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Poon MTC, Piper RJ, Thango N, Fountain DM, Marcus HJ, Lippa L, Servadei F, Esene IN, Freyschlag CF, Neville IS, Rosseau G, Schaller K, Demetriades AK, Robertson FC, Hutchinson PJ, Price SJ, Baticulon RE, Glasbey JC, Bhangu A, Jenkinson MD, Kolias AG. Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic. Neuro Oncol 2023; 25:1299-1309. [PMID: 37052643 PMCID: PMC10326494 DOI: 10.1093/neuonc/noad019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/14/2023] Open
Abstract
BACKGROUND This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic. METHODS We prospectively included adults aged ≥18 years who underwent surgery for a malignant or benign intracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients' location by World Bank income groups (high [HIC], upper-middle [UMIC], and low- and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality. RESULTS Among 1016 patients, the number of patients in each income group was 765 (75.3%) in HIC, 142 (14.0%) in UMIC, and 109 (10.7%) in LLMIC. The management of 200 (19.8%) patients changed from usual care, most commonly delayed surgery. Within 30 days after surgery, 14 (1.4%) patients had a COVID-19 diagnosis and 39 (3.8%) patients died. In the multivariable model, LLMIC was associated with increased mortality (odds ratio 2.83, 95% credible interval 1.37-5.74) compared to HIC. CONCLUSIONS The first wave of the pandemic had a significant impact on surgical decision-making. While the incidence of SARS-CoV-2 infection within 30 days after surgery was low, there was a disparity in mortality between countries and this warrants further examination to identify any modifiable factors.
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Affiliation(s)
- Michael T C Poon
- Usher Institute, University of Edinburgh, Edinburgh, UK
- Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Rory J Piper
- Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK
| | - Nqobile Thango
- Department of Surgery, Division of Neurosurgery, University of Cape Town, Cape Town, South Africa
| | - Daniel M Fountain
- Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK
| | - Hani J Marcus
- National Hospital for Neurology and Neurosurgery, London, UK
- UCL Queen Square Institute of Neurology, London, UK
| | - Laura Lippa
- Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda Milan, Italy
| | - Franco Servadei
- Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital, Milano, Italy
| | - Ignatius N Esene
- Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon
| | - Christian F Freyschlag
- Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria
| | - Iuri S Neville
- Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil
| | - Gail Rosseau
- George Washington University School of Medicine and Health Sciences, Washington, DC, United States
| | - Karl Schaller
- Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland
| | | | - Faith C Robertson
- Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States
| | - Peter J Hutchinson
- Academic Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK
| | - Stephen J Price
- Department of Clinical Neurosciences, Division of Neurosurgery, Cambridge, UK
| | - Ronnie E Baticulon
- Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines
| | - James C Glasbey
- NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, UK
| | | | - Michael D Jenkinson
- Department of Neurosurgery, Walton Centre & University of Liverpool, Liverpool, UK
| | - Angelos G Kolias
- Department of Clinical Neurosciences, Division of Neurosurgery, Cambridge, UK
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Mischkulnig M, Hopp B, Wadiura LI, Khalaveh F, Kiesel B, Rössler K, Widhalm G, Dorfer C. Treatment of high-grade glioma patients during the COVID-19 pandemic: Impact on overall survival, tumor size and delay of treatment. PLoS One 2023; 18:e0287993. [PMID: 37390078 PMCID: PMC10313013 DOI: 10.1371/journal.pone.0287993] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 06/19/2023] [Indexed: 07/02/2023] Open
Abstract
BACKGROUND Throughout the last years, the coronavirus disease 2019 (COVID-19) pandemic posed a major challenge to the optimal and timely treatment of neurooncological patients around the world. While the importance of prompt surgical treatment in high-grade gliomas is widely accepted, there is sparse data on the impact of the pandemic on patients suffering from this malignant disease. METHODS We performed a retrospective analysis of patients undergoing surgical high-grade glioma treatment at the Medical University of Vienna between March 2020 and February 2021, as well as a control cohort of patients who received treatment between January and December 2019. Time lag between referral for surgical treatment to actual surgery, preoperative tumor volume and overall patient survival were compared between groups. RESULTS A total of 118 patients, including 62 cases treated during the first year of the COVID-19 pandemic, as well as 56 control patients, were investigated in this study. Median interval to surgery was significantly shorter in patients treated during COVID-19 compared with the control group (4.00 versus 7.00 days; p = 0.0005). In contrast, patients treated during COVID-19 exhibited marginally larger preoperative tumor volumes, while overall patient survival was comparable between groups. CONCLUSIONS The COVID-19 pandemic did not negatively affect the overall survival of patients undergoing surgical high-grade glioma treatment at our institution. The significantly shorter treatment delay in patients treated during the pandemic likely reflects increased resource allocation for this critical patient population.
