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1.
Medicine (Baltimore) ; 100(10): e24030, 2021 Mar 12.
Artigo em Inglês | MEDLINE | ID: mdl-33725816

RESUMO

ABSTRACT: The aim of the study was to determine if multiple intraspinal anomalies increase the risk of scoliosis correction compared to the normal intraspinal condition or 1 or 2 intraspinal anomalies in congenital scoliosis (CS) and whether correction for multiple intraspinal anomalies need to be performed with preliminary neurosurgical intervention before scoliosis correction.A total of 318 consecutive CS patients who underwent corrective surgery without preliminary neurosurgical intervention at a single institution from 2008 to 2016 were retrospectively reviewed, with a minimum of 2 years of follow-up. The patients were divided into 3 groups according to different intraspinal conditions. In the normal group (N group; n = 196), patients did not have intraspinal anomalies. In the abnormal group (A group; n = 93), patients had 1 or 2 intraspinal anomalies. In the multiple anomaly group (M group; n = 29), patients had 3 or more intraspinal anomalies including syringomyelia, split cord malformation [SCM], tethered cord, low conus, intraspinal mass, Chiari malformation or/and arachnoid cyst. The occurrence of complications as well as perioperative and radiographic data were analyzed.The incidence rate of multiple intraspinal anomalies in CS patients was 9.1% (29/318). No significant difference was observed in the perioperative outcomes or radiographic parameters at the final follow-up. There were no significant differences among the 3 groups in the total, major or neurological complication rates (all P > .05). Two patients (1 in the N group and 1 in the A group) experienced transient neurological complications, whereas no patient experienced permanent neurological deficits during surgery or follow-up.To our knowledge, the current study reported the largest cohort of intraspinal anomalies in patients with CS that has been reported in the literature. The results of our study demonstrated that patients with congenital scoliosis associated with intraspinal anomalies, even multiple intraspinal anomalies that coexist with more complex intraspinal pathologies, may safely and effectively achieve scoliosis correction without preliminary neurological intervention. More complex intraspinal pathologies do not seem to increase the risk of neurosurgical complications during corrective surgery.


Assuntos
Anormalidades Múltiplas/cirurgia , Procedimentos Ortopédicos/efeitos adversos , Complicações Pós-Operatórias/epidemiologia , Escoliose/cirurgia , Doenças da Medula Espinal/complicações , Medula Espinal/anormalidades , Anormalidades Múltiplas/epidemiologia , Adolescente , Tomada de Decisão Clínica , Feminino , Seguimentos , Humanos , Masculino , Procedimentos Neurocirúrgicos/normas , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Procedimentos Ortopédicos/normas , Procedimentos Ortopédicos/estatística & dados numéricos , Complicações Pós-Operatórias/etiologia , Estudos Retrospectivos , Escoliose/complicações , Escoliose/congênito , Escoliose/epidemiologia , Medula Espinal/cirurgia , Doenças da Medula Espinal/epidemiologia , Doenças da Medula Espinal/cirurgia , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/cirurgia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
2.
Medicine (Baltimore) ; 100(4): e24207, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33530213

RESUMO

ABSTRACT: Currently, minute structures, such as cervical nerve roots, can be viewed using magnetic resonance imaging (MRI) sequences; however, studies comparing multiple sequences in the same set of patients are rare. The aim of the study is to compare the diagnostic values of three 3.0-T MRI sequences used in the imaging of cervical nerve roots.This study included 2 phases. In the first phase (n = 45 patients), the most optimal MRI sequence was determined. In the second phase, this MRI sequence was compared with surgical results (n = 31 patients). The three-dimensional double-echo steady-state (3D-DESS), multi-echo data image combination (MEDIC), and 3D sampling perfection with application-optimized contrasts using different flip angle evolutions (3D-SPACE) sequences were performed to analyze the image quality. Furthermore, the most optimal MRI sequence was compared with surgical results to determine the agreement rate.The image quality scores of the 3 sequences were significantly different (P < .05). The score for 3D-DESS sequence was superior to that of MEDIC sequence, while the score for 3D-SPACE sequence was the worst. For visualization of compressed nerve roots, 3D-DESS sequence was superior to the other 2 sequences in terms of the total quality score and compressed nerve root score. Therefore, 3D-DESS sequence was used for MRI in 31 patients with cervical spondylosis in the second phase of this study. The diagnostic agreement rate was 93.5%.This study concluded that in patients with cervical radiculopathy, the 3D-DESS sequence is superior to the MEDIC and 3D-SPACE sequences and shows a high agreement rate with the surgical diagnosis.


