Analysis of Neurosurgical Cases Before and During the Coronavirus Disease 2019 Pandemic from a Tertiary-Care Centre in India.
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ABSTRACT: Objective
We present the unique administrative issues as well as specific patient-related and surgeon-related challenges and solutions implemented while treating neurosurgical patients during the coronavirus disease 2019 (COVID-19) pandemic vis-à-vis pre-COVID-19 times at our tertiary-care center.Methods
This is a retrospective study comparing the outcome of the neurosurgical patients treated from the beginning of lockdown in India on March 25, 2020 to November 30, 2020 with that of same period in the previous year, 2019.Results
There were 687 neurosurgery admissions during the study period compared with 2550 admissions in 2019. The total number of surgeries performed in neurosurgery also showed a similar trend, with only 654 surgeries in 2020 compared with 3165 surgeries in 2019. During COVID-19 times, 474 patients were operated on including both trauma and nontrauma cases. Of the 50 patients with suspected/indeterminate COVID-19 who were operated on, 5 turned out to be positive for COVID-19. Significant differences were seen in the mortality (P < 0.01) and morbidity (P < 0.01) among patients with trauma on comparing COVID and pre-COVID periods. Similarly, a significant difference was observed in the mortality (P < 0.001) and morbidity (P < 0.001) in patients who did not have trauma.Conclusions
The higher mortality and morbidity during the COVID pandemic is primarily attributable to poorer baseline clinical status. Our experience from this COVID period might not only help us in tackling subsequent waves but also help other institutions in the developing world to be better prepared for similar circumstances.
SUBMITTER: Sharma R
PROVIDER: S-EPMC8197626 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:ObjectiveIn the present study, we quantified the effect of the coronavirus disease 2019 (COVID-19) on the volume of adult and pediatric neurosurgical procedures, inpatient consultations, and clinic visits at an academic medical center.MethodsNeurosurgical procedures, inpatient consultations, and outpatient appointments at Vanderbilt University Medical Center were identified from March 23, 2020 through May 8, 2020 (during COVID-19) and March 25, 2019 through May 10, 2019 (before COVID-19). The neurosurgical volume was compared between the 2 periods.ResultsA 40% reduction in weekly procedural volume was demonstrated during COVID-19 (median before, 75; interquartile range [IQR], 72-80; median during, 45; IQR, 43-47; P < 0.001). A 42% reduction occurred in weekly adult procedures (median before, 62; IQR, 54-70; median during, 36; IQR, 34-39; P < 0.001), and a 31% reduction occurred in weekly pediatric procedures (median before, 13; IQR, 12-14; median during, 9; IQR, 8-10; P = 0.004). Among adult procedures, the most significant decreases were seen for spine (P < 0.001) and endovascular (P < 0.001) procedures and cranioplasty (P < 0.001). A significant change was not found in the adult open vascular (P = 0.291), functional (P = 0.263), cranial tumor (P = 0.143), or hydrocephalus (P = 0.173) procedural volume. Weekly inpatient consultations to neurosurgery decreased by 24% (median before, 99; IQR, 94-114; median during, 75; IQR, 68-84; P = 0.008) for adults. Weekly in-person adult and pediatric outpatient clinic visits witnessed a 91% decrease (median before, 329; IQR, 326-374; median during, 29; IQR, 26-39; P < 0.001). In contrast, weekly telehealth encounters increased from a median of 0 (IQR, 0-0) before to a median of 151 (IQR, 126-156) during COVID-19 (P < 0.001).ConclusionsSignificant reductions occurred in neurosurgical operations, clinic visits, and inpatient consultations during COVID-19. Telehealth was increasingly used for assessments. The long-term effects of the reduced neurosurgical volume and increased telehealth usage on patient outcomes should be explored.
