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":"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。","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":"<p><strong>Background: </strong> 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).</p><p><strong>Methods: </strong> 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.</p><p><strong>Results: </strong> 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%).</p><p><strong>Conclusion: </strong> 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.</p>","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":"{\"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\":\"<p><strong>Background: </strong> 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).</p><p><strong>Methods: </strong> 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.</p><p><strong>Results: </strong> 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%).</p><p><strong>Conclusion: </strong> 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.</p>\",\"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}","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}
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.
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.
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.
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