Assuntos
Vértebras Cervicais/inervação , Interpretação de Imagem Assistida por Computador/estatística & dados numéricos , Imagem por Ressonância Magnética/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Radiculopatia/diagnóstico , Adulto , Idoso , Vértebras Cervicais/diagnóstico por imagem , Vértebras Cervicais/cirurgia , Meios de Contraste , Feminino , Humanos , Interpretação de Imagem Assistida por Computador/métodos , Imageamento Tridimensional/métodos , Imageamento Tridimensional/estatística & dados numéricos , Imagem por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/métodos , Reprodutibilidade dos Testes , Estudos Retrospectivos , Raízes Nervosas Espinhais/diagnóstico por imagem , Raízes Nervosas Espinhais/cirurgia , Adulto Jovem
3.
J Surg Res ; 257: 239-245, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-32862051

RESUMO

BACKGROUND: With an aging population, the number of patients on antiplatelet medications and traumatic brain injury (TBI) is increasing. Our study aimed to evaluate the role of platelet transfusion on outcomes after traumatic intracranial bleeding (IB) in these patients. METHODS: We analyzed our prospectively maintained TBI database from 2014 to 2016. We included all isolated TBI patients with an IB, who were on preinjury antiplatelet agents and excluded patients taking anticoagulants. Outcome measures included the progression of IB, neurosurgical intervention, and mortality. Regression analysis was performed. RESULTS: A total of 343 patients met the inclusion criteria. Mean age was 58 ± 11 y, 58% were men, and median injury severity score was 15 (10-24). Distribution of antiplatelet agents was as follows: aspirin (60%) and clopidogrel (35%). Overall, 74% patients received platelet transfusion after admission with a median number of two platelet units. After controlling for confounders, patients who received one unit of pooled platelets had no difference in progression of IB (odds ratio [OR]: 0.98, [0.6-1.9], P = 0.41), need for neurosurgical intervention (OR: 1.09, [0.7-2.5], P = 0.53), and mortality (OR: 0.84, [0.6-1.8], P = 0.51). However, patients who received two units of pooled platelets had lower rate of progression of IB (OR: 0.69, [0.4-0.8], P = 0.02), the need for neurosurgical intervention (OR: 0.81, [0.3-0.9], P = 0.03), and mortality (OR: 0.84, [0.5-0.9], P = 0.04). Both groups were compared with those who did not receive platelet transfusion. CONCLUSIONS: The use of two units of platelet may decrease the risk of IB progression, neurosurgical intervention, and mortality in patients on preinjury antiplatelet agents and TBI. Further studies should focus on developing protocols for platelet transfusion to improve outcomes in these patients. LEVEL OF EVIDENCE: Level III prognostic.


Assuntos
Hemorragia Intracraniana Traumática/terapia , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Inibidores da Agregação de Plaquetas/efeitos adversos , Transfusão de Plaquetas/estatística & dados numéricos , Idoso , Progressão da Doença , Feminino , Humanos , Escala de Gravidade do Ferimento , Hemorragia Intracraniana Traumática/diagnóstico , Hemorragia Intracraniana Traumática/mortalidade , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Prospectivos , Estudos Retrospectivos , Resultado do Tratamento
4.
J Clin Neurosci ; 80: 156-161, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33099339

RESUMO

BACKGROUND: There has been a dramatic change in the pattern of patients being seen in hospitals and surgeries performed during the ongoing COVID-19 pandemic. The objective of this study is to study the change in the volume and spectrum of surgeries performed during the ongoing COVID-19 pandemic compared to pre-COVID-19 era. METHODS: Details of all patients who were operated under department of neurosurgery at our institute since the onset of COVID-19 pandemic in India were collected and compared to the same time period last year. The demographic profile, diagnosis, surgery performed, type of surgery (routine/emergency, cranial/spinal and major/minor) in these two groups were compared. They were further categorized into various categories [neuro-oncology (brain and spine tumors), neuro-trauma (head injury and spinal trauma), congenital cases, degenerative spine, neuro-vascular, CSF diversion procedures, etc.] and compared between the two groups. RESULTS: Our study showed a drastic fall (52.2%) in the number of surgeries performed during the pandemic compared to pre-COVID era. 11.3% of patients operated during COVID-19 pandemic were non-emergent surgeries compared to 57.7% earlier (p = 0.000). There was increase in proportion of minor cases from 28.8% to 41.5% (p = 0.106). The proportion of spinal cases decreased from 27.9% to 11.3% during the COVID-19 pandemic (p = 0.043). CONCLUSIONS: The drastic decrease in the number of surgeries performed will result in large backlog of patients waiting for 'elective' surgery. There is a risk of these patients presenting at a later stage with progressed disease and the best way forward would be to resume work with necessary precautions and universal effective COVID-19 testing.