| S-EPMC7319935 | biostudies-literature
Project description:ObjectiveWe sought to understand how the coronavirus disease 2019 pandemic has affected the neurosurgical workforce.MethodsWe created a survey consisting of 22 questions to assess the respondent's operative experience, location, type of practice, subspecialty, changes in clinic and operative volumes, changes to staff, and changes to income since the pandemic began. The survey was distributed electronically to neurosurgeons throughout the United States and Puerto Rico.ResultsOf the 724 who opened the survey link, 457 completed the survey. The respondents were from throughout the United States and Puerto Rico and represented all practices types and subspecialties. Nearly all respondents reported hospital restrictions on elective surgeries. Most reported a decline in clinic and operative volume. Nearly 70% of respondents saw a decrease in the work hours of their ancillary providers, and almost one half (49.1%) of the respondents had had to downsize their practice staff, office assistants, nurses, schedulers, and other personnel. Overall, 43.6% of survey respondents had experienced a decline in income, and 27.4% expected a decline in income in the upcoming billing cycle. More senior neurosurgeons and those with a private practice, whether solo or as part of a group, were more likely to experience a decline in income as a result of the pandemic compared with their colleagues.ConclusionThe coronavirus disease 2019 pandemic will likely have a lasting effect on the practice of medicine. Our survey results have described the early effects on the neurosurgical workforce. Nearly all neurosurgeons experienced a significant decline in clinical volume, which led to many downstream effects. Ultimately, analysis of the effects of such a pervasive pandemic will allow the neurosurgical workforce to be better prepared for similar events in the future.
| S-EPMC7550862 | biostudies-literature
Project description:ObjectivesExamine well-being, measured as burnout and professional fulfillment, across critical care healthcare professionals, ICUs, and hospitals within a health system; examine the impact of the coronavirus disease 2019 pandemic.DesignTo complement a longitudinal survey administered to medical critical care physicians at the end of an ICU rotation, which began in May 2018, we conducted a cross-sectional survey among critical care professionals across four hospitals in December 2018 to January 2019. We report the results of the cross-sectional survey and, to examine the impact of the coronavirus disease 2019 pandemic, the longitudinal survey results from July 2019 to May 2020.SettingAcademic medical center.SubjectsFour-hundred eighty-one critical care professionals, including 353 critical care nurses, 58 advanced practice providers, 57 physicians, and 13 pharmacists, participated in the cross-sectional survey; 15 medical critical care physicians participated in the longitudinal survey through the coronavirus disease 2019 pandemic.InterventionsNone.Measurements and main resultsBurnout was present in 50% of ICU clinicians, ranging from 42% for critical care physicians to 55% for advanced practice providers. Professional fulfillment was less common at 37%, with significant variability across provider (p = 0.04), with a low of 23% among critical care pharmacists and a high of 53% among physicians. Well-being varied significantly at the hospital and ICU level. Workload and job demand were identified as drivers of burnout and meaning in work, culture and values of work community, control and flexibility, and social support and community at work were each identified as drivers of well-being. Between July 2019 and March 2020, burnout and professional fulfillment were present in 35% (15/43) and 58% (25/43) of medical critical care physician responses, respectively. In comparison, during the coronavirus disease 2019 pandemic, burnout and professional fulfillment were present in 57% (12/21) and 38% (8/21), respectively.ConclusionsBurnout was common across roles, yet differed across ICUs and hospitals. Professional fulfillment varied by provider role. We identified potentially modifiable factors related to clinician well-being that can inform organizational strategies at the ICU and hospital level. Longitudinal studies, designed to assess the long-term impact of the coronavirus disease 2019 pandemic on the well-being of the critical care workforce, are urgently needed.
