1. Neurosurgery and coronavirus: impact and challenges—lessons learnt from the first wave of a global pandemic
- Author
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Alexandra Maria Velicu, Francesco Vergani, Harutomo Hasegawa, Mohammed Faruque, Gordan Grahovac, Nicholas Thomas, Irfan Malik, Eleni Maratos, Christopher Chandler, Christos M. Tolias, Ahilan Kailaya-Vasan, Sinan Barazi, Josephine Jung, David E. Bell, Pandurang Kulkarni, Richard Gullan, Keyoumars Ashkan, Ahmed Raslan, Cristina Bleil, Sanjeev Bassi, Bassel Zebian, Richard Selway, Ranjeev Bhangoo, and Daniel C. Walsh
- Subjects
Male ,Emergency Medical Services ,medicine.medical_specialty ,Neurosurgery ,Clinical Neurology ,Comorbidity ,Global Health ,Emergency referrals ,Subspecialty ,Neurosurgical Procedures ,State Medicine ,Cohort Studies ,03 medical and health sciences ,0302 clinical medicine ,Multidisciplinary approach ,Health care ,Pandemic ,medicine ,Humans ,Prospective Studies ,030212 general & internal medicine ,Pandemics ,Referral and Consultation ,Patient Care Team ,SARS-CoV-2 ,business.industry ,COVID-19 ,Original Article - Infection ,Perioperative ,Private sector ,United Kingdom ,Hospitalization ,Coronavirus ,Elective Surgical Procedures ,Emergency medicine ,Female ,Interdisciplinary Communication ,Surgery ,Patient Safety ,Neurology (clinical) ,business ,030217 neurology & neurosurgery ,Cohort study - Abstract
Introduction and objectivesThe 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.MethodsA 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.ResultsOverall, 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.ConclusionThe 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.
- Published
- 2020