Non-intubated vs. intubated video-assisted thoracoscopic bullectomy - a retrospective cohort study.

INTRODUCTION: Thoracic surgery procedures evolved enormously over time from open surgery to video assisted thoracoscopic surgery (VATS) and now non-intubated uniportal VATS. At our centre, the initial approach for bullectomy was by uniportal intubated VATS (iVATS) for most cases. Only in mid-2020, in the midst of COVID-19 pandemic, uniportal non-intubated VATS (NiVATS) took precedence. We compared the outcome of bullectomy via iVATS versus NiVATS for a period of 5 years. MATERIALS AND METHODS: We reviewed the medical records of all patients that underwent bullectomy from 1st June 2017 to 31st May 2022. Mann Whitney U-test was completed for all variables. Primary objective was to compare operating time (OT), global operating time (GOT), post-operative length of stay (LOS) and complication rate. RESULTS: A total of 90 bullectomies performed in which 36 were approached via iVATS and 54 NiVATS. It was found that the post-operative LOS, GOT, and OT were significantly shorter in the NiVATS as compared to iVATS. Complication rate between both groups showed no significant difference. CONCLUSION: NiVATS bullectomy demonstrated a safe and reliable alternative surgical approach with superior surgical outcome than iVATS bullectomy.

Momento de la cirugía en pacientes iraquíes con Contagio de COVID-19 / Timing of surgery in Iraqi patients with COVID-19 infection

Los pacientes con infección perioperatoria por COVID-19 tienen un alto riesgo de muerte y complicaciones posoperatorias. En la actualidad, la infección por COVID-19 en Irak representó 1.696.390 casos con 19.087 muertes. Un estudio nacional, único y observacional que incluyó pacientes con infección por COVID-19 que se sometieron a cualquier tipo de cirugía en el Hospital General de Abu-Graib, Bagdad, Irak, durante el período del 19 de marzo de 2020 al 30 de abril de 2021. Tiempo desde el diagnóstico de la infección por COVID-19 El día de la cirugía se recogió como factor categórico dividido en: (a) 0-3 semanas; (b) 4­6 semanas; (c) >6 semanas. Edad; sexo; estado físico de la Sociedad Americana de Anestesiólogos (ASA); comorbilidades cardíacas; comorbilidades respiratorias; indicación de cirugía; grado de cirugía; y se documentaron los tipos quirúrgicos. Se incluyeron un total de 378 pacientes con una edad media de 47,89±16,03 años. Las mujeres eran más que los hombres (65,87% > 34,13%). Aproximadamente, el 76,72% de los pacientes pertenecían a ASA I-II, mientras que el 23,28% eran ASA III-IV. Alrededor del 19,05% de los pacientes sufría de comorbilidades cardíacas. 266/378 de los pacientes se quejaron de comorbilidades respiratorias. Cirugía indicada en 35,45% condiciones benignas, 27,5% obstetricia, 7,65% cirugía oncológica y 29,4% operaciones traumáticas. Operaciones mayores documentadas en 205/378 pacientes. Las intervenciones quirúrgicas de urgencia realizadas en (176, 46,56%), mientras que los casos electivos fueron 202/378 (53,44%). En total, en el momento de la operación, 80 (21,16 %) pacientes tenían un diagnóstico preoperatorio de COVID-19. El tiempo desde el diagnóstico de COVID-19 hasta la cirugía fue de 0 a 3 semanas en 98 pacientes (25,93 %), de 4 a 6 semanas en 115 pacientes (30,42 %) y >6 semanas en 165 pacientes (43,65 %). La tasa de mortalidad postoperatoria global fue del 9,52% (36/378). Con respecto a la complicación cardiaca de la O.P., no hubo asociación significativa en relación al momento previo a la cirugía (p=0,08). Sin embargo, la complicación cardíaca global fue del 16,4%. En general, el 44,97 % (170/378) de los pacientes desarrollaron una complicación pulmonar por O.P. durante el período de seguimiento. Hasta donde sabemos, este es el primer estudio que proporciona datos sólidos sobre el momento óptimo para la cirugía después de la infección por COVID-19 en Irak. El momento óptimo de la cirugía después de la infección por COVID-19 fue de más de 6 semanas. Descubrimos que los riesgos de morbilidad y mortalidad por O.P. son mayores si los pacientes son operados dentro de las 6 semanas posteriores al diagnóstico de infección por COVID-19.

