Changes in nationwide in-hospital stroke care during the first four waves of COVID-19 in Germany

Dengler, Julius; Prass, Konstantin; Palm, Frederick; Hohenstein, Sven; Pellisier, Vincent; Stoffel, Michael; Hong, Bujung; Meier‐Hellmann, Andreas; Kuhlen, Ralf; Bollmann, Andreas; Rosahl, Steffen K.

doi:10.1177/23969873221089152

Cited by 17 publications

(20 citation statements)

References 34 publications

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“…Herein, the relatively high percentage of poor outcomes early in the pandemic correlates with the lowest transfer rates. A similar trend was noted in cases of ischemic stroke in Germany, where hospital admissions were lowest and patient outcomes poorest early in the pandemic before normalizing later as vaccination rate rose and health systems became more experienced with COVID-19 ( 35 ). This may support the notion that during this period, patients avoided or delayed seeking care early in their disease course, causing them to present with a more advanced degree of pathology.…”

Section: Discussionsupporting

confidence: 58%

The Scope and Impact of the COVID-19 Pandemic on Neuroemergent Patient Transfers, Clinical Care and Patient Outcomes

Woodward

Meza²,

Richards³

et al. 2022

Front. Surg.

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IntroductionThe SARS-CoV-2 (COVID-19) pandemic continues to substantially alter previously established clinical practice patterns and has transformed patient care in American healthcare. However, studies to evaluate the impact of COVID-19 on neuroemergent patient care and associated clinical outcomes are limited. Herein, we describe the impact of COVID-19 on the Neuroemergency Transfer Program (NTP) - a novel, urban, high volume interhospital patient transfer program.ObjectiveTo evaluate and describe the clinical impact of the COVID-19 pandemic on the NTP.Study DesignA single-center retrospective study of prospectively collected consecutive neuroemergent patient transfer data between 2018–2021 was analyzed. Adult patients were divided based upon transfer date into a Pre-COVID (PCOV) or COVID cohort. Patient demographics, transfer characteristics and clinical data and outcomes were analyzed.Results3,096 patients were included for analysis. Mean age at transfer in the PCOV and COVID cohorts were 62.4 ± 0.36 and 61.1 ± 0.6 years. A significant decrease in mean transfers per month was observed between cohorts (PCOV = 97.8 vs. COV = 68.2 transfers/month, p < 0.01). Total transfer time in the PCOV cohort was 155.1 ± 3.4 min which increased to 169.3 ± 12.8 min in the COVID cohort (p = 0.13). Overall mean transfer distance was significantly longer in the PCOV cohort at 22.0 ± 0.4 miles vs. 20.3 ± 0.67 miles in the COV cohort (p = 0.03). The relative frequency of transfer diagnoses was unchanged between cohorts. A significant increase in mean inpatient length of stay was noted, 7.9 ± 0.15 days to 9.6 ± 0.33 days in the PCOV vs. COVID cohorts (p < 0.01). Ultimately, no difference in the frequency of good vs. poor clinical outcome were noted between the PCOV (79.8% and 19.4%) vs. COV (78.8% and 20.4%) cohorts.ConclusionThe impact of COVID-19 on current healthcare dynamics are far reaching. Here, we show a significant decrease in interhospital patient transfers and increased length of stay between a Pre-COVID and COVID cohort. Further work to better elucidate the specific interplay of clinical contributors to account for these changes is indicated.

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Section: Discussionsupporting

confidence: 58%

The Scope and Impact of the COVID-19 Pandemic on Neuroemergent Patient Transfers, Clinical Care and Patient Outcomes

Woodward

Meza²,

Richards³

et al. 2022

Front. Surg.

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“…5 The global COVID-19 pandemic has affected not only patients suffering from the disease itself but also those with unrelated conditions, such as cardiac or neurologic emergencies. [13][14][15][16] Especially during the first pandemic wave, decreases in hospitalization rates and rates of transfer to intensive care units and increases in mortality rates were observed for those conditions. This is unusual, since most hospitals did not discontinue emergency cardiac or neurologic care and hospital overburdening was a rare phenomenon, especially in countries with ample hospital bed capacity.…”

Section: Discussionmentioning

confidence: 99%

Effects of the COVID-19 Pandemic on Spinal Fusion Procedures for Spinal Infections in a Nationwide Hospital Network in Germany

