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Castaño-Leon AM, Paredes I, Lagares A, Gomez PA, González-Leon P, Perez-Nuñez A, Jiménez-Roldán L, Delgado-Fernández J, Eiriz Fernández C, García-Pérez D, Moreno-Gómez LM, Esteban-Sinovas O, Delgado-López PD, Martín-Alonso J, Kaen A, Tirado-Caballero J, Ordóñez-Carmona M, Arteaga-Romero F, González-Pombo M, F Alén J, Gil-Simoes R, Torres CV, Navas-García M, Blasco García de Andoain G, Frade-Porto N, González-Tarno P, Martin Segura A, Gelabert-González M, Menéndez-Cortezón B, Rodríguez-Botana B, Pérez-Alfayate R, Fernández-García C, Ferrández-Pujante B, Vargas-Jiménez AC, Cotúa C, de la Lama A, Calero Félix L, Ruiz-Juretschke F, García-Leal R, Valera-Melé M, Casitas Hernando V, Rivero B, Orduna-Martínez J, Casado Pellejero J, Fustero De Miguel D, Díaz Molina J, Moles Herbera J, Castelló-Ruiz MJ, Gomar-Alba M, García-Pérez F, Hernández-García BJ, Villaseñor-Ledezma JJ, Otero-Rodríguez Á, Ailagas de Las Heras JJ, Gonçalves-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 Ruiz A, Calvo M, Miranda-Lloret P, Rodríguez-Cadarso M, Antón J, Roca Barber A, Quiroz-Tejada A, Carbayo-Lozano G, Bermúdez G, Paternain Martin C, De la Fuente Villa P, Fidalgo De la Rosa M, Sistiaga-Gracia ÍL, Zabalo G. Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study. BMJ Open 2022; 12:e061208. [PMID: 35977759 PMCID: PMC9388715 DOI: 10.1136/bmjopen-2022-061208] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [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: 11/07/2022] Open
Abstract
OBJECTIVES The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery. DESIGN This was an observational retrospective study. SETTINGS A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020. PARTICIPANTS A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease. PRIMARY AND SECONDARY OUTCOME MEASURES The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection. RESULTS More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p<0.001), degenerative spine (OR=0.296, p=0.027) and expedited indications (OR=6.095, p<0.001) were independent factors for being operated on during the pandemic. CONCLUSIONS Patients awaiting neurosurgery experienced significant collateral damage even when they were considered for scheduled procedures.
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Affiliation(s)
- Ana M Castaño-Leon
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Igor Paredes
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Alfonso Lagares
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Pedro A Gomez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
| | - Pedro González-Leon
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Angel Perez-Nuñez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | - Luis Jiménez-Roldán
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
- Instituto de Investigación Sanitaria Hospital 12 de Octubre (imas12), Madrid, Spain
- Departamento de Cirugía, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain
| | | | | | - Daniel García-Pérez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Luis M Moreno-Gómez
- Neurosurgery Department, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | | | | | - Ariel Kaen
- Neurosurgery Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | | | | | | | - Marta González-Pombo
- Neurosurgery Department, Hospital Universitario Virgen del Rocio, Sevilla, Spain
| | - José F Alén
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Ricardo Gil-Simoes
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Cristina V Torres
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | - Marta Navas-García
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | - Natalia Frade-Porto
- Neurosurgery Department, Hospital Universitario de la Princesa, Madrid, Spain
| | | | | | - Miguel Gelabert-González
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Beatriz Menéndez-Cortezón
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | - Brais Rodríguez-Botana
- Neurosurgery Department, Complejo Hospitalario Universitario de Santiago de Compostela, Santiago de Compostela, Spain
| | | | | | | | | | - Carlos Cotúa
- Neurosurgery Department, Hospital Clinico Universitario San Carlos, Madrid, Spain
| | - Adolfo de la Lama
- Neurosurgery Department, Complejo Hospitalario de Vigo Alvaro Cunqueiro, Vigo, Spain
| | - Lourdes Calero Félix
- Neurosurgery Department, Complejo Hospitalario de Vigo Alvaro Cunqueiro, Vigo, Spain
| | | | - Roberto García-Leal
- Neurosurgery Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | - Marc Valera-Melé
- Neurosurgery Department, Hospital General Universitario Gregorio Maranon, Madrid, Spain
| | | | - Belén Rivero
- Neurosurgery Department, Hospital Infantil Universitario Niño Jesús, Madrid, Spain
| | | | | | | | - Jorge Díaz Molina
- Neurosurgery Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Jesús Moles Herbera
- Neurosurgery Department, Hospital Universitario Miguel Servet, Zaragoza, Spain
| | - Maria J Castelló-Ruiz
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | - Mario Gomar-Alba
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | - Fernando García-Pérez