Assuntos
Infecções por Coronavirus/epidemiologia , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/isolamento & purificação , Criança , Pré-Escolar , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Feminino , Humanos , Índia/epidemiologia , Lactente , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/diagnóstico , Adulto Jovem
5.
Clin Neurol Neurosurg ; 198: 106237, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33002677

RESUMO

OBJECTIVE: This observational cross-sectional multicenter study aimed to evaluate the longitudinal impact of the coronavirus disease 2019 (COVID-19) pandemic on neurosurgical practice. METHODS: We included 29 participating neurosurgeons in centers from all geographical regions in the Kingdom of Saudi Arabia. The study period, which was between March 5, 2020 and May 20, 2020, was divided into three equal periods to determine the longitudinal effect of COVID-19 measures on neurosurgical practice over time. RESULTS: During the 11-week study period, 474 neurosurgical interventions were performed. The median number of neurosurgical procedures per day was 5.5 (interquartile range [IQR]: 3.5-8). The number of cases declined from 72 in the first week and plateaued at the 30's range in subsequent weeks. The most and least number of performed procedures were oncology (129 [27.2 %]) and functional procedures (6 [1.3 %]), respectively. Emergency (Priority 1) cases were more frequent than non-urgent (Priority 4) cases (178 [37.6 %] vs. 74 [15.6 %], respectively). In our series, there were three positive COVID-19 cases. There was a significant among-period difference in the length of hospital stay, which dropped from a median stay of 7 days (IQR: 4-18) to 6 (IQR: 3-13) to 5 days (IQR: 2-8). There was no significant among-period difference with respect to institution type, complications, or mortality. CONCLUSION: Our study demonstrated that the COVID-19 pandemic decreased the number of procedures performed in neurosurgery practice. The load of emergency neurosurgery procedures did not change throughout the three periods, which reflects the need to designate ample resources to cover emergencies. Notably, with strict screening for COVID -19 infections, neurosurgical procedures could be safely performed during the early pandemic phase. We recommend to restart performing neurosurgical procedures once the pandemic gets stabilized to avoid possible post pandemic health-care system intolerable overload.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Controle de Infecções/organização & administração , Neurocirurgia/organização & administração , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Arábia Saudita , Adulto Jovem
6.
Neurol India ; 68(5): 1133-1138, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33109863

RESUMO

Background: There is a significant knowledge gap and anxiety among health care workers (HCWs) including neurosurgeons regarding in-hospital disease transmission and use of personal protective equipment (PPE) during the ensuing COVID-19 pandemic. Objective: To assess present practice and perceptions among Indian neurosurgeons with respect to type of surgeries performed, PPE usage and SARS-CoV-2 testing. Materials and Methods: A 12-item questionnaire on surgeries performed in the 6 weeks prior to the survey date, PPE usage, and preoperative SARS-CoV-2 testing was circulated electronically to Indian neurosurgeons from May 12, 2020 to May 31, 2020 and their responses analyzed. Results: Two hundred forty-four neurosurgeons (237 males) participated in the survey; of whom, 230 had performed surgeries during the pandemic period. In total, 84.3% of respondents were performing semiemergency or emergency procedures only. N95 masks were utilized by only 83% of the respondents (n = 230) while performing surgical procedures. Only 40.9% of the respondents were satisfied regarding adequacy of available PPE. Preoperative SARS-CoV2 testing as well as testing of all asymptomatic patients prior to admission into ward/intensive care unit was perceived to be beneficial in reducing transmission risk by more than 85% respondents. More than 90% respondents felt that HCWs including neurosurgeons were at risk of acquiring infection through an outpatient consultation from an asymptomatic individual. Conclusions: Access to and utilization of appropriate PPE was lacking among the one-fifth of neurosurgeons who participated in this survey. To gain the confidence of neurosurgeons, hospitals should address their concerns regarding PPE and testing of patients prior to surgery and admission to the hospital.


Assuntos
Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/prevenção & controle , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pandemias/prevenção & controle , Equipamento de Proteção Individual/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Adulto , Idoso , Infecções Assintomáticas , Betacoronavirus , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/transmissão , Feminino , Humanos , Índia/epidemiologia , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Masculino , Pessoa de Meia-Idade , Neurocirurgiões , Neurocirurgia , Pneumonia Viral/epidemiologia , Pneumonia Viral/transmissão , Inquéritos e Questionários
7.
Plast Reconstr Surg ; 146(2): 381-388, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740591

