Does Coronavirus Disease 2019 (COVID-19) Affect Perioperative Morbidity and Mortality for Patients Requiring Emergency Instrumented Spinal Surgery? A Single-Center Cohort Study.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic sent shockwaves through health services worldwide. Resources were reallocated. Patients with COVID-19 still required instrumented spinal surgery for emergencies. Clinical outcomes for these patients are not known. The objective of this study was to evaluate the effects of COVID-19 on perioperative morbidity and mortality for patients undergoing emergency instrumented spinal surgery and to determine risk factors for increased morbidity/mortality. METHODS: This retrospective cohort study included 11 patients who were negative for COVID-19 and 8 patients who were positive for COVID-19 who underwent emergency instrumented spinal surgery in 1 hospital in the United Kingdom during the pandemic peak. Data collection was performed through case note review. Patients in both treatment groups were comparable for age, sex, body mass index (BMI), comorbidities, surgical indication, and preoperative neurologic status. Predefined perioperative outcomes were recorded within a 30-day postoperative period. Univariable analysis was used to identify risk factors for increased morbidity. RESULTS: There were no mortalities in either treatment group. Four patients positive for COVID-19 (50%) developed a complication compared with 6 (55%) in the COVID-19-negative group (P > 0.05). The commonest complication in both groups was respiratory infection. Three patients positive for COVID-19 (37.5%) required intensive care unit admission, compared with 4 (36%) in the COVID-19-negative group (P > 0.05). The average time between surgery and discharge was 19 and 10 days in COVID-19-positive and -negative groups, respectively (P = 0.02). In the COVID-19 positive group, smoking, abnormal BMI, preoperative oxygen requirement, presence of fever, and oxygen saturations <95% correlated with increased risk of complications. CONCLUSIONS: Emergency instrumented spinal surgery in patients positive for COVID-19 was associated with increased length of hospital stay. There was no difference in occurrence of complications or intensive care unit admission. Risk factors for increased morbidity in patients with COVID-19 included smoking, abnormal BMI, preoperative oxygen requirement, fever and saturations <95%.

Obesity and posterior spinal fat content: impact on complications in non-complex lumbar spine surgery.

AIM: Obesity is increasing in prevalence across the world with a potentially very significant impact in spine surgery. This study aimed to characterise this in the setting of neurosurgical spine practise at a single centre in UK. Uniquely, we assess the contribution of posterior spinal fat content to intraoperative complications. MATERIALS AND METHODS: All cases of lumbar spine surgery in 1 year were investigated. Case note review was carried out documenting patient demographics, comorbidities, operative details, complications and length of stay. Ninety-four complete datasets were compiled from 128 cases. The posterior spinal fat content was recorded from T2-weighted MRI. Body mass index (BMI) was correlated with each measure using logistic multiple regression and contingency table analysis. RESULTS: Mean BMI was 28.3 (SD: 5.2) comprising one underweight (BMI <18.5), 26 normal weight (BMI: 18.5-24.9), 32 overweight (BMI ≥25), 33 obese (BMI ≥30) and two morbidly obese patients (BMI ≥40). BMI (coefficient: 0.03, SE: 0.01, p = 0.005) and posterior spinal fat content (coefficient: 0.01, SE: 0.005, p = 0.042) correlated significantly with increasing length of stay. Procedure (p = 0.006) and complication rate (p = 0.010) also correlated with length of stay. Neither BMI nor posterior spinal fat content had a significant effect on the incidence of perioperative complications (p = 0.932, p = 0.742), operating time (p = 0.454, p = 0.748) or blood loss (p = 0.127, p = 0.692). There were three non-operative complications in the obese and overweight groups compared with none in the normal weight group, but this was not significant. Overall complication rate was 15%. CONCLUSION: Obesity and posterior spinal fat content correlate with the length of stay in simple spine surgery. There is a non-significant trend towards increased non-operative complications in overweight and obese patients, which could reach significance with larger numbers and prospective data. Excess posterior spinal fat is not associated with increased operative complications, operating time or blood loss.

Patient safety and image transfer between referring hospitals and neuroscience centres: could we do better?

INTRODUCTION: District general hospital scanners have historically been linked to regional neuroscience units for specialist opinions on scans and to make decisions on transfer of patients requiring neurosurgical management. The implementation of digital picture archiving and communication systems (PACS) in all hospitals in the UK has disrupted these dedicated links and technical and information governance issues have delayed reprovision of electronic transfer of images for rapid expert decision making in this group of patients. We studied improvement in image transfer to acute neurosurgery units over a 4-year period. METHODS: Four-year sequential review of national provision of image transfer facilities into neurosurgery units; observational study of delays associated with image transfer modalities in one representative tertiary referral centre. RESULTS: During the 4 years of study, all hospitals nationally have implemented digital PACS systems for image viewing. Remote image viewing facilities have gradually changed with dedicated image links being replaced by remote PACS access. However, a minority of referrals (12%) still require images to be physically transferred between hospitals using couriers for CD-ROMs. The detailed study within our own unit shows that this adds a mean delay of 5.8 h to decision making. CONCLUSIONS: Image transfer in neuroscience has been neglected following the shift to PACS servers. The recommendations of the 2004 Neuroscience Critical Care Report are unmet and patient safety is being threatened by a continued failure to implement a coordinated solution to this problem.

Direct observation of treatment for tuberculosis: a randomized controlled trial of community health workers versus family members.

We implemented community-based direct observation of treatment, short course (DOTS), including a randomized controlled trial of direct observation either by community health workers (CHWs) or family members, under operational conditions in a region of Swaziland. There was a high death rate of 15%, due to the high HIV rates in the region. There was no significant difference in the cure and completion rate between direct observation of treatment by CHWs and family members [2% difference (95% CI -3% to 7%), exact P = 0.52]. A before-and-after comparison of outcomes demonstrated that the cure and treatment completion rate improved from a baseline of 27-67% following implementation of community-based DOTS. We conclude that community-based tuberculosis DOTS can improve successful outcomes of treatment. However, direct observation can be undertaken effectively using either daily family or CHW supervision. The choice of treatment supporter should be based on access, patient preference and availability of CHW resource.