Patients with perioperative COVID-19 infection are at high risk of death and complications postoperatively. Nowadays, COVID-19 infection in Iraq accounted 1,696,390 cases with 19,087 deaths. A national, single, and observational study that included patients with COVID-19 infection undergoing any type of surgery in Abu-Graib General Hospital, Baghdad Iraq during period from 19 March 2020 to 30 April 2021. Time from the diagnosis of COVID-19 infection to day of surgery was collected as a categorical factor divided into: (a) 0­3 wks; (b) 4­6 wks; (c) >6 wks. Age; sex; American Society of Anesthesiologists (ASA) physical status; cardiac comorbidities; respiratory comorbidities; indication for surgery; surgery grade; and surgical types were documented. A total of 378 patient were included with mean age was 47.89±16.03 years. Females were more than males (65.87% > 34.13%). Approximately, 76.72% of patients belonged within ASA I-II, whereas 23.28% were ASA III-IV. About 19.05% of patients suffered from cardiac comorbidities. 266/378 of patients complained from respiratory comorbidities. Surgery indicated in 35.45% benign conditions, 27.5% obstetrics, 7.65% oncological surgery, and 29.4% traumatic operations. Major operations documented in 205/378 patients. Emergencies surgical intervention done in (176, 46.56%), whereas elective cases were 202/378 (53.44%). In total at operation timing, 80(21.16%) patients had a preoperative COVID-19 diagnosis. The time from COVID-19 diagnosis to surgery was 0­3 weeks in 98 patients (25.93%), 4­6 weeks in 115 patients (30.42%), and >6 weeks in 165 patients (43.65%). The overall postoperative mortality rate was 9.52% (36/378). In regard to P. O. cardiac complication, there was no significant association in relation to timing before surgery (p=0.08). However, the overall cardiac complication was 16.4%. Overall, 44.97% (170/378) of patients developed a P. O. pulmonary complication within period of follow-up. To our knowledge this is the first study to provide strong data regarding the optimal timing for surgery following COVID-19 infection in Iraq. The optimal timing of surgery after COVID-19 infection was more than 6 wks. We found that risks of P. O. morbidity and mortality are greatest if patients are operated within 6 wks of diagnosis of COVID-19 infection

Tracheostomy timing and clinical outcomes in ventilated COVID-19 patients: a systematic review and meta-analysis.

BACKGROUND: The association of tracheostomy timing and clinical outcomes in ventilated COVID-19 patients remains controversial. We performed a meta-analysis to evaluate the impact of early tracheostomy compared to late tracheostomy on COVID-19 patients' outcomes. METHODS: We searched Medline, Embase, Cochrane, and Scopus database, along with medRxiv, bioRxiv, and Research Square, from December 1, 2019, to August 24, 2021. Early tracheostomy was defined as a tracheostomy conducted 14 days or less after initiation of invasive mechanical ventilation (IMV). Late tracheostomy was any time thereafter. Duration of IMV, duration of ICU stay, and overall mortality were the primary outcomes of the meta-analysis. Pooled odds ratios (OR) or the mean differences (MD) with 95%CIs were calculated using a random-effects model. RESULTS: Fourteen studies with a cumulative 2371 tracheostomized COVID-19 patients were included in this review. Early tracheostomy was associated with significant reductions in duration of IMV (2098 patients; MD - 9.08 days, 95% CI - 10.91 to - 7.26 days, p < 0.01) and duration of ICU stay (1224 patients; MD - 9.41 days, 95% CI - 12.36 to - 6.46 days, p < 0.01). Mortality was reported for 2343 patients and was comparable between groups (OR 1.09, 95% CI 0.79-1.51, p = 0.59). CONCLUSIONS: The results of this meta-analysis suggest that, compared with late tracheostomy, early tracheostomy in COVID-19 patients was associated with shorter duration of IMV and ICU stay without modifying the mortality rate. These findings may have important implications to improve ICU availability during the COVID-19 pandemic. Trial registration The protocol was registered at INPLASY (INPLASY202180088).