Abduljawwad

Pamnani

Stoffel

et al. 2022

J Neurol Surg A Cent Eur Neurosurg

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Background The full impact of the COVID-19 pandemic on surgical spine care is difficult to assess due to a lack in nationwide evidence from more recent phases of the pandemic. We aimed to describe changes in in-hospital processes associated with spinal fusion procedures in the treatment of spinal infections (SI) during different phases of the pandemic. Methods In this retrospective observational study, we examined the in-hospital prevalence and outcomes of spinal fusion procedures for SI (along with patient characteristics, rates of transfer to intensive care units, and mortality rates) during the first four waves of the pandemic compared with the corresponding prepandemic periods in 2019. We used administrative data from a nationwide network of 76 hospitals managing 7% of all in-hospital cases in Germany. Results We observed no significant change in the prevalence of SI fusion procedures during the pandemic, neither in total numbers (349 vs. 373) nor for each wave separately. On a patient level, we found no differences in age, sex, and the prevalence of paresis, and no relevant differences in associated comorbidities. The rate of mechanical ventilation did not change during any of the examined pandemic waves: it ranged between 9.5 and 18.6% during the pandemic and 3.1 and 16.0% during the corresponding prepandemic control periods. The rate of transfer to intensive care changed only during wave 4 (from 70.4 to 54.8%; p = 0.046) but not in any other pandemic phases. We observed no changes in in-hospital mortality rates (range: 2.9–9.7% vs. 6.2–11.3%) or in duration of hospital stay (range: 26.2–30.8 days vs. 20.8–29.2 days). Conclusions The main finding of our study is that within this nationwide network of spine care centers in Germany, the delivery of surgical treatment of SI by means of spinal fusion procedures was maintained throughout the first four waves of the pandemic. Furthermore, there were no relevant changes in patient demographics, in-hospital processes, and mortality rates.

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BackgroundSince COVID-19 was declared a pandemic in March 2020 evidence suggests substantial changes in access to and quality-of-care for other major serious and life-threatening conditions, such as stroke. 1,2 Stroke center admission and multidisciplinary investigations and treatment are the hallmarks of modern stroke care. Fulfillment of quality performance measures is associated with lower stroke recurrence, lower mortality, and improved functional outcome.

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mentioning

confidence: 99%

Quality in stroke care during the early phases of the COVID-19 pandemic: A nationwide study

Blauenfeldt

Hedegaard

Kruuse

et al. 2022

European Stroke Journal

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Introduction: Evidence-based early stroke care as reflected by fulfillment of process performance measures, is strongly related to better patient outcomes after stroke and transient ischemic attack (TIA). Detailed data on the resilience of stroke care services during the COVID-19 pandemic are limited. We aimed to examine the quality of early stroke care at Danish hospitals during the early phases of the COVID-19 pandemic. Materials and methods: We extracted data from Danish national health registries in five time periods (11 March, 2020–27 January, 2021) and compared these to a baseline pre-pandemic period (13 March, 2019–10 March, 2020). Quality of early stroke care was assessed as fulfilment of individual process performance measures and as a composite measure (opportunity-based score). Results: A total of 23,054 patients were admitted with stroke and 8153 with a TIA diagnosis in the entire period. On a national level, the opportunity-based score (95% confidence interval [CI]) at baseline for ischemic patients was 81.1% (80.8–81.4), for intracerebral hemorrhage (ICH) 85.5% (84.3–86.6), and for TIA 96.0% (95.3–96.1). An increase of 1.1% (0.1–2.2) and 1.5% (0.3–2.7) in the opportunity-based score was observed during the first national lockdown period for AIS and TIA followed by a decline of −1.3% (−2.2 to −0.4) in the gradual reopening phase for AIS indicators. We found a significant negative association between regional incidence rates and quality-of-care in ischemic stroke patients implying that quality decreases when admission rates increase. Conclusion: The quality of acute stroke/TIA care in Denmark remained high during the early phases of the pandemic and only minor fluctuations occurred.

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Changes in nationwide in-hospital stroke care during the first four waves of COVID-19 in Germany

Cited by 17 publications

References 34 publications

The Scope and Impact of the COVID-19 Pandemic on Neuroemergent Patient Transfers, Clinical Care and Patient Outcomes

The Scope and Impact of the COVID-19 Pandemic on Neuroemergent Patient Transfers, Clinical Care and Patient Outcomes

Effects of the COVID-19 Pandemic on Spinal Fusion Procedures for Spinal Infections in a Nationwide Hospital Network in Germany

Quality in stroke care during the early phases of the COVID-19 pandemic: A nationwide study

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