RESUMO

BACKGROUND: Patients undergoing trigger-site deactivation surgery for headaches report a high prevalence (approximately 37 percent) of prior head or neck injury. Traditional medical treatment often fails to treat these posttraumatic patients. It is unclear whether surgery mirrors these poor outcomes. This study aims to describe the characteristics of posttraumatic headache surgery patients and compare their postoperative results to those of patients without a history of head or neck injury. METHODS: One hundred forty-two patients undergoing trigger-site deactivation surgery were prospectively enrolled. Patients were requested to complete a preoperative questionnaire on headache history, including the Migraine Headache Index and information on prior head or neck injury. Follow-up surveys were requested at approximately 12 months postoperatively. RESULTS: Seventy patients (49 percent) reported a history of head or neck injury, and 41 (29 percent) classified the injury as the precipitating event leading to their headache onset. Patients with a precipitating event were significantly less likely to report a family history of migraine. There was no significant difference in mean preoperative Migraine Headache Index between cohorts. At 12 months postoperatively, there was no significant difference in Migraine Headache Index reduction between groups. The proportion of patients who experienced at least a 50 and 80 percent improvement in Migraine Headache Index per group, respectively, was 83 and 67 percent (atraumatic), 76 and 68 percent (posttraumatic), and 71 and 63 percent (precipitating event). CONCLUSIONS: This study suggests that surgical outcomes in posttraumatic headache patients are comparable to those without injury. Trigger-site deactivation surgery candidates with a history of injury can therefore expect similar outcomes as reported for patients overall. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, II.


Assuntos
Traumatismos Craniocerebrais/complicações , Descompressão Cirúrgica/estatística & dados numéricos , Transtornos de Enxaqueca/cirurgia , Lesões do Pescoço/complicações , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/diagnóstico , Transtornos de Enxaqueca/etiologia , Medição da Dor/estatística & dados numéricos , Resultado do Tratamento
8.
Epileptic Disord ; 22(4): 439-442, 2020 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-32759092

RESUMO

The COVID-19 pandemic shook European healthcare systems, with unavoidable gaps in the management of patients with chronic diseases. We describe the impact of the pandemic on epilepsy care in three tertiary epilepsy centres from Spain and Italy, the most affected European countries. The three epilepsy centres, members of the European EpiCARE network, manage more than 5,700 people with epilepsy. In Bologna and Barcelona, the hospitals housing the epilepsy centres were fully converted into COVID-19 units. We describe the reorganization of the clinics and report on the frequency of SARS-CoV-2 in people with epilepsy as well as the frequency of seizures in patients admitted to the COVID units. Finally, we elaborate on critical issues regarding the second phase of the pandemic. The activities related to epilepsy care were reduced to less than 10% and were deprioritized. Discharges were expedited and elective epilepsy surgeries, including vagal nerve stimulator implantations, cancelled. Hospitalizations and EEG examinations were limited to emergencies. The outpatient visits for new patients were postponed, and follow-up visits mostly managed by telehealth. Antiseizure medication weaning plans and changes in vagal nerve stimulator settings were halted. Among the 5,700 people with epilepsy managed in our centres, only 14 tested positive for SARS-CoV-2, without obvious impact on their epilepsy. None of the 2,122 patients admitted to COVID units experienced seizures among the early symptoms. Epilepsy care was negatively impacted by the pandemic, irrespective of COVID-19 epidemiology or conversion of the hospital into a COVID-19 centre. The pandemic did not silence the needs of people with epilepsy, and this must be considered in the planning of the second phase.


Assuntos
Infecções por Coronavirus , Epilepsia/terapia , Necessidades e Demandas de Serviços de Saúde/tendências , Pandemias , Pneumonia Viral , Infecções por Coronavirus/complicações , Eletroencefalografia/estatística & dados numéricos , Epilepsia/complicações , Epilepsia/cirurgia , Europa (Continente) , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Unidades Hospitalares/organização & administração , Hospitalização/estatística & dados numéricos , Humanos , Itália , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pneumonia Viral/complicações , Convulsões/epidemiologia , Convulsões/etiologia , Espanha , Telemedicina
9.
Acta Neurochir (Wien) ; 162(9): 2221-2233, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32642834