Effects of COVID-19 pandemic on colorectal cancer surgery

ABSTRACT BACKGROUND: The coronavirus disease-19 (COVID-19) pandemic has changed the course of diseases that require emergency surgery. OBJECTIVE: To evaluate the effect of the COVID-19 pandemic on colorectal cancer disease stage. DESIGN AND SETTING: Retrospective analysis in the city of Rize, Turkey. METHODS: This was a comparative analysis on two groups of patients with various symptoms who underwent surgical colorectal cancer treatment. Group 1 comprised patients operated between March 11, 2019, and December 31, 2019; while group 2 comprised patients at the same time of the year during the COVID-19 pandemic. RESULTS: Groups 1 and 2 included 56 and 48 patients, respectively. The rate of presentation to the emergency service was higher in Group 2 (P < 0.02). The stage of the pathological lymph nodes and the rate of liver metastasis was higher in Group 2 (P < 0.004 and P < 0.041, respectively). The disease stage was found to be more advanced in Group 2 (P < 0.005). The rate of postoperative complications was higher in Group 2 (P < 0.014). CONCLUSION: The presentation of patients with suspicious findings to the hospital was delayed, due both to the fear of catching COVID-19 and to the pandemic precautions that were proposed and implemented by healthcare authorities worldwide. Among the patients who presented to the hospital with emergency complaints and in whom colorectal cancer was detected, their disease was at a more advanced stage and thus a higher number of emergency oncological surgical procedures were performed on those patients.

Lung Transplantation for Patients With COVID-19.

The COVID-19 pandemic has caused acute lung injury in millions of individuals worldwide. Some patients develop COVID-related acute respiratory distress syndrome (CARDS) and cannot be liberated from mechanical ventilation. Others may develop post-COVID fibrosis, resulting in substantial disability and need for long-term supplemental oxygen. In both of these situations, treatment teams often inquire about the possibility of lung transplantation. In fact, lung transplantation has been successfully employed for both CARDS and post-COVID fibrosis in a limited number of patients worldwide. Lung transplantation after COVID infection presents a number of unique challenges that transplant programs must consider. In those with severe CARDS, the inability to conduct proper psychosocial evaluation and pretransplantation education, marked deconditioning from critical illness, and infectious concerns regarding viral reactivation are major hurdles. In those with post-COVID fibrosis, our limited knowledge about the natural history of recovery after COVID-19 infection is problematic. Increased knowledge of the likelihood and degree of recovery after COVID-19 acute lung injury is essential for appropriate decision-making with regard to transplantation. Transplant physicians must weigh the risks and benefits of lung transplantation differently in a post-COVID fibrosis patient who is likely to remain stable or gradually improve in comparison with a patient with a known progressive fibrosing interstitial lung disease (fILD). Clearly lung transplantation can be a life-saving therapeutic option for some patients with severe lung injury from COVID-19 infection. In this review, we discuss how lung transplant providers from a number of experienced centers approach lung transplantation for CARDS or post-COVID fibrosis.

Stellate ganglion block reduces symptoms of Long COVID: A case series.

After recovering from COVID-19, a significant proportion of symptomatic and asymptomatic individuals develop Long COVID. Fatigue, orthostatic intolerance, brain fog, anosmia, and ageusia/dysgeusia in Long COVID resemble "sickness behavior," the autonomic nervous system response to pro-inflammatory cytokines (Dantzer et al., 2008). Aberrant network adaptation to sympathetic/parasympathetic imbalance is expected to produce long-standing dysautonomia. Cervical sympathetic chain activity can be blocked with local anesthetic, allowing the regional autonomic nervous system to "reboot." In this case series, we successfully treated two Long COVID patients using stellate ganglion block, implicating dysautonomia in the pathophysiology of Long COVID and suggesting a novel treatment.

Neurosurgery at the crossroads of immunology and nanotechnology. New reality in the COVID-19 pandemic.

Neurosurgery as one of the most technologically demanding medical fields rapidly adapts the newest developments from multiple scientific disciplines for treating brain tumors. Despite half a century of clinical trials, survival for brain primary tumors such as glioblastoma (GBM), the most common primary brain cancer, or rare ones including primary central nervous system lymphoma (PCNSL), is dismal. Cancer therapy and research have currently shifted toward targeted approaches, and personalized therapies. The orchestration of novel and effective blood-brain barrier (BBB) drug delivery approaches, targeting of cancer cells and regulating tumor microenvironment including the immune system are the key themes of this review. As the global pandemic due to SARS-CoV-2 virus continues, neurosurgery and neuro-oncology must wrestle with the issues related to treatment-related immune dysfunction. The selection of chemotherapeutic treatments, even rare cases of hypersensitivity reactions (HSRs) that occur among immunocompromised people, and number of vaccinations they have to get are emerging as a new chapter for modern Nano neurosurgery.

