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Hossain I, Younsi A, Castaño Leon AM, Lippa L, Tóth P, Terpolilli N, Tobieson L, Latini F, Raabe A, Depreitere B, Rostami E. Huge variability in restrictions of mobilization for patients with aneurysmal subarachnoid hemorrhage - A European survey of practice. Brain Spine 2023; 3:101731. [PMID: 37383447 PMCID: PMC10293289 DOI: 10.1016/j.bas.2023.101731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 03/09/2023] [Accepted: 03/16/2023] [Indexed: 06/30/2023]
Abstract
Introduction One of the major goals of neurointensive care is to prevent secondary injuries following aSAH. Bed rest and patient immobilization are practiced in order to decrease the risk of DCI. Research question To explore the current practices in place concerning the management of patients with aSAH, specifically, protocols and habits regarding restrictions of mobilization and HOB positioning. Material and methods A survey was designed, modified, and approved by the panel of the Trauma & Critical Care section of the EANS to cover the practice of restrictions of patient mobilization and HOB positioning in patients with aSAH. Results Twenty-nine physicians from 17 countries completed the questionnaire. The majority (79.3%) stated that non-secured aneurysm and the presence of an EVD were the factors related to the establishment of restriction of mobilization. The average duration of the restriction varied widely ranging between 1 and 21 days. The presence of an EVD (13.8%) was found to be the main reason to recommend restriction of HOB elevation. The average duration of restriction of HOB positioning ranged between 3 and 14 days. Rebleeding or complications related to CSF over-drainage were found to be related to these restrictions. Discussion and conclusion Restriction of patient mobilization regimens vary widely in Europe. Current limited evidence does not support an increased risk of DCI rather the early mobilization might be beneficial. Large prospective studies and/or the initiative of a RCT are needed to understand the significance of early mobilization on the outcome of patients with aSAH.
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Affiliation(s)
- Iftakher Hossain
- Neurocenter, Department of Neurosurgery, Turku University Hospital, Turku, Finland
- Department of Clinical Neurosciences, Neurosurgery Unit, University of Cambridge, Addenbrooke's Hospital, Cambridge, United Kingdom
| | - Alexander Younsi
- Department of Neurosurgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Ana Maria Castaño Leon
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Laura Lippa
- Department of Neurosurgery, Ospedale Niguarda, Milano, Italy
| | - Péter Tóth
- Department of Neurosurgery, University of Pecs, Hungary
| | - Nicole Terpolilli
- Department of Neurosurgery, Munich University Hospital, Munich, Germany
| | - Lovisa Tobieson
- Department of Neurosurgery of Linköping, Linköping University, Linköping, Sweden
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Francesco Latini
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Andreas Raabe
- Department of Neurosurgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Bart Depreitere
- Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
| | - Elham Rostami
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
- Department of Neuroscience, Karolinska Institute, Stockholm, Sweden
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Paredes I, Castaño Leon AM, Lagares A, Jimenez Roldan L, Perez-Nuñez A, González-Leon P, Delgado-Fernandez J, Eiriz C, García-Pérez D, Moreno-Gomez LM, Esteban-Sinovas O, Delgado-López P, Martín-Alonso J, Kaen A, Tirado-Caballero J, Ordóñez Carmona M, Arteaga Romero F, Gonzalez Pombo M, Alén JF, Gil-Simoes R, Torres CV, Navas Garcia M, Blasco G, Frade-Porto N, González-Tarno P, Martin Segura A, Gelabert-Gonzalez M, Menendez Cortezon B, Rodriguez Botana B, Pérez-Alfayate R, Fernandez Garcia C, Ferrandez Pujante B, Vargas-Jiménez A, Cotúa C, de la Lama A, Calero L, Ruiz-Juretschke F, Garcia Leal R, Valera Mele M, Casitas Hernando V, Rivero Martín B, Orduna J, Casado Pellejero J, Fustero De Miguel D, Diaz-Molina J, Moles Herbera J, Castello Ruiz MJ, Gomar Alba M, Garcia Perez F, Hernandez Garcia BJ, Villaseñor Ledezma J, Otero Rodríguez Á, Ailagas JJ, Goncalves-Estella J, Sousa Casasnovas P, Pascual Argente D, Ruiz Martín L, Roa Montes de Oca JC, Arandia Guzmán D, García Martín A, Torres Carretero L, Garrido Ruíz PA, Calvo M, Miranda-Lloret P, Rodriguez-Cadarso Suarez-Vence M, Anotn Oltra J, Roca Barber A, Quiroz Tejada A, Carbayo Lozano G, Bermudez Vilar G, Paternain Martin C, Dela FuenteVilla P, Fidalgo De la Rosa M, Sistiaga García ÍL, Zabalo San Juan G. Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: a nationwide study in Spain. BMJ Open 2021; 11:e053983. [PMID: 34893486 PMCID: PMC9065769 DOI: 10.1136/bmjopen-2021-053983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
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.