RESUMO

BACKGROUND: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19), which began as an epidemic in China and spread globally as a pandemic, has necessitated resource management to meet emergency needs of Covid-19 patients and other emergent cases. We have conducted a survey to analyze caseload and measures to adapt indications for a perception of crisis. METHODS: We constructed a questionnaire to survey a snapshot of neurosurgical activity, resources, and indications during 1 week with usual activity in December 2019 and 1 week during SARS-CoV-2 pandemic in March 2020. The questionnaire was sent to 34 neurosurgical departments in Europe; 25 departments returned responses within 5 days. RESULTS: We found unexpectedly large differences in resources and indications already before the pandemic. Differences were also large in how much practice and resources changed during the pandemic. Neurosurgical beds and neuro-intensive care beds were significantly decreased from December 2019 to March 2020. The utilization of resources decreased via less demand for care of brain injuries and subarachnoid hemorrhage, postponing surgery and changed surgical indications as a method of rationing resources. Twenty departments (80%) reduced activity extensively, and the same proportion stated that they were no longer able to provide care according to legitimate medical needs. CONCLUSION: Neurosurgical centers responded swiftly and effectively to a sudden decrease of neurosurgical capacity due to relocation of resources to pandemic care. The pandemic led to rationing of neurosurgical care in 80% of responding centers. We saw a relation between resources before the pandemic and ability to uphold neurosurgical services. The observation of extensive differences of available beds provided an opportunity to show how resources that had been restricted already under normal conditions translated to rationing of care that may not be acceptable to the public of seemingly affluent European countries.


Assuntos
Infecções por Coronavirus/epidemiologia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Unidades de Terapia Intensiva/provisão & distribução , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Centro Cirúrgico Hospitalar/provisão & distribução , Europa (Continente) , Recursos em Saúde/provisão & distribução , Humanos , Pandemias , Inquéritos e Questionários
10.
Neurol India ; 68(3): 595-602, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32643671

RESUMO

Background: The COVID-19 pandemic has created an unprecedented challenge for medical professionals throughout the world to tackle the rapidly changing scenario. The objective of this survey was to analyze the change in neurosurgical practice in India following the COVID-19 outbreak and assess its impact on practising neurosurgeons. Materials and Methods: Between May 7th and 23rd, 2020, a validated questionnaire was circulated amongst practising neurosurgeons across the country by social media and e-mails, regarding changes in the patterns of patients seen, adaptations made in their practice, effect on surgeries performed, financial burden, and impact on their personal lives. The responses were kept anonymous and were analyzed for correlations between the changes observed and independent factors such as hospital affiliations, teaching professions, and neurosurgical experience. Results: Our survey showed a drastic fall in the number of neurosurgical patients seen in the outpatient department (OPD) as well as the number of surgeries performed. A drop of 76.25% was seen in OPD patients (P = 0.000) and that of 70.59% in surgeries performed (P = 0.000). There was no uniformity among the neurosurgeons in the number of COVID-19 tests being done before elective/emergency surgery and in the use of protective gear while examining patients. Private practitioners were more affected financially as compared to those in the government sector. The pandemic has affected the research work of 53.23% of all respondents, with those in the teaching profession (70.96%) more affected than those in the non-teaching profession (24.67%). Conclusions: Evidence-based policies, screening COVID-19 tests with better sensitivity, and better-quality personal protective equipment kits in adequate numbers are required to protect our medical professionals from COVID-19. Mental health issues among neurosurgeons may also be an issue, this being a high risk speciality and should be closely watched for.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Neurocirurgia/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Padrões de Prática Médica/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adulto , Betacoronavirus , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Masculino , Programas de Rastreamento , Neurocirurgiões/economia , Neurocirurgiões/psicologia , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Admissão e Escalonamento de Pessoal , Pneumonia Viral/diagnóstico , Inquéritos e Questionários
11.
J Clin Neurosci ; 78: 53-59, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32624367

RESUMO

Sepsis is a life-threatening condition resulting from systemic infection, with mortality rates approaching 30%. Most neurological surgeries are now performed electively, which permits medical optimization preoperatively. We performed a retrospective cohort analysis of 122,466 adult elective neurosurgical patients from 2012 to 2018 in the National Surgical Quality Improvement Program database. To select for a medically optimized population, patients were included if they arrived from home on the day of surgery, were not pregnant or puerperium, and had no documented evidence of preexisting infection. We analyzed demographic, comorbidity, and operative information; performed multivariate logistic regression to explore factors predictive of postoperative sepsis; and evaluated outcomes for patients who developed sepsis. Overall, 0.87% of patients developed postoperative sepsis (n = 1,067). The rate of sepsis was higher in the cranial subpopulation (1.21%; n = 330) and lower in the spinal subpopulation (0.77%; n = 733). The overall sepsis cohort was older, had more males, was more functionally dependent, had longer operation durations, and had higher rates of medical comorbidities. Minority race and smoking were not associated with sepsis. The sepsis cohort fared worse than the control cohort across all outcome measures, including prolonged length-of-stay (≥90th percentile), discharge anywhere but home, 30-day readmission, 30-day reoperation, and 30-day mortality. Results for the cranial and spine subpopulations follow similar trends. In summary, sepsis in the elective neurosurgical population is an uncommon but devastating cause of excess morbidity and mortality.