| S-EPMC7587602 | biostudies-literature
Project description:BackgroundTeledermatology has evolved as a valuable option to outpatient visits during the current pandemic. We set up a smartphone-based hybrid model of teledermatology services providing direct care to patients at our center. To analyse patient and physician-experience and acceptability for teledermatology over a 6-month-period, along with clinicodemographic profile of patients.MethodologySingle-center, retrospective study conducted from May 20, 2020 to October 31, 2020. Patient satisfaction level for teledermatology was assessed on a 4-point scale and compared with the satisfaction level during their previous physical visits prior to COVID-19 pandemic. A physician assessment form was utilised to record the experience of dermatologists while providing teledermatology services.ResultsOf 7530 patients registered, a successful consult was provided to 6125 patients (81.34%). Average number of teleconsultations/day rose from 23.60 in May 2020 to 77.96 in October 2020. Mean age of patients availing teledermatology services was 33.60 ± 16.99 years. Average distance to care and travel time were 100.90 ± 171.77 km and 135 ± 222.32 min, respectively. A definitive diagnosis could be ascertained in 5724 patients (93.45%) and in-person visit was recommended to 133 patients (2.2%). Out of 6125 patients, 5229 could be contacted for feedback, 935 (18.18%), 2230 (42.65%), 1749 (33.45%), and 300 patients (5.70%) reported being very satisfied, satisfied, partially satisfied, and unsatisfied, respectively. Of 1914 patients, who had availed in-person OPD facilities prior to the pandemic, 914 patients (49.62%) preferred in-person visits. Of 34 dermatologists surveyed, 88.2% felt comfortable providing teleconsultations and 82.4% felt the need to continue teledermatology services in the upcoming months.ConclusionsOverall, teledermatology is a valid alternative for in-person dermatology visits during the current crisis; helping with initial triage and further patient management. Further refinement of the process could lead to even more acceptability.
| S-EPMC8209945 | biostudies-literature
Project description:AimUnderstanding how medical students perceive emergency medical care is important in promoting education and recruitment in the field of emergency medicine. This study aimed to clarify the perceptions of undergraduate medical students on emergency medical care with a focus on comparing their perceptions before and during the coronavirus disease 2019 (COVID-19) pandemic.MethodsFourth-year undergraduate medical students were invited to complete a self-administered questionnaire in 2017 and 2020. Free comments on emergency medical care were analyzed via text mining. The relationships among categorical words were evaluated via correlation matrix and correspondence analysis.ResultsThe number of written words per student were not significantly different between 2017 (4.9 ± 3.4) and 2020 (5.3 ± 4.1). In 2017, the most frequently used word was "busy," and the words "patients," "life," and "care" were not related to each other significantly. In 2020, the frequency of the word "busy" decreased and the word "patients" was related to "life" (P < 0.01) and "care" (P < 0.01). In the correspondence analysis, seven words including "life" and "care" were associated with "patients," which demonstrates that these words tended to occur together.ConclusionsAlthough the responses of the medical students regarding emergency medical care before and during the COVID-19 pandemic included similar words, their expressions tended to be related to patient care or patient life during the pandemic. This change in perception might cultivate a sense of mission and responsibility and an interest in emergency medical care among medical students.
| S-EPMC8987347 | biostudies-literature
Project description:Background/introductionCOVID-19 pandemic has been at its peak for the past 6months and has affected more than 215 countries around the world. India is now the 2nd most-affected nation with more than 48,00,000 cases and 79,000 deaths. Despite this, and the fact that it is a lower-middle-income nation the number of deaths is almost 1/3rd of the USA and ½ of Brazil. There has, however, been no experience published from non-COVID designated hospitals where the aim is to manage non-infected cases with neurosurgical ailments while keeping the number of infected cases to a minimum.MethodsWe analyzed the number of neurosurgical cases (non-trauma) done in the past 5 months (March- July 2020) in our institute which is the largest neurosurgical center by volume in southern India and compared the same to the concurrent 5 months in 2019 and 5 months preceding the pandemic. We also reviewed the total number of cases infected with COVID-19 managed during this time.ResultsWe operated a total of 630 cases(non-trauma) in these 5 months and had 9 COVID-19 infected cases operated during this time. There was a 57% (p=0.002) reduction in the number of cases operated as compared to the same 5 months in the preceding year. We employed a dual strategy of Rapid Antigen testing and surgery for cases needing emergency intervention and Reverse Transcriptase-Polymerase chain reaction test for elective cases. The hospital was divided into three zones (red, orange, and green) depending on infectivity level with minimal interaction. Separate teams were designated for each zone and thus we were able to effectively manage even infected cases despite the absence of pulmonology/medical specialists.ConclusionWe present a patient management protocol for non-COVID designated hospitals in high volume centers with the constraints of a lower-middle-income nation and demonstrate its effectiveness. Strict zoning targeted testing and effective triage can help in management during the pandemic.
