers to maintain lines of communications, incorporating modern technology to run clinics and MDTs, restructuring patient pathways/facilities, and initiating the delivery of NHS care within private sector hospitals. Through this multi-modal approach we were able to minimize service disruptions, the complications, and mortality.

Authors+Show Affiliations

Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK. Neurosciences Clinical Trials Unit, King's College Hospital, London, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK. Josephine.Jung@nhs.net. Neurosciences Clinical Trials Unit, King's College Hospital, London, UK. Josephine.Jung@nhs.net.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK. Neurosciences Clinical Trials Unit, King's College Hospital, London, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.Department of Neurosurgery, King's College Hospital, Denmark Hill, London, SE5 9RS, UK.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

33222008

Citation

Ashkan, Keyoumars, et al. "Neurosurgery and Coronavirus: Impact and Challenges-lessons Learnt From the First Wave of a Global Pandemic." Acta Neurochirurgica, vol. 163, no. 2, 2021, pp. 317-329.
Ashkan K, Jung J, Velicu AM, et al. Neurosurgery and coronavirus: impact and challenges-lessons learnt from the first wave of a global pandemic. Acta Neurochir (Wien). 2021;163(2):317-329.
Ashkan, K., Jung, J., Velicu, A. M., Raslan, A., Faruque, M., Kulkarni, P., Bleil, C., Hasegawa, H., Kailaya-Vasan, A., Maratos, E., Grahovac, G., Vergani, F., Zebian, B., Barazi, S., Malik, I., Bell, D., Walsh, D., Bhangoo, R., Tolias, C., ... Gullan, R. (2021). Neurosurgery and coronavirus: impact and challenges-lessons learnt from the first wave of a global pandemic. Acta Neurochirurgica, 163(2), 317-329. https://doi.org/10.1007/s00701-020-04652-8
Ashkan K, et al. Neurosurgery and Coronavirus: Impact and Challenges-lessons Learnt From the First Wave of a Global Pandemic. Acta Neurochir (Wien). 2021;163(2):317-329. PubMed PMID: 33222008.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neurosurgery and coronavirus: impact and challenges-lessons learnt from the first wave of a global pandemic. AU - Ashkan,Keyoumars, AU - Jung,Josephine, AU - Velicu,Alexandra Maria, AU - Raslan,Ahmed, AU - Faruque,Mohammed, AU - Kulkarni,Pandurang, AU - Bleil,Cristina, AU - Hasegawa,Harutomo, AU - Kailaya-Vasan,Ahilan, AU - Maratos,Eleni, AU - Grahovac,Gordan, AU - Vergani,Francesco, AU - Zebian,Bassel, AU - Barazi,Sinan, AU - Malik,Irfan, AU - Bell,David, AU - Walsh,Daniel, AU - Bhangoo,Ranjeev, AU - Tolias,Christos, AU - Bassi,Sanjeev, AU - Selway,Richard, AU - Thomas,Nick, AU - Chandler,Christopher, AU - Gullan,Richard, Y1 - 2020/11/21/ PY - 2020/09/22/received PY - 2020/11/12/accepted PY - 2020/11/23/pubmed PY - 2021/1/29/medline PY - 2020/11/22/entrez KW - Coronavirus KW - Emergency referrals KW - Neurosurgery KW - Pandemic SP - 317 EP - 329 JF - Acta neurochirurgica JO - Acta Neurochir (Wien) VL - 163 IS - 2 N2 - INTRODUCTION AND OBJECTIVES: The novel severe acute respiratory syndrome coronavirus 2 (COVID-19) pandemic has had drastic effects on global healthcare with the UK amongst the countries most severely impacted. The aim of this study was to examine how COVID-19 challenged the neurosurgical delivery of care in a busy tertiary unit serving a socio-economically diverse population. METHODS: A prospective single-centre cohort study including all patients referred to the acute neurosurgical service or the subspecialty multidisciplinary teams (MDT) as well as all emergency and elective admissions during COVID-19 (18th March 2020-15th May 2020) compared to pre-COVID-19 (18th of January 2020-17th March 2020). Data on demographics, diagnosis, operation, and treatment recommendation/outcome were collected and analysed. RESULTS: Overall, there was a reduction in neurosurgical emergency referrals by 33.6% and operations by 55.6% during the course of COVID-19. There was a significant increase in the proportion of emergency operations performed during COVID-19 (75.2% of total, n=155) when compared to pre-COVID-19 (n = 198, 43.7% of total, p < 0.00001). In contrast to other published series, the 30-day perioperative mortality remained low (2.0%) with the majority of post-operative COVID-19-infected patients (n = 13) having underlying medical co-morbidities and/or suffering from post-operative complications. CONCLUSION: The capacity to safely treat patients requiring urgent or emergency neurosurgical care was maintained at all times. Strategies adopted to enable this included proactively approaching the referrers to maintain lines of communications, incorporating modern technology to run clinics and MDTs, restructuring patient pathways/facilities, and initiating the delivery of NHS care within private sector hospitals. Through this multi-modal approach we were able to minimize service disruptions, the complications, and mortality. SN - 0942-0940 UR - https://www.unboundmedicine.com/medline/citation/33222008/Neurosurgery_and_coronavirus:_impact_and_challenges_lessons_learnt_from_the_first_wave_of_a_global_pandemic_ L2 - https://dx.doi.org/10.1007/s00701-020-04652-8 DB - PRIME DP - Unbound Medicine ER -