Assuntos
Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Sepse/epidemiologia , Adulto , Idoso , Comorbidade , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Morbidade , Alta do Paciente , Readmissão do Paciente , Complicações Pós-Operatórias/epidemiologia , Gravidez , Melhoria de Qualidade , Reoperação , Estudos Retrospectivos , Coluna Vertebral/cirurgia , Fatores de Tempo
12.
World Neurosurg ; 142: e481-e486, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32698080

RESUMO

BACKGROUND: Every aspect of the medical field has been heavily affected by the coronavirus disease 2019 (COVID-19) pandemic, and neurosurgical services are no exception. Several departments have reported their experiences and protocols to provide insights for others impacted. The goals of this study are to report the load and variety of neurosurgical cases and clinic visits after discontinuing the COVID-19 Battle Plan at an academic tertiary care referral center to provide insights for other departments going through the same transition. METHODS: The clinical data of all patients who underwent a neurosurgical intervention between May 4, 2020, and June 4, 2020 were obtained from a prospectively maintained database. Data of the control group were retrospectively collected from the medical records to compare the types of surgeries/interventions and clinic visits performed by the same neurosurgical service before the COVID-19 pandemic started. RESULTS: One hundred sixty-one patients underwent neurosurgical interventions, and seven-hundred one patients were seen in clinic appointments, in the 4-week period following easing back from our COVID-19 "Battle Plan." Discontinuing the "Battle Plan" resulted in increases in case load to above-average practice after a week but a continued decrease in clinic appointments throughout the 4 weeks compared with average practice. CONCLUSIONS: As policy-shaping crises like pandemics abate, easing back to "typical" practice can be completed effectively by appropriately allocating resources. This can be accomplished by anticipating increases in neurosurgical volume, specifically in the functional/epilepsy and brain tumor subspecialties, as well as continued decreases in neurosurgical clinic volume, specifically in elective spine.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pandemias , Pneumonia Viral , Carga de Trabalho/estatística & dados numéricos , Centros Médicos Acadêmicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Emergências , Serviço Hospitalar de Emergência , Feminino , Florida , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Neurocirurgia , Adulto Jovem
13.
World Neurosurg ; 142: e434-e439, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32688039

RESUMO

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 pandemic has created challenges to neurosurgical patient care. Despite editorials evaluating neurosurgery responses to 2019 novel coronavirus disease (COVID-19), data reporting effects of COVID-19 on neurosurgical case volume, census, and resident illness are lacking. The aim of this study was to present a real-world analysis of neurosurgical volumes, resident deployment, and unique challenges encountered during the severe acute respiratory syndrome coronavirus 2 outbreak peak in New York City. METHODS: Daily census and case volume data were prospectively collected throughout the severe acute respiratory syndrome coronavirus 2 outbreak in spring 2020. Neurosurgical census was compared against COVID-19 system-wide data. Neurosurgical cases during the crisis were analyzed and compared with 7-week periods from 2019 and early 2020. Resident deployment and illness were reviewed. RESULTS: From March 16, 2020, to May 5, 2020, residents participated in 72 operations and 69 endovascular procedures compared with 448 operations and 253 endovascular procedures from January 2020 to February 2020 and 530 operations and 340 endovascular procedures from March 2019 to May 2019. There was a 59% reduction in neurosurgical census during the outbreak (median 24 patients, 2.75 average total cases daily). COVID-19 neurosurgical admissions peaked in concert with the system-wide pandemic. Three residents demonstrated COVID-19 symptoms (no hospitalizations occurred) for a total 24 workdays lost (median 7 workdays). CONCLUSIONS: These data provide real-world guidance on neurosurgical infrastructure needs during a COVID-19 outbreak. While redeployment to support the COVID-19 response was required, a significant need remained to continue to provide critical neurosurgical service.


Assuntos
Infecções por Coronavirus/epidemiologia , Internato e Residência , Neurocirurgia/educação , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/organização & administração , Pneumonia Viral/epidemiologia , Adulto , Idoso , Betacoronavirus , Infecções por Coronavirus/terapia , Procedimentos Endovasculares/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neurocirurgia/organização & administração , Cidade de Nova Iorque/epidemiologia , Pandemias , Pneumonia Viral/terapia
16.
World Neurosurg ; 141: e1017-e1026, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32599184