- Neurosurgery Department, Complejo Hospitalario Universitario Torrecardenas, Almeria, Spain
| | | | | | - Álvaro Otero-Rodríguez
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | | | - Pablo Sousa-Casasnovas
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Daniel Pascual-Argente
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Laura Ruiz Martín
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | | | - Daniel Arandia Guzmán
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Andoni García Martín
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Luis Torres Carretero
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Alejandra Garrido Ruiz
- Neurosurgery Department, Complejo Asistencial Universitario de Salamanca, Salamanca, Spain
| | - Marta Calvo
- Neurosurgery Department, Hospital General Universitario de Ciudad Real, Ciudad Real, Spain
| | - Pablo Miranda-Lloret
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | | | - Joan Antón
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - Amparo Roca Barber
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | - Arnold Quiroz-Tejada
- Neurosurgery Department, Hospital Politécnico y Universitario La Fe, Valencia, Spain
| | | | - Garazi Bermúdez
- Neurosurgery Department, Hospital Universitario Cruces, Barakaldo, Spain
| | | | | | | | | | - Gorka Zabalo
- Neurosurgery Department, Hospital Universitario Cruces, Barakaldo, Spain
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Mirabet V, García D, Roca A, Quiroz AR, Antón J, Rodríguez-Cadarso M, Ocete D, Aranda L, Melero A, Guillot AJ, Yagüe N, Guillén I, Botella C. Cranioplasty with Autologous Bone Flaps Cryopreserved with Dimethylsulphoxide: Does Tissue Processing Matter. World Neurosurg 2021; 149:e582-e591. [PMID: 33556597 DOI: 10.1016/j.wneu.2021.01.131] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 01/25/2021] [Accepted: 01/26/2021] [Indexed: 10/22/2022]
Abstract
OBJECTIVE The aim of this article was to study the outcome of patients who underwent cranioplasty with cryopreserved autologous bone after decompressive craniectomy. METHODS Data from 74 patients were retrospectively analyzed. They were divided into groups according to the storage time and the age at cranioplasty. To assess the predictive potential for complication, factors were related to successive stages (preoperative, craniectomy, tissue processing, cranioplasty, and postoperative). Cooling and warming rates applied on bone flap were calculated. The ability to inhibit microbial growth was determined exposing bone fragments to a panel of microorganisms. The concentration of antibiotics eluted from the bone was also determined. A bone explant culture method was used to detect living cells in the thawed cranial bone. RESULTS Hydrocephalus was significantly more frequent in pediatric patients (26.7%) than in adults (5.1%). The overall rate of bone flap resorption was 21.6% (43.7% of which required reoperation). Surgical site infection after cranioplasty was detected in 6.8% of patients. There was no correlation between infection as a postoperative complication and previous microbiological-positive culture during processing. The cause of craniectomy did not influence the risk of bone flap contamination. Vancomycin was the only antibiotic detected in the supernatant where the bone was incubated. Outgrowth from bone explants was observed in 36.8% of thawed skulls. An early start of bone flap processing at the tissue bank had a positive effect on cell viability. CONCLUSIONS The outcome after autologous cranioplasty is a multifactorial process, which is modulated by patient-related, surgery-related, and bone-related factors.
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Affiliation(s)
- Vicente Mirabet
- Cell and Tissue Bank, Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain.
| | - Daniel García
- Cell and Tissue Bank, Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain
| | - Amparo Roca
- Cell and Tissue Bank, Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain
| | - Arnold R Quiroz
- Cell and Tissue Bank, Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain
| | - Joan Antón
- Cell and Tissue Bank, Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain
| | | | - Dolores Ocete
- Service of Microbiology, Consorcio Hospital General Universitario, Valencia, Spain
| | - Lucas Aranda
- Service of Microbiology, Consorcio Hospital General Universitario, Valencia, Spain
| | - Ana Melero
- Department of Pharmacy, Pharmaceutical Technology and Parasitology, Universitat de València, Valencia, Spain
| | - Antonio J Guillot
- Department of Pharmacy, Pharmaceutical Technology and Parasitology, Universitat de València, Valencia, Spain
| | - Nuria Yagüe
- Cell and Tissue Bank, Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain
| | - Isabel Guillén
- Department of Pharmacy, Faculty of Health Sciences, Universidad Cardenal Herrera-CEU, Valencia, Spain
| | - Carlos Botella
- Cell and Tissue Bank, Centro de Transfusión de la Comunidad Valenciana, Valencia, Spain
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