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.
Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic / Michael T C, Poon; Rory J, Piper; Nqobile, Thango; Daniel M, Fountain; Hani J, Marcus; Laura, Lippa; Franco, Servadei; Ignatius N, Esene; Christian F, Freyschlag; Iuri S, Neville; Gail, Rosseau; Karl, Schaller; Andreas K, Demetriades; Faith C, Robertson; Peter J, Hutchinson; Stephen J, Price; Ronnie E, Baticulon; James C, Glasbey; Aneel, Bhangu; Michael D, Jenkinson; Angelos G, Kolias; Burtscher, J; Trivik-Barrientos, F; Bauer, M; Freyschlag, C; Lemos Vieira da Cunha, M; Persad, A; Pham, H; Wood, M; Christensen, P; Haldrup, M; H Iversen, L; Ø Kristensen, H; Mekhael, M; Mikic, N; Crespo, A; Díaz, P; Tactuk, N; Abdelsamed, A; Y Azzam, A; Salem, H; Seleim, A; Abd-Elsalam, S; Badr, H; Elbahnasawy, M; Essa, M; Gamal Badr, S; Ghoneim, A; Hamad, O; Hamada, M; Hawila, A; S Morsy, M; Sarsik, S; Ballouhey, Q; Salle, H; Barrios Duarte, A; Lopez Muralles, I; Lowey, M; L Portilla, A; Recinos, G; Arora, R; Kottayasamy Seenivasagam, R; Sadhasivam, S; Babu, N; Kheni, Y; Kommu, V; Rao, S; Moiyadi, A; Pandey, D; S Pramesh, C; Shetty, P; Singh, V; A Islam, A; Kembuan, G; Pajan, H; Safari, H; Bàmbina, F; D'Andrea, G; Familiari, P; Picotti, V; Bruzzaniti, P; Chiarella, V; Di Bartolomeo, A; Frati, A; Giugliano, M; Lapolla, P; Salvati, M; Santoro, A; K Scafa, A; Gagliardi, F; Medone, M; Mortini, P; Piloni, M; Belvedere, A; Droghetti, M; Frio, F; Neri, J; P Pezzuto, A; Poggioli, G; Rottoli, M; S Russo, I; Aquila, F; Gambacciani, C; Lippa, L; Pieri, F; S Santonocito, O; Al Abdallah, M; Ayasra, F; Ayasra, Y; Qasem, A; J Abu Za'nouneh, F; A Al Shraideh, A; Fahmawee, T; Ibrahim, A; K Abou Chaar, M; Al-Najjar, H; Elayyan, M; Abusannoga, M; Alawami, A; Alawami, M; Albashri, M; Malek, A; Abdulwahed, E; Biala, M; Ghamgh, R; Arkha, Y; Bechri, H; El Ouahabi, A; Y Oudrhiri, M; El Azhari, A; M Louraoui, S; Rghioui, M; Bougrine, M; Derkaoui Hassani, F; El Abbadi, N; Akinmade, A; Fayose, S; Okunlola, A; Dawang, Y; Obande, J; Olori, S; Abdur-Rahman, L; Adeleke, N; Adeyeye, A; Javed, S; Yaqoob, E; Al-Slaibi, I; A Alzeerelhouseini, H I; Jobran, F; Alshahrani, M; Alsharif, F; A Azab, M; Al Otaibi, F; Aldahash, H; Alhazzaa, N; Alhefdhi, A; Alsumai, T; Farrash, F; Spangenberg, P; Ajlan, A; Al-Habib, A; Alatar, A; Bin Nasser, A; Elwatidy, S; Nouh, T; Abdulfattah, F; Alanazi, F; Albaqami, F; Alsowaina, K; Bascarevic, V; Bogdanovic, I; Grujičić, D; Ilic, R; Milićević, M; Milisavljević, F; Miljković, A; Paunovic, A; Šćepanović, V; Stanimirovic, A; Todorovic, M; M Castaño-Leon, A; Delgado Fernandez, J; Eiriz Fernandez, C; Esteban Sinovas, O; Garcia Perez, D; Gomez, P; Jimenez-Roldan, L; Lagares, A; Moreno-Gomez, L; Paredes, I; Pérez Núñez, A; Aldecoa Ansorregui, I; Di Somma, A; Enseñat Nora, J; Fabregas, N; Ferrés, A; J Gonzalez Sanchez, J; Gracia, I; A Hoyos Castro, J; Langdon, C; Oleaga, L; Pedrosa, L; Poblete Carrizo, J; A Reyes Figueroa, L; Roldan Ramos, P; Rumia-Arboix, J; I Tercero-Uribe, A; E Topczewski, T; Torales, J; Torné, R; Valero, R; Mahfoud, M; Bekheit, M; Ashcroft, J; Coughlin, P; J Davies, R; Hutchinson, P; Z Khan, D; Kolias, A; Mannion, R; Mohan, M; Price, S; Santarius, T; Singh, A; Yordanov, S; Ganau, M; Jeyaretna, D; Piper, R; Sravanam, S; Mcsorley, N; Solth, A; Chowdhury, Y; Karia, K; Solomou, G; C Soon, W; Stevens, A; Topham, C; Ughratdar, I; Alakandy, L; Bhattathiri, P; Brown, J; Canty, M; Grivas, A; Hassan, S; Lammy, S; Littlechild, P; Maseland, C; Mathieson, C; O'Kane, R; St George, E; Suttner, N; Taylor, W; Al-Tamimi, Y; Bacon, A; Crank, M; Rominiyi, O; Sinha, S; M Brennan, P; Pasricha, R; Anzak, A; Leal Silva, I; Sohrabi, C; Thakur, B; Patkar, P; Phang, I; Colombo, F; Fountain, D; T Hasan, M; Karabatsou, K; Laurente, R; Pathmanaban, O; Choi, D; Hutchison, R; Jain, A; Luoma, V; Marcus, H; May, R; Menon, A; Pramodana, B; Webber, L; Elmoslemany, T; Jenkinson, M; P Millward, C; Zakaria, R; Bigelow, B; Etchill, E; Gabre-Kidan, A; Jenny, H; Ladd, M; Long, C; Malapati, H; Margalit, A; Rapaport, S; Rose, J; Tsai, L; Vervoort, D; Yesantharao, P; Arzumanov, G; Glass, N; Zhao, K; Aoun, S; S Ban, V; H Batjer, H; Caruso, J; M Ruzgar, N; Sion, M; Ullrich, S. - In: NEURO-ONCOLOGY. - ISSN 1522-8517. - (2023). [10.1093/neuonc/noad019]
Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic
H Salle;F Bàmbina;P Familiari;V Picotti;P Bruzzaniti;V Chiarella;A Frati;P Lapolla;A K Scafa;A Qasem;A Ibrahim;M Todorovic;D Choi;A Jain;R May;
2023
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.| File | Dimensione | Formato | |
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