RESUMO

BACKGROUND: The novel coronavirus and subsequent pandemic have drastically transfigured health care delivery. Surgical specialties have seen severe alterations or reductions to practice, with neurosurgery being one example in which staff and resource reallocation has occurred to meet wider public health needs. This review summarizes the published evidence detailing early experiences and changes to neurosurgical practice in response to the coronavirus disease 2019 (COVID-19) pandemic. METHODS: A systematic review was conducted up until April 21, 2020 in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, by searching Medline, EMBASE, PubMed, Scopus, Cochrane Central, and Web of Science Core Collection databases. Individual studies were qualitatively assessed to outline core themes detailing changes to practice. Iterative analysis allowed themes to be developed and applied to all studies included in the review. RESULTS: In total, 13 themes from 18 studies were identified, grouped into 3 overriding themes: logistics, human resources, and clinical delivery. Studies originated from 3 of the most affected countries (United States, China, and Italy), comprising expert opinions, letters to the editor, editorials, case reports, or perspective pieces. The commonest themes discussed include cancellation of elective operations, reduction in outpatient services, and pandemic rotas. CONCLUSIONS: This review summarizes the early responses of the neurosurgical community to the COVID-19 pandemic and presents a menu of interventions to be considered in future pandemic response, or in recurrent outbreaks of COVID-19. Whilst our review is limited by the low quality of evidence and rapid rate of change in our understanding of COVID-19, it provides a valuable summary of initial responses by the neurosurgical community to a global pandemic.


Assuntos
Infecções por Coronavirus/complicações , Infecções por Coronavirus/terapia , Doenças do Sistema Nervoso/etiologia , Doenças do Sistema Nervoso/cirurgia , Neurocirurgia/estatística & dados numéricos , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pneumonia Viral/complicações , Pneumonia Viral/terapia , Humanos , Pandemias
17.
J Surg Res ; 255: 106-110, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32543374

RESUMO

BACKGROUND: Pediatric brain injuries are common, but current management of patients with mild traumatic intracranial hemorrhage (T-ICH) is suboptimal, often including unnecessary repeat head CT (RHCT) and neurosurgical consultation (NSC). Brain Injury Guidelines (BIG) have been developed to standardize the management of TBI, and recent work suggests they may be applied to children. The aim of this study was to apply BIG to a low-risk pediatric TBI population to further determine whether the framework can be safely applied to children in a way that reduces overutilization of RHCTs and NSC. METHODS: A retrospective chart review of a Level I Adult and Pediatric Trauma Center's pediatric registry over 4 y was performed. BIG was applied to these patients to evaluate the utility of RHCT and need for neurosurgical intervention (NSG-I) in those meeting BIG-1 criteria. Those with minor skull fracture (mSFx) who otherwise met BIG-1 criteria were also included. RESULTS: Twenty-eight patients with low-risk T-ICH met criteria for review. RHCT was performed in seven patients, with only two being prompted by clinical neurologic change/deterioration. NSC occurred in 21 of the cases. Ultimately, no patient identified by BIG-1 ± mSFx required NSG-I. CONCLUSIONS: Application of BIG criteria to children with mild T-ICH appears capable of reducing RHCT and NSC safely. Additionally, those with mSFx that otherwise fulfill BIG-1 criteria can be managed similarly by acute care surgeons. Further prospective studies should evaluate the application of BIG-1 in larger patient populations to support the generalizability of these findings.


Assuntos
Tomada de Decisão Clínica/métodos , Hemorragia Intracraniana Traumática/cirurgia , Procedimentos Neurocirúrgicos/normas , Provedores de Redes de Segurança/normas , Centros de Traumatologia/normas , Adolescente , Encéfalo/irrigação sanguínea , Encéfalo/diagnóstico por imagem , Criança , Pré-Escolar , Feminino , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Escala de Gravidade do Ferimento , Hemorragia Intracraniana Traumática/diagnóstico , Masculino , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Seleção de Pacientes , Guias de Prática Clínica como Assunto , Estudos Prospectivos , Encaminhamento e Consulta/normas , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Provedores de Redes de Segurança/estatística & dados numéricos , Tomografia Computadorizada por Raios X/normas , Tomografia Computadorizada por Raios X/estatística & dados numéricos , Centros de Traumatologia/estatística & dados numéricos , Resultado do Tratamento
18.
World Neurosurg ; 140: e395-e400, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32505658

