Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study
Authors: Castaño-Leon Ana M , Paredes Igor , Lagares Alfonso , Gomez Pedro A , González-Leon Pedro , Perez-Nuñez Angel , Jiménez-Roldán Luis , Delgado-Fernández Juan , Eiriz Fernández Carla , García-Pérez Daniel , Moreno-Gómez Luis M , Esteban-Sinovas Olga , Delgado-López Pedro D , Martín-Alonso Javier , Kaen Ariel , Tirado-Caballero Jorge , Ordóñez-Carmona Marta , Arteaga-Romero Francisco , González-Pombo Marta , F Alén José , Gil-Simoes Ricardo , Torres Cristina V , Navas-García Marta , Blasco García de Andoain Guillermo , Frade-Porto Natalia , González-Tarno Patricia , Martin Segura Adrian , Gelabert-González Miguel , Menéndez-Cortezón Beatriz , Rodríguez-Botana Brais , Pérez-Alfayate Rebeca , Fernández-García Carla , Ferrández-Pujante Borja , Vargas-Jiménez Andres C , Cotúa Carlos , de la Lama Adolfo , Calero Félix Lourdes , Ruiz-Juretschke Fernando , García-Leal Roberto , Valera-Melé Marc , Casitas Hernando Vicente , Rivero Belén , Orduna-Martínez Javier , Casado Pellejero Juan , Fustero De Miguel David , Díaz Molina Jorge , Moles Herbera Jesús , Castelló-Ruiz Maria J , Gomar-Alba Mario , García-Pérez Fernando , Hernández-García Borja J , Villaseñor-Ledezma Jorge J , Otero-Rodríguez Álvaro , Ailagas de las Heras Juan J , Gonçalves-Estella Jesus , Sousa-Casasnovas Pablo , Pascual-Argente Daniel , Ruiz Martín Laura , Roa Montes de Oca Juan C , Arandia Guzmán Daniel , García Martín Andoni , Torres Carretero Luis , Garrido Ruiz Alejandra , Calvo Marta , Miranda-Lloret Pablo , Rodríguez-Cadarso Miguel , Antón Joan , Roca Barber Amparo , Quiroz-Tejada Arnold , Carbayo-Lozano Guillermo , Bermúdez Garazi , Paternain Martin Clara , De la Fuente Villa Pablo , Fidalgo De la Rosa Marina , Sistiaga-Gracia Íñigo L , Zabalo Gorka 
Published: August 2022

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.