Decompressive Surgery in the Treatment of Acute Ischemic Stroke during the First Four Waves of the COVID-19 Pandemic in Germany: A Nationwide Observational Cohort Study.

IF 0.9 4区医学 Q4 CLINICAL NEUROLOGY

Journal of neurological surgery. Part A, Central European neurosurgery Pub Date : 2024-09-01 Epub Date: 2023-08-18 DOI:10.1055/a-2156-5363

Hussain Gheewala, Muath Aldergham, Steffen Rosahl, Michael Stoffel, Yu-Mi Ryang, Oliver Heese, Rüdiger Gerlach, Ralf Burger, Barbara Carl, Rudolf A Kristof, Thomas Westermaier, Jorge Terzis, Farid Youssef, Gerardo Rico Gonzalez, Frederic Bold, Ali Allam, Ralf Kuhlen, Sven Hohenstein, Andreas Bollmann, Julius Dengler

{"title":"Decompressive Surgery in the Treatment of Acute Ischemic Stroke during the First Four Waves of the COVID-19 Pandemic in Germany: A Nationwide Observational Cohort Study.","authors":"Hussain Gheewala, Muath Aldergham, Steffen Rosahl, Michael Stoffel, Yu-Mi Ryang, Oliver Heese, Rüdiger Gerlach, Ralf Burger, Barbara Carl, Rudolf A Kristof, Thomas Westermaier, Jorge Terzis, Farid Youssef, Gerardo Rico Gonzalez, Frederic Bold, Ali Allam, Ralf Kuhlen, Sven Hohenstein, Andreas Bollmann, Julius Dengler","doi":"10.1055/a-2156-5363","DOIUrl":null,"url":null,"abstract":"Background: The COVID-19 pandemic has significantly affected acute ischemic stroke (AIS) care. In this study, we examined the effects of the pandemic on neurosurgical AIS care by means of decompressive surgery (DS).Methods: In this retrospective observational study, we compared the characteristics, in-hospital processes, and in-hospital mortality rates among patients hospitalized for AIS during the first four waves of the pandemic (between January 1, 2020 and October 26, 2021) versus the corresponding periods in 2019 (prepandemic). We used administrative data from a nationwide hospital network in Germany.Results: Of the 177 included AIS cases with DS, 60 were from 2019 and 117 from the first four pandemic waves. Compared with the prepandemic levels, there were no changes in weekly admissions for DS during the pandemic. The same was true for patient age (range: 51.7-60.4 years), the number of female patients (range: 33.3-57.1%), and the prevalence of comorbidity, as measured by the Elixhauser Comorbidity Index (range: 13.2-20.0 points). Also, no alterations were observed in transfer to the intensive care unit (range: 87.0-100%), duration of in-hospital stay (range: 14.6-22.7 days), and in-hospital mortality rates (range: 11.8-55.6%).Conclusion: In Germany, compared with the prepandemic levels, AIS patients undergoing DS during the first four waves of the pandemic showed no changes in demographics, rates of comorbidity, and in-hospital mortality rates. This is in contrast to previous evidence on patients with less critical types of AIS not requiring DS and underlines the uniqueness of the subgroup of AIS patients requiring DS. Our findings suggests that these patients, in contrast to AIS patients in general, were unable to forgo hospitalization during the COVID-19 pandemic. Maintaining the delivery of DS is an essential aspect of AIS care during a pandemic.","PeriodicalId":16544,"journal":{"name":"Journal of neurological surgery. Part A, Central European neurosurgery","volume":" ","pages":"478-484"},"PeriodicalIF":0.9000,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of neurological surgery. Part A, Central European neurosurgery","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1055/a-2156-5363","RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2023/8/18 0:00:00","PubModel":"Epub","JCR":"Q4","JCRName":"CLINICAL NEUROLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background: The COVID-19 pandemic has significantly affected acute ischemic stroke (AIS) care. In this study, we examined the effects of the pandemic on neurosurgical AIS care by means of decompressive surgery (DS).