RESUMO

INTRODUCTION: Substantial healthcare resources have been diverted to manage the effects of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic, and nonemergency neurosurgery has been effectively closed. As we begin to emerge from the crisis, we will need to manage the backlog of nonemergency neurosurgical patients whose treatment has been delayed and remain responsive to further possible surges of SARS-CoV-2 infections. METHODS: In the present study, we aimed to identify the core themes and challenges that will limit resumption of a normal neurosurgical service after the SARS-CoV-2 pandemic and to provide pragmatic advice and solutions that could be of utility to clinicians seeking to resume nonemergency neurosurgical care. We reviewed the relevant international policies, a wide range of journalistic and media sources, and expert opinion documents to address the stated aims. RESULTS: We have presented and discussed a range of factors that could become potential barriers to resuming full elective neurosurgical provision and important steps that must be completed to achieve pre-SARS-CoV-2 surgical capacity. We also explored how these challenges can be overcome and outlined the key requirements for a successful neurosurgical exit strategy from the pandemic. CONCLUSION: The performance of nonemergency neurosurgery can start once minimum criteria have been fulfilled: 1) a structured prioritization of surgical cases; 2) virus infection incidence decreased sufficiently to release previously diverted healthcare resources; 3) adequate safety criteria met for patients and staff, including sufficient personal protective equipment and robust testing availability; and 4) maintenance of systems for rapid communication at organizational and individual levels.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus , Serviços Médicos de Emergência , Procedimentos Neurocirúrgicos , Pandemias , Pneumonia Viral , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/virologia , Serviços Médicos de Emergência/estatística & dados numéricos , Humanos , Incidência , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/virologia , Reino Unido/epidemiologia
19.
World Neurosurg ; 139: e774-e783, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32376382

RESUMO

BACKGROUND: Although nontraumatic diseases affect fewer people than traumatic neurosurgical diseases, they require expertise more often. The authors sought to understand the barriers to nontraumatic neurosurgical diseases (NTNSDs) in a country with limited access to neurosurgical care. METHODS: This cross-sectional study with retrospective data collection was carried out in 2 Cameroonian reference hospitals for a year. Multiple imputations were used to generate data for the missing variables-death and discharge with sequelae. Bivariate relationships were evaluated using the chi-square and Mann-Whitney U tests. Odds ratios were equally calculated, and the results were considered significant for a P value <0.05. RESULTS: NTNSDs represented 44.1% of neurosurgical activity. Our study included 177 patients with a mean age of 43.7 ± 21.2 years. More than half (53.1%) were female, 78% lived in a different region from that of the neurosurgical center, 18.1% had health insurance, 39.5% were referrals, and the mean symptom-to-admission delay was 409.0 ± 1301.7 days. Most (87%) of the patients had undergone at least 1 of the diagnostic examinations prescribed to them. Men (P = 0.029) and rural dwellers (P = 0.017) had shorter symptom-to-admission delays than women and urban dwellers, respectively. The mean length of stay was 18.2 ± 13.4, and 80.8% of patients were treated surgically. Thirty-one (17.5%) patients died in the hospital: 9 were treated surgically, and 22 were treated conservatively or expectantly. CONCLUSIONS: Patients with NTNSD present at the definitive care facilities late. This delay is attributable to financial and geographic barriers.


Assuntos
Acesso aos Serviços de Saúde , Doenças do Sistema Nervoso/epidemiologia , Doenças do Sistema Nervoso/cirurgia , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Adolescente , Adulto , Idoso , Camarões , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Tempo para o Tratamento , Adulto Jovem
20.
World Neurosurg ; 140: e195-e202, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32389878

RESUMO

BACKGROUND: The COVID-19 pandemic has caused severe economic consequences by local governmental measures to contain the outbreak. We provide insight on the impact that health care restriction has made on neurosurgical activity in Latin Iberoamerica. METHODS: We performed an internet-based survey among presidents and members of the societies of the Latin American Federation of Neurosurgical Societies (FLANC). We blindly analyzed information regarding local conditions and their impact on neurosurgical praxis using SPSS software. RESULTS: Information came from 21 countries. Sixteen society presidents reported having suspended regular activities and deferring local scheduled congresses, 14 reported mandatory isolation by government, and 4 instituted a telemedicine project. Four-hundred eighty-six colleagues, mean age 49 years, reported a mean 79% reduction in their neurosurgical praxis. Seventy-six percent of neurosurgeons have savings to self-support for 3-6 months if restrictions are long lasting. CONCLUSIONS: Stopping activities among societies of the FLANC, together with a drop of 79% of neurosurgical praxis, adds to deficits in provider's protection equipment and increasing demand for attention in the health care systems, representing a huge financial risk to their sustainability. Neurosurgeons should be involved in local policies to protect health and economy. Telemedicine represents an excellent solution, avoiding another pandemic of severe diseases across all-specialties as nonessential care can turn essential if left untreated. Financial support and ethics code review is needed to battle this new disease, designated the occupational disease of the decade, that continues to scrag the health care system. Times of crisis are times of great opportunities for humanity to evolve.


Assuntos
Betacoronavirus/patogenicidade , Infecções por Coronavirus/cirurgia , Neurocirurgia/estatística & dados numéricos , Pneumonia Viral/cirurgia , Surtos de Doenças/prevenção & controle , Humanos , América Latina , Pessoa de Meia-Idade , Procedimentos Neurocirúrgicos/estatística & dados numéricos , Pandemias , Sociedades Médicas
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