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Affiliation(s)
- Igor Paredes
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Alfonso Lagares
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis Jimenez Roldan
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Angel Perez-Nuñez
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Pedro González-Leon
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Carla Eiriz
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Daniel García-Pérez
- Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | | | - Ariel Kaen
- Department of Neurosurgery, Virgen del Rocio University Hospital, Sevilla, Andalucía, Spain
| | | | - Marta Ordóñez Carmona
- Department of Neurosurgery, Virgen del Rocio University Hospital, Sevilla, Andalucía, Spain
| | | | - Marta Gonzalez Pombo
- Department of Neurosurgery, Virgen del Rocio University Hospital, Sevilla, Andalucía, Spain
| | - José F Alén
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ricardo Gil-Simoes
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Cristina V Torres
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Marta Navas Garcia
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Guillermo Blasco
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Natalia Frade-Porto
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Adrian Martin Segura
- Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain
| | - Miguel Gelabert-Gonzalez
- Department of Neurosurgery, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Beatriz Menendez Cortezon
- Department of Neurosurgery, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Brais Rodriguez Botana
- Department of Neurosurgery, Complexo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Galicia, Spain
| | - Rebeca Pérez-Alfayate
- Department of Neurosurgery, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | | | - Andres Vargas-Jiménez
- Department of Neurosurgery, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Carlos Cotúa
- Department of Neurosurgery, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | | | | | - Fernando Ruiz-Juretschke
- Department of Neurosurgery, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Roberto Garcia Leal
- Department of Neurosurgery, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Marc Valera Mele
- Department of Neurosurgery, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Vicente Casitas Hernando
- Department of Neurosurgery, Hospital General Universitario Gregorio Maranon, Madrid, Madrid, Spain
| | - Belén Rivero Martín
- Department of Neurosurgery, Hospital Universitario del Niño Jesús, Madrid, Spain
| | - Javier Orduna
- Department of Neurosurgery, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | - Juan Casado Pellejero
- Department of Neurosurgery, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | | | - Jorge Diaz-Molina
- Department of Neurosurgery, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | - Jesus Moles Herbera
- Department of Neurosurgery, Hospital Universitario Miguel Servet, Zaragoza, Aragón, Spain
| | | | - Mario Gomar Alba
- Department of Neurosurgery, Hospital Universitario Torrecardenas, Almería, Spain
| | | | | | - Javier Villaseñor Ledezma
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Álvaro Otero Rodríguez
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Juan José Ailagas
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Jesús Goncalves-Estella
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Pablo Sousa Casasnovas
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Daniel Pascual Argente
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Laura Ruiz Martín
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | | | - Daniel Arandia Guzmán
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Andoni García Martín
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | - Luis Torres Carretero
- Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain
| | | | - Marta Calvo
- Department of Neurosurgery, Ciudad Real General University Hospital, Ciudad Real, Castilla-La Mancha, Spain
| | - Pablo Miranda-Lloret
- Neurosurgical Department, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | | | - Joan Anotn Oltra
- Neurosurgical Department, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | - Amparo Roca Barber
- Neurosurgical Department, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | - Arnold Quiroz Tejada
- Neurosurgical Department, La Fe University and Polytechnic Hospital, Valencia, Comunidad Valenciana, Spain
| | | | - Garazi Bermudez Vilar
- Department of Neurosurgery, Cruces University Hospital, Barakaldo, País Vasco, Spain
| | | | | | | | | | - Gorka Zabalo San Juan
- Department of Neurosurgery, Cruces University Hospital, Barakaldo, País Vasco, Spain
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