Tracheostomy in COVID-19 acute respiratory distress syndrome patients and follow-up: A parisian bicentric retrospective cohort.

BACKGROUND: Tracheostomy has been proposed as an option to help organize the healthcare system to face the unprecedented number of patients hospitalized for a COVID-19-related acute respiratory distress syndrome (ARDS) in intensive care units (ICU). It is, however, considered a particularly high-risk procedure for contamination. This paper aims to provide our experience in performing tracheostomies on COVID-19 critically ill patients during the pandemic and its long-term local complications. METHODS: We performed a retrospective analysis of prospectively collected data of patients tracheostomized for a COVID-19-related ARDS in two university hospitals in the Paris region between January 27th (date of first COVID-19 admission) and May 18th, 2020 (date of last tracheostomy performed). We focused on tracheostomy technique (percutaneous versus surgical), timing (early versus late) and late complications. RESULTS: Forty-eight tracheostomies were performed with an equal division between surgical and percutaneous techniques. There was no difference in patients' characteristics between surgical and percutaneous groups. Tracheostomy was performed after a median of 17 [12-22] days of mechanical ventilation (MV), with 10 patients in the "early" group (≤ day 10) and 38 patients in the "late" group (> day 10). Survivors required MV for a median of 32 [22-41] days and were ultimately decannulated with a median of 21 [15-34] days spent on cannula. Patients in the early group had shorter ICU and hospital stays (respectively 15 [12-19] versus 35 [25-47] days; p = 0.002, and 21 [16-28] versus 54 [35-72] days; p = 0.002) and spent less time on MV (respectively 17 [14-20] and 35 [27-43] days; p<0.001). Interestingly, patients in the percutaneous group had shorter hospital and rehabilitation center stays (respectively 44 [34-81] versus 92 [61-118] days; p = 0.012, and 24 [11-38] versus 45 [22-71] days; p = 0.045). Of the 30 (67%) patients examined by a head and neck surgeon, 17 (57%) had complications with unilateral laryngeal palsy (n = 5) being the most prevalent. CONCLUSIONS: Tracheostomy seems to be a safe procedure that could help ICU organization by delegating work to a separate team and favoring patient turnover by allowing faster transfer to step-down units. Following guidelines alone was found sufficient to prevent the risk of aerosolization and contamination of healthcare professionals.

Percutaneous Dilational Tracheostomy at the Epicenter of the SARS-CoV-2 Pandemic: Impact on Critical Care Resource Utilization and Early Outcomes.

BACKGROUND: The COVID-19 pandemic overwhelmed New York City hospitals early in the pandemic. Shortages of ventilators and sedatives prompted tracheostomy earlier than recommended by professional societies. This study evaluates the impact of percutaneous dilational tracheostomy (PDT) in COVID+ patients on critical care capacity. METHODS: This is a single-institution prospective case series of mechanically ventilated COVID-19 patients undergoing PDT from April 1 to June 4, 2020 at a public tertiary care center. RESULTS: Fifty-five patients met PDT criteria and underwent PDT at a median of 13 days (IQR 10, 18) from intubation. Patient characteristics are found in Table 1. Intravenous midazolam, fentanyl, and cisatracurium equivalents were significantly reduced 48 hours post-PDT (Table 2). Thirty-five patients were transferred from the ICU and liberated from the ventilator. Median time from PDT to ventilator liberation and ICU discharge was 10 (IQR 4, 14) and 12 (IQR 8, 17) days, respectively. Decannulation occurred in 45.5% and 52.7% were discharged from acute inpatient care (Figure 1). Median follow-up for the study was 62 days. Four patients had bleeding complications postoperatively and 11 died during the study period. Older age was associated with increased odds of complication (OR 1.12, 95% CI 1.04, 1.23) and death (OR=1.15, 95% CI 1.05, 1.30). All operators tested negative for COVID-19 during the study period. CONCLUSION: These findings suggest COVID-19 patients undergoing tracheostomy within the standard time frame can improve critical care capacity in areas strained by the pandemic with low risk to operators. Long-term outcomes after PDT deserve further study.

Lung Transplantation as a way to Escape Pneumonia in Patients with COVID-19: Lessons from ARDS and Influenza.