| S-EPMC7832520 | biostudies-literature
Project description:ObjectivesThe coronavirus disease (COVID) 2019 pandemic and resultant stay-at-home orders altered caregivers' responsibilities and children's daily environments. We aimed to compare the epidemiology and morbidity of foreign body ingestions (FBIs) during the COVID pandemic and the prior year.MethodsWe performed a retrospective review of children cared for at our tertiary care children's hospital for FBI from March to July 2019 (pre-COVID) and March to July 2020 (COVID). Cases were identified via a search of all diagnoses of foreign bodies (FBs) in the alimentary tract. Charts were reviewed to determine the types of FBs ingested and the patients' clinical courses.ResultsA total of 71 encounters were identified. Thirty ingestions occurred in the pre-COVID cohort and 42 in the COVID cohort. One patient ingested 2 different FBs. There was a significantly higher rate of FBIs per day in May 2020 (COVID) compared with May 2019 (pre-COVID; 0.387 versus 0.161; P = 0.046). The median age at presentation was not significantly different between the two groups (pre-COVID, 63.8 months; COVID, 62.5 months; P = 0.78). FBs were located in the esophagus less frequently in the COVID cohort than in the pre-COVID cohort (P < 0.01). Endoscopies were less frequently performed in the COVID cohort (52.4% versus 70.0%; odds ratio, 0.47; 95% CI, 0.15-1.40).ConclusionsThe frequency of FBIs trended higher in the COVID cohort, with significantly more FBIs in May 2020 when compared with May 2019. Patients in the COVID cohort more frequently had FBs located beyond the esophagus, indicating later presentation and a lesser need for urgent endoscopic removal.
| S-EPMC8808762 | biostudies-literature
Project description:Merin YohannanIntroduction Timely diagnosis of lung cancer is critical because treatment outcomes correspond to the stage of disease. This study identified patient and physician determined reasons for diagnostic delays. Materials and Method s This was an observational cross-sectional study, conducted at a tertiary care institution in South India, for 12 months. From 207 consecutively selected patients, with a presumptive lung cancer diagnosis, 150 were enrolled utilizing a prefixed questionnaire. The time intervals from appreciation of initial respiratory symptoms to a final tissue diagnosis were defined sequentially as approach interval, referral interval, and diagnostic interval and factors causing delay in each interval were identified. Results In a state with 100% literacy, the mean time to approach a doctor was 8 weeks (range: 0-336 days; SD: 7.95) with a delay seen in 52% of the study group. Referring a suspect lung cancer diagnosis to a specialist, took an average of 4.98 weeks (range: 1-26 weeks; SD: 5.64) with referral delays in 47.3% of patients. The mean diagnostic interval was 9.21 days (range: 3-41 days; SD: 7.18) and 16.7% of cases had diagnostic delays in spite of a definite procedure. Conclusion In a tuberculosis endemic location, empirical treatment with anti-tuberculosis therapy and prolonged antibiotic courses without serially monitoring the course of disease are responsible for referral delays. Also, 88.2% of the total females studied, presented late due to family and work pressures, fear of being stigmatized and being on prolonged home remedies. A wider dissemination and awareness on lung cancer are needed especially among females. A low threshold to reinvestigate and an early referral to a pulmonary or lung cancer specialist, when expected clinicoradiological improvement is lacking, in microbiologically negative tuberculosis should be highlighted.