Methods: In this retrospective observational study, we compared the characteristics, in-hospital processes, and in-hospital mortality rates among patients hospitalized for AIS during the first four waves of the pandemic (between January 1, 2020 and October 26, 2021) versus the corresponding periods in 2019 (prepandemic). We used administrative data from a nationwide hospital network in Germany.

Results: Of the 177 included AIS cases with DS, 60 were from 2019 and 117 from the first four pandemic waves. Compared with the prepandemic levels, there were no changes in weekly admissions for DS during the pandemic. The same was true for patient age (range: 51.7-60.4 years), the number of female patients (range: 33.3-57.1%), and the prevalence of comorbidity, as measured by the Elixhauser Comorbidity Index (range: 13.2-20.0 points). Also, no alterations were observed in transfer to the intensive care unit (range: 87.0-100%), duration of in-hospital stay (range: 14.6-22.7 days), and in-hospital mortality rates (range: 11.8-55.6%).

Conclusion: In Germany, compared with the prepandemic levels, AIS patients undergoing DS during the first four waves of the pandemic showed no changes in demographics, rates of comorbidity, and in-hospital mortality rates. This is in contrast to previous evidence on patients with less critical types of AIS not requiring DS and underlines the uniqueness of the subgroup of AIS patients requiring DS. Our findings suggests that these patients, in contrast to AIS patients in general, were unable to forgo hospitalization during the COVID-19 pandemic. Maintaining the delivery of DS is an essential aspect of AIS care during a pandemic.

查看原文本刊更多论文

德国新冠肺炎大流行前四波期间减压手术治疗急性缺血性卒中：全国观察队列研究。

背景：新冠肺炎大流行严重影响了急性缺血性中风（AIS）的护理。在这项研究中，我们通过减压手术（DS）检查了疫情对神经外科AIS护理的影响。方法：在这项回顾性观察性研究中，我们比较了前四波疫情期间（2020年1月1日至2021年10月26日）因AIS住院的患者与2019年同期（疫情前）的特征、住院过程和住院死亡率。我们使用了来自德国全国医院网络的管理数据。结果：在177例包括DS的AIS病例中，60例来自2019年，117例来自前四波疫情。与疫情前的水平相比，疫情期间DS的每周入院人数没有变化。根据Elixhauser共病指数测量，患者年龄（范围：51.7-6.4岁）、女性患者人数（范围：33.3-57.1%）和共病患病率也是如此（范围：13.2-20.0分）。此外，在转入重症监护室（范围：87.0-100%）、住院时间（范围：14.6-2.7天）和住院死亡率（范围：11.8-55.6%）方面也没有观察到变化。结论：在德国，与疫情前的水平相比，在前四波疫情期间接受DS的AIS患者在人口统计学、合并症发生率和住院死亡率方面没有变化。这与之前关于不需要DS的不太严重类型AIS患者的证据形成了对比，并强调了需要DS的AIS患者亚组的独特性。我们的研究结果表明，与一般AIS患者相比，这些患者在新冠肺炎大流行期间无法放弃住院治疗。在疫情期间，维持DS的提供是AIS护理的一个重要方面。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Journal of neurological surgery. Part A, Central European neurosurgery CLINICAL NEUROLOGY-SURGERY

CiteScore

2.30

自引率

0.00%

发文量

期刊介绍： The Journal of Neurological Surgery Part A: Central European Neurosurgery (JNLS A) is a major publication from the world''s leading publisher in neurosurgery. JNLS A currently serves as the official organ of several national neurosurgery societies. JNLS A is a peer-reviewed journal publishing original research, review articles, and technical notes covering all aspects of neurological surgery. The focus of JNLS A includes microsurgery as well as the latest minimally invasive techniques, such as stereotactic-guided surgery, endoscopy, and endovascular procedures. JNLS A covers purely neurosurgical topics.