Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic
Authors: Poon Michael T C , Piper Rory J , Thango Nqobile , Fountain Daniel M , Marcus Hani J , Lippa Laura , Servadei Franco , Esene Ignatius N , Freyschlag Christian F , Neville Iuri S , Rosseau Gail , Schaller Karl , Demetriades Andreas K , Robertson Faith C , Hutchinson Peter J , Price Stephen J , Baticulon Ronnie E , Glasbey James C , Bhangu Aneel , Jenkinson Michael D , Kolias Angelos G ,   Writing Group of the COVIDSurg-Cancer neurosurgery investigators on behalf of the COVIDSurg Collaborative; British Neurosurgical Trainee Research Collaborative; WFNS Young Neurosurgeons Committee; NIHR Global Health Research Group on Acquired Brain and Spine Injury, Burtscher J , Trivik-Barrientos F , Bauer M , Freyschlag C , Lemos Vieira da Cunha M , Persad A , Pham H , Wood M , Christensen P , Haldrup M , Iversen L H , Kristensen H Ø , Mekhael M , Mikic N , Crespo A , Díaz P , Tactuk N , Abdelsamed A , Azzam A Y , Salem H , Seleim A , Abd-elsalam S , Badr H , Elbahnasawy M , Essa M , Gamal Badr S , Ghoneim A , Hamad O , Hamada M , Hawila A , Morsy M S , Sarsik S , Ballouhey Q , Salle H , Barrios Duarte A , Lopez Muralles I , Lowey M , Portilla A L , Recinos G , Arora R , Kottayasamy Seenivasagam R , Sadhasivam S , Babu N , Kheni Y , Kommu V , Rao S , Moiyadi A , Pandey D , Pramesh C S , Shetty P , Singh V , Islam A A , Kembuan G , Pajan H , Safari H , Bàmbina F , D’Andrea G , Familiari P , Picotti V , Bruzzaniti P , Chiarella V , Di bartolomeo A , Frati A , Giugliano M , Lapolla P , Salvati M , Santoro A , Scafa A K , Gagliardi F , Medone M , Mortini P , Piloni M , Belvedere A , Droghetti M , Frio F , Neri J , Pezzuto A P , Poggioli G , Rottoli M , Russo I S , Aquila F , Gambacciani C , Lippa L , Pieri F , Santonocito O S , Al Abdallah M , Ayasra F , Ayasra Y , Qasem A , Abu Za’nouneh F J , Al_shraideh A A , Fahmawee T , Ibrahim A , Abou Chaar M K , Al-Najjar H , Elayyan M , Abusannoga M , Alawami A , Alawami M , Albashri M , Malek A , Abdulwahed E , Biala M , Ghamgh R , Arkha Y , Bechri H , El Ouahabi A , Oudrhiri M Y , El Azhari A , Louraoui S M , Rghioui M , Bougrine M , Derkaoui Hassani F , El Abbadi N , Akinmade A , Fayose S , Okunlola A , Dawang Y , Obande J , Olori S , Abdur-Rahman L , Adeleke N , Adeyeye A , Javed S , Yaqoob E , Al-Slaibi I , Alzeerelhouseini H I A , Jobran F , Alshahrani M , Alsharif F , Azab M A , Al Otaibi F , AlDahash H , Alhazzaa N , Alhefdhi A , AlSumai T , Farrash F , Spangenberg P , Ajlan A , Al-Habib A , Alatar A , Bin Nasser A , Elwatidy S , Nouh T , Abdulfattah F , Alanazi F , Albaqami F , Alsowaina K , Bascarevic V , Bogdanovic I , Grujičić D , Ilic R , Milićević M , Milisavljević F , Miljković A , Paunovic A , Šćepanović V , Stanimirovic A , Todorovic M , Castaño-Leon A M , Delgado Fernandez J , Eiriz Fernandez C , Esteban Sinovas O , Garcia Perez D , Gomez P , Jimenez-Roldan L , Lagares A , Moreno-Gomez L , Paredes I , Pérez Núñez A , Aldecoa Ansorregui I , Di Somma A , Enseñat Nora J , Fabregas N , Ferrés A , Gonzalez Sanchez J J , Gracia I , Hoyos Castro J A , Langdon C , Oleaga L , Pedrosa L , Poblete Carrizo J , Reyes Figueroa L A , Roldan Ramos P , Rumia-Arboix J , Tercero-Uribe A I , Topczewski T E , Torales J , Torné R , Valero R , Mahfoud M , Bekheit M , Ashcroft J , Coughlin P , Davies R J , Hutchinson P , Khan D Z , Kolias A , Mannion R , Mohan M , Price S , Santarius T , Singh A , Yordanov S , Ganau M , Jeyaretna D , Piper R , Sravanam S , McSorley N , Solth A , Chowdhury Y , Karia K , Solomou G , Soon W C , Stevens A , Topham C , Ughratdar I , Alakandy L , Bhattathiri P , Brown J , Canty M , Grivas A , Hassan S , Lammy S , Littlechild P , Maseland C , Mathieson C , O’Kane R , George E St , Suttner N , Taylor W , Al-Tamimi Y , Bacon A , Crank M , Rominiyi O , Sinha S , Brennan P M , Pasricha R , Anzak A , Leal Silva I , Sohrabi C , Thakur B , Patkar P , Phang I , Colombo F , Fountain D , Hasan M T , Karabatsou K , Laurente R , Pathmanaban O , Choi D , Hutchison R , Jain A , Luoma V , Marcus H , May R , Menon A , Pramodana B , Webber L , Elmoslemany T , Jenkinson M , Millward C P , Zakaria R , Bigelow B , Etchill E , Gabre-Kidan A , Jenny H , Ladd M , Long C , Malapati H , Margalit A , Rapaport S , Rose J , Tsai L , Vervoort D , Yesantharao P , Arzumanov G , Glass N , Zhao K , Aoun S , Ban V S , Batjer H H , Caruso J , Ruzgar N M , Sion M , Ullrich S 
Published: April 2023

Abstract

Background
This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic.

Methods
We prospectively included adults aged ≥18 years who underwent surgery for a malignant or benign intracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients’ location by World Bank income groups (high [HIC], upper-middle [UMIC], and low- and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality.

Results
Among 1016 patients, the number of patients in each income group was 765 (75.3%) in HIC, 142 (14.0%) in UMIC, and 109 (10.7%) in LLMIC. The management of 200 (19.8%) patients changed from usual care, most commonly delayed surgery. Within 30 days after surgery, 14 (1.4%) patients had a COVID-19 diagnosis and 39 (3.8%) patients died. In the multivariable model, LLMIC was associated with increased mortality (odds ratio 2.83, 95% credible interval 1.37–5.74) compared to HIC.

Conclusions
The first wave of the pandemic had a significant impact on surgical decision-making. While the incidence of SARS-CoV-2 infection within 30 days after surgery was low, there was a disparity in mortality between countries and this warrants further examination to identify any modifiable factors.