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Affiliation(s)
- Mario Mischkulnig
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Benjamin Hopp
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Lisa I. Wadiura
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Farjad Khalaveh
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Barbara Kiesel
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Karl Rössler
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Georg Widhalm
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
| | - Christian Dorfer
- Department of Neurosurgery, Medical University Vienna, Vienna, Austria
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Chari A, Piper RJ, Edlmann E, Woodfield J, Brennan PM, Turner C, Jenkinson MD, Hutchinson PJ, Kolias AG. Delivering Large-Scale Neurosurgical Studies in the UK: The Impact of Trainees. World Neurosurg 2022; 161:343-349. [PMID: 35505553 DOI: 10.1016/j.wneu.2021.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/01/2021] [Indexed: 11/17/2022]
Abstract
The UK neurosurgical community has a track record of delivering high-quality, practice-changing clinical research studies, facilitated by a robust clinical research infrastructure and close collaborations between neurosurgical centers. More recently, these large-scale studies have been conceived, developed, and delivered by neurosurgical trainees, working under the umbrella of the British Neurosurgical Trainee Research Collaborative (BNTRC). In this paper, we outline the current landscape of large-scale neurosurgical studies in the UK, focusing on the role of trainees in facilitating this research. Importantly, we focus on our experience of trainee-led studies, including the development of the network, current challenges, and future directions. We believe that a similar model can be applied in different settings and countries, which will drive up the quality of neurosurgical research, ultimately benefiting future neurosurgical patients.
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Affiliation(s)
- Aswin Chari
- Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom; Developmental Neuroscience, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Rory J Piper
- Department of Neurosurgery, Great Ormond Street Hospital, London, United Kingdom; Developmental Neuroscience, Great Ormond Street Institute of Child Health, University College London, London, United Kingdom
| | - Ellie Edlmann
- Department of Neurosurgery, South West Neurosurgical Centre, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom; Faculty of Health, Peninsula Medical School, University of Plymouth, United Kingdom
| | - Julie Woodfield
- Department of Neurosurgery, NHS Lothian, Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom
| | - Paul M Brennan
- Department of Neurosurgery, NHS Lothian, Edinburgh, United Kingdom; Centre for Clinical Brain Sciences, University of Edinburgh, United Kingdom
| | - Carole Turner
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Michael D Jenkinson
- Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom; Department of Neurosurgery, The Walton Centre NHS Foundation Trust, Liverpool, United Kingdom
| | - Peter J Hutchinson
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom; National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom
| | - Angelos G Kolias
- Division of Neurosurgery, Department of Clinical Neurosciences, University of Cambridge, Cambridge, United Kingdom; Department of Neurosurgery, Addenbrooke's Hospital, Cambridge, United Kingdom; National Institute for Health Research Global Health Research Group on Neurotrauma, University of Cambridge, Cambridge, United Kingdom.
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Practice Patterns in Surgical Neuro-Oncology Among Low- and Middle-Income Countries During the Coronavirus Disease 2019 Pandemic: A Scoping Review and Situational Report from the Philippines. World Neurosurg 2022; 159:189-197.e7. [PMID: 34902600 PMCID: PMC8709263 DOI: 10.1016/j.wneu.2021.12.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2021] [Revised: 12/04/2021] [Accepted: 12/06/2021] [Indexed: 11/23/2022]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) pandemic has negatively affected the outcomes of surgical neuro-oncology patients worldwide. We aimed to review the practice patterns in surgical neuro-oncology in low- and middle-income countries (LMICs). We also present a situational report from our own country. METHODS A scoping review was performed following the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews) guidelines. RESULTS Twelve studies were included in the review. Most of the studies were from Asia (India, China, Iran, and Turkey), and 1 was from Brazil. Quantitative reports showed a decrease in the number of surgical neuro-oncology operations between pre-COVID-19 and post-COVID-19 time frames, but similar proportions of neuro-oncology procedures. Qualitative review showed similar practice patterns between LMICs and high-income countries, except for limitations in resources such as negative-pressure operating rooms and intensive care units, and maintenance of face-to-face consults despite the adoption of telemedicine. Limited data on adjuvant therapy were available in LMICs. CONCLUSIONS In our review, we found that the practice patterns in surgical neuro-oncology in LMICs during the COVID-19 pandemic are similar to those in high-income countries, except for a few modifications because of resource limitation and patient preferences.
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