| S-EPMC10691914 | biostudies-literature
Project description:BACKGROUND:The coronavirus disease 2019 (COVID-19) pandemic has had a tremendous impact on the healthcare system. Owing to restrictions in elective surgery and social distancing guidelines, the training curriculum for neurosurgical trainees has been rapidly evolving. This evolution could have significant long-term effects on the training of neurosurgery residents. The objective of the present study was to assess the effects of COVID-19 on neurosurgical training programs and residents. METHODS:A survey consisting of 31 questions assessing changes to resident clinical and educational workload and their sentiment regarding how these changes might affect their careers was distributed electronically to neurosurgery residents in the United States and Canada. RESULTS:The survey respondents were from 29 states and Canada and were relatively evenly spread across all levels of residency. Nearly 82% reported that the inpatient and outpatient volumes had been either greatly (44.0%) or moderately (37.8%) reduced. Greater than 91% reported that their work responsibilities or access to the hospital had been reduced, with a significant reduction in work hours and a significant increase in resident didactics (P < 0.001). Senior residents expressed concern about their educational experience and their future career prospects as a result of the pandemic. CONCLUSION:Universally, residents have experienced reduced work hours and a reduction in their operative case volumes. Programs have adapted by increasing didactic time and using electronic platforms. It is quite possible that this remarkable period will prompt a critical reappraisal of the pre-COVID-19 adequacy of educational content in our training programs and that the enhanced educational efforts driven by this pandemic could be lasting.
| S-EPMC7274118 | biostudies-literature
Project description:ObjectivesTo compare patient management and outcome during the first and second waves of the coronavirus 2019 pandemic.DesignSingle-center prospective cohort study.SettingTertiary-care University Hospital.PatientsAll adult patients admitted in either the first (from March 15 to May 15, 2020) or second (from October 1 to November 30, 2020) wave of coronavirus disease 2019.InterventionsNone.Measurements and main resultsPrimary outcome was 30-day mortality. During the second wave of the coronavirus disease 2019 pandemic, 33 patients (4.8%) were transferred due to overcrowding and excluded from analysis. There were 341 (first wave of the coronavirus disease 2019 pandemic) and 695 (second wave of the coronavirus disease 2019 pandemic) coronavirus disease 2019 patients admitted to the hospital, with median age first wave of the coronavirus disease 2019 pandemic as 68 (57-80) and second wave of the coronavirus disease 2019 pandemic as 71 (60-80) (p = 0.15), and similar admission severity. For the first wave of the coronavirus disease 2019 pandemic versus second wave of the coronavirus disease 2019 pandemic, 30-day mortality was 74/341 (22%) and 98/662 (15%) (p = 0.007). In the ward, 11/341 (3.2%) and 404/662 (61%) received dexamethasone (p < 0.001); 6/341 (2%) and 79/662 (12%) received high-flow nasal oxygen (p < 0.0001); 2/341 (0.6%) and 88/662 (13.3%) received remdesivir (p < 0.0001); 249/341 (73%) and 0/662 (0%) received hydroxychloroquine (p < 0.0001); and 87/341 (26%) and 128/662 (19%) (p = 0.024) patients were transferred to ICU. On ICU admission, median Sequential Organ Failure Assessment was 6 (3-7) and 4 (3-6) (p = 0.02). High-flow nasal oxygen was given to 16/87 (18%) and 102/128 (80%) (p < 0.001); 69/87 (79%) and 56/128 (44%) received mechanical ventilation (p < 0.001) with durations 17 days (10-26 d) and 10 days (5-17 d) (p = 0.01). Median ICU length of stay was 14 days (5-27 d) and 6 days (3-11 d) (p < 0.001). Finally, 16/87 (18%) and 8/128 (6%) received renal replacement therapy (p = 0.0055); and 64/87 (74%) and 51/128 (40%) needed vasopressor support (p < 0.001).ConclusionsThe main therapeutic changes between the first wave of the coronavirus disease 2019 pandemic and the second wave of the coronavirus disease 2019 pandemic were use of steroids, unrestrictive use of high-flow nasal oxygen for hypoxemic patients, and transfer of patients to other geographic areas in the case of ICU overcrowding. These changes were associated with a decrease in 30-day mortality, ICU admission, and organ support.
| S-EPMC8162523 | biostudies-literature