Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: a nationwide study in Spain.
OBJECTIVE
To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain.


SETTINGS
The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied.


PARTICIPANTS
This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020.


INTERVENTIONS
An exploratory factorial analysis was performed to select the most relevant variables of the sample.


PRIMARY AND SECONDARY OUTCOME MEASURES
Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection.


RESULTS
Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/105 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade ≥3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/105 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated.


CONCLUSIONS
Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/105 people/week) was a statistically independent predictor of mortality.


TRIAL REGISTRATION NUMBER
CEIM 20/217.
['Paredes|Igor|I|http://orcid.org/0000-0002-3846-4164', 'Castaño Leon|Ana Maria|AM|http://orcid.org/0000-0002-7918-5049', 'Lagares|Alfonso|A|', 'Jimenez Roldan|Luis|L|', 'Perez-Nuñez|Angel|A|', 'González-Leon|Pedro|P|', 'Delgado-Fernandez|Juan|J|http://orcid.org/0000-0002-4251-8356', 'Eiriz|Carla|C|', 'García-Pérez|Daniel|D|', 'Moreno-Gomez|Luis Miguel|LM|', 'Esteban-Sinovas|Olga|O|', 'Delgado-López|Pedro|P|', 'Martín-Alonso|Javier|J|', 'Kaen|Ariel|A|', 'Tirado-Caballero|Jorge|J|', 'Ordóñez Carmona|Marta|M|', 'Arteaga Romero|Francisco|F|', 'Gonzalez Pombo|Marta|M|', 'Alén|José F|JF|', 'Gil-Simoes|Ricardo|R|', 'Torres|Cristina V|CV|', 'Navas Garcia|Marta|M|', 'Blasco|Guillermo|G|', 'Frade-Porto|Natalia|N|', 'González-Tarno|Patricia|P|', 'Martin Segura|Adrian|A|', 'Gelabert-Gonzalez|Miguel|M|', 'Menendez Cortezon|Beatriz|B|', 'Rodriguez Botana|Brais|B|', 'Pérez-Alfayate|Rebeca|R|', 'Fernandez Garcia|Carla|C|', 'Ferrandez Pujante|Borja|B|', 'Vargas-Jiménez|Andres|A|', 'Cotúa|Carlos|C|', 'de la Lama|Adolfo|A|', 'Calero|Lourdes|L|', 'Ruiz-Juretschke|Fernando|F|', 'Garcia Leal|Roberto|R|', 'Valera Mele|Marc|M|', 'Casitas Hernando|Vicente|V|', 'Rivero Martín|Belén|B|', 'Orduna|Javier|J|', 'Casado Pellejero|Juan|J|', 'Fustero De Miguel|David|D|', 'Diaz-Molina|Jorge|J|', 'Moles Herbera|Jesus|J|', 'Castello Ruiz|Maria Jose|MJ|', 'Gomar Alba|Mario|M|', 'Garcia Perez|Fernando|F|', 'Hernandez Garcia|Borja Jesus|BJ|', 'Villaseñor Ledezma|Javier|J|', 'Otero Rodríguez|Álvaro|Á|', 'Ailagas|Juan José|JJ|', 'Goncalves-Estella|Jesús|J|', 'Sousa Casasnovas|Pablo|P|', 'Pascual Argente|Daniel|D|', 'Ruiz Martín|Laura|L|', 'Roa Montes de Oca|Juan Carlos|JC|', 'Arandia Guzmán|Daniel|D|', 'García Martín|Andoni|A|', 'Torres Carretero|Luis|L|', 'Garrido Ruíz|Patricia Alejandra|PA|', 'Calvo|Marta|M|', 'Miranda-Lloret|Pablo|P|', 'Rodriguez-Cadarso Suarez-Vence|Miguel|M|', 'Anotn Oltra|Joan|J|', 'Roca Barber|Amparo|A|', 'Quiroz Tejada|Arnold|A|', 'Carbayo Lozano|Guillermo|G|', 'Bermudez Vilar|Garazi|G|', 'Paternain Martin|Clara|C|', 'Dela FuenteVilla|Pablo|P|', 'Fidalgo De la Rosa|Marina|M|', 'Sistiaga García|Íñigo L|ÍL|', 'Zabalo San Juan|Gorka|G|']
adult surgery neurological injury neurological oncology neurosurgery