In this era, the novel Coronavirus, referred to as Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), a life-threatening virus with a high mortality rate (4.2%) and with no absolute treatment as of yet, may ultimately result in acute respiratory distress syndrome (ARDS). ARDS is one of the fatal complications, highlighted by pulmonary infiltration and severe hypoxemia. This condition can be developed from primary lung inflammation caused by various viruses, particularly influenza viruses, some of the most common human pathogens. Due to this issue, many studies explored several approaches for ARDS treatment. Lung transplantation has been claimed as an efficient cure for severe ARDS and Influenza, which can also be offered for treating critical lung complications of SARS-CoV-2. Thereupon, to the best of our knowledge for the first time, we aimed to review all available data about capability of lung transplantation for the treatment of critically ill patients with ARDS, Influenza, and SARS-CoV-2.

Covid-19: demanda reprimida de cirurgias eletivas / Covid-19: pent-up demand for elective surgeries

A pandemia causada pelo SARS-CoV-2 impôs grandes sobrecarga aos sistemas de saúde em todo o mundo. A partir de março de 2020, no intuito de priorizar os recursos assistenciais ao atendimento dos casos de COVID-19, consultas e procedimentos cirúrgicos eletivos foram suspensos por diferentes períodos de tempo conforme a situação epidemiológica de cada país. No Brasil e em Goiás, o número de procedimentos cirúrgicos eletivos diminuiu consideravelmente durante a pandemia, comparado aos anos anteriores tabela (1). Em todo o território nacional, em 2020, houve uma redução de 41,5% do total de cirurgias eletivas e, no estado de 30,9% em relação a 2019 (GOIÁS, 2021). A redução da oferta de cirurgias eletivas gera atraso para realização de condutas terapêuticas, agravamento de condições preexistentes, piora do prognóstico do paciente, aumento da morbimortalidade e maior impacto financeiro para os sistemas de saúde (ROYAL COLLEGE OF SURGEONS OF ENGLAND, 2021).

The pandemic caused by SARS-CoV-2 has imposed great burden on health systems worldwide. From March 2020, in order to prioritize care resources to attend the cases of COVID-19, consultations and elective surgical procedures were suspended for different periods of time according to the epidemiological situation of each country. In Brazil and Goiás, the number of elective surgical procedures decreased considerably during the pandemic, compared to previous years table (1). Nationwide, in 2020, there was a 41.5% reduction in all elective surgeries and, in the state, 30.9% compared to 2019 (GOIÁS, 2021). The reduction in the supply of elective surgeries generates delay in performing therapeutic approaches, worsening of preexisting conditions, worsening of the patient's prognosis, increased morbidity and mortality and greater financial impact on health systems (ROYAL COLLEGE OF SURGEONS OF ENGLAND, 2021)

Providing safe perioperative care in cardiac surgery during the COVID-19 pandemic.

The coronavirus disease 2019 (COVID-19) pandemic has potentiated the need for implementation of strict safety measures in the medical care of surgical patients - and especially in cardiac surgery patients, who are at a higher risk of COVID-19-associated morbidity and mortality. Such measures not only require minimization of patients' exposure to COVID-19 but also careful balancing of the risks of postponing nonemergent surgical procedures and providing appropriate and timely surgical care. We provide an overview of current evidence for preoperative strategies used in cardiac surgery patients, including risk stratification, telemedicine, logistical challenges during inpatient care, appropriate screening capacity, and decision-making on when to safely operate on COVID-19 patients. Further, we focus on perioperative measures such as safe operating room management and address the dilemma over when to perform cardiovascular surgical procedures in patients at risk.

Predictors of Telemedicine Utilization in a Pediatric Neurosurgical Population During the COVID-19 Pandemic.

OBJECTIVE: In the wake of the COVID-19 pandemic, telemedicine has become rapidly adopted by the neurosurgical community; however, few studies have examined predictors of telemedicine utilization. Here, we analyze patient variables associated with the acceptance of a telemedicine encounter by a pediatric neurosurgical population during the early phases of the COVID-19 pandemic. METHODS: All patients seen in a single institution's outpatient pediatric neurosurgery clinic between April 1, 2020 and July 31, 2020 were retrospectively reviewed. Demographic variables were collected for each patient's first completed encounter. Patients participating in telemedicine were compared with those seen in person. Univariate analysis was performed using the Wilcoxon rank sum test for continuous variables and Fischer exact test for categorical variables. A logistic regression multivariable analysis was then performed. RESULTS: We included 682 patients (374 telemedicine and 308 in person). Univariate analysis demonstrated that telemedicine visits were more likely to occur at earlier study dates (P < 0.001) and that patients participating in telemedicine visits were more likely to be established rather than new patients (P < 0.001), White or Caucasian (P < 0.001), not Hispanic or Latino (P < 0.001), English-speaking (P < 0.001), non-Medicare/Medicaid recipients (P < 0.001), have lower no-show rates (P = 0.006), and live farther from the hospital (P = 0.005). Multivariable analysis demonstrated older age (P = 0.031), earlier appointment date (P < 0.01), established patient status (P < 0.001), English-speaking (P < 0.02), and non-Medicare/Medicaid insurance (P < 0.05) were significant predictors of telemedicine utilization. CONCLUSIONS: Significant demographic differences exist among pediatric patients who participated in telemedicine versus those who requested an in-person visit at our institution. Addressing barriers to access will be crucial for promoting health equity in continued utilization of telemedicine.

First lung transplantation as a treatment of a patient supported with extracorporeal membrane oxygenation (ECMO) after COVID-19 in Poland.

A 44-year-old male with no history of underlying diseases was referred to academic hospital due to ARDS with confirmed SARSCoV-2 infection after 7 days of mechanical ventilation. Veno-venous (VV) extracorporeal membrane oxygenation (ECMO) was initiated as no improvement was noted in prone position. Mechanical ventilation was continued with TV of 3-4 mL/kg. A gradual decline of static lung compliance was observed from baseline 35 mL/cm H20 to 8 mL/cm H2O. The chest CT scan revealed extensive ground-glass areas with a significant amount of traction bronchiectasis after 3 weeks since admission. When the patient was negative for SARS-CoV-2 during the 4th week of ECMO, the decision to perform an emergency lung transplantation (LTx) was made based on the ongoing degradation of lung function and irreversible damage to lung structure. The patient was transferred to the transplant center where he was extubated, awaiting the transplant on passive oxygen therapy and ECMO. Double lung transplantation was performed on the day 30th of ECMO. Currently, the patient is self-reliant. He does not need oxygen therapy and continues physiotherapy. ECMO may be life-saving in severe cases of COVID-19 ARDS but some of these patients may require LTx, especially when weaning proves impossible. VV ECMO as a bridging method is more difficult but ultimately more beneficial due to insufficient number of donors, and consequently long waiting time in Poland.

#Neurosurgery: A Temporal and Content Analysis of Academic Neurosurgery on Twitter.

BACKGROUND: Social media has become ubiquitous in modern medicine. Academic neurosurgery has increased adoption to promote individual and departmental accomplishments, engage with patients, and foster collaboration. We sought to quantitatively evaluate the adoption of one of the most used social media platforms, Twitter, within academic neurosurgery. METHODS: A quantitative and qualitative analysis of Twitter use across 118 academic neurosurgery departments with residency programs in the United States was performed in March 2019 and March 2021. We collated Twitter handles, Doximity residency ranking (a peer-determined ranking system), geographic location, and Twitter demographics (tweets, followers, likes, and tweet content) from before and after the coronavirus disease 2019 (COVID-19) pandemic. Tweet content was characterized by reviewers over a predetermined 6-month period. Linear regression and parametric/nonparametric tests were used for analysis. RESULTS: Departmental accounts grew 3.7 accounts per year between 2009 and 2019 (R2 = 0.96), but 43 accounts (130%) were added between 2019 (n = 33) and 2021 (n = 76). This growth, coinciding with the COVID-19 pandemic, changed the model from linear to exponential growth (R2 = 0.97). The highest-ranking programs based on Doximity were significantly more likely to have an account (P < 0.001) and have more followers (P < 0.0001). Tweet content analysis revealed prioritization of faculty/resident activity (mean 49.9%) throughout the quartiles. CONCLUSIONS: We demonstrate rapid uptake in Twitter use among U.S. academic neurosurgical departments, accelerated by COVID-19. With the impact of COVID-19, it is clear that there will be continued rapid adoption of this platform within neurosurgery, and future studies should explore the outcomes of peer collaboration, patient engagement, and dissemination of medical information.