Covid-19 diffusion in a neurosurgical “clean” department: the asymptomatic Trojan horse

Rustemi, Oriela; Segna, Alessandro; Zanusso, Mariano; Volpin, Lorenzo; Raneri, Fabio

doi:10.1007/s00701-020-04386-7

Cited by 3 publications

(3 citation statements)

References 3 publications

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“…Few cases among healthcare workers were reported during the period considered and no cases were reported in the following 2 months. All cases were reported in the earlier part of the month and were due to unpreparedness and unawareness at epidemic outbreak as already described by Rustemi et al 2 These data mean that adequate protective gear in a COVID-19-free ward can significantly reduce exposure and risk of infection if adequate safety measures are adopted (described in Table 4).…”

Section: Discussionsupporting

confidence: 59%

“…1 Indications given by international societies confirmed the value of delaying elective procedures to contain the spread of SARS-CoV-2, to reduce the patient load in ICUs with non-COVID-19 patients, and to reduce the possibility of treating asymptomatic patients with SARS-CoV-2 who would be at high risk of deteriorating and would increase the risk of infecting health professionals and other patients. [1][2][3][4][5][6] Italy became the epicenter of the epidemic in March 2020, with a toll of 110,574 infected, 13,155 deaths, and 4035 patients occupying ICUs on April 1, 2020. These numbers were concentrated mostly in the northern regions of Veneto, Piedmont, Emilia-Romagna and, most of all, Lombardy.…”

Section: Discussionmentioning

confidence: 99%

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Neurosurgery in times of a pandemic: a survey of neurosurgical services during the COVID-19 outbreak in the Veneto region in Italy

Raneri

Rustemi

Zambon

et al. 2020

Neurosurgical Focus

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OBJECTIVEThe purpose of this study was to analyze the effect of the coronavirus disease 2019 (COVID-19) outbreak and of the subsequent lockdown on the neurosurgical services of the Veneto region in Italy compared to the previous 4 years.METHODSA survey was conducted in all 6 neurosurgical departments in the Veneto region to collect data about surgical, inpatient care and endovascular procedures during the month of March for each year from 2016 to 2020. Safety measures to avoid infection from SARS-CoV-2 and any COVID-19 cases reported among neurosurgical patients or staff members were considered.RESULTSThe mean number of neurosurgical admissions for the month of March over the 2016–2019 period was 663, whereas in March 2020 admissions decreased by 42%. Emergency admissions decreased by 23%. The average number of neurosurgical procedures was 697, and declined by 30% (range −10% to −51% in individual centers). Emergency procedures decreased in the same period by 23%. Subarachnoid hemorrhage and spontaneous intracerebral hemorrhage both decreased in Veneto—by 25% and 22%, respectively. Coiling for unruptured aneurysm, coiling for ruptured aneurysm, and surgery for ruptured aneurysm or arteriovenous malformation diminished by 49%, 27%, and 78%, respectively. Endovascular procedures for acute ischemic stroke (AIS) increased by 33% in 2020 (28 procedures in total). There was a slight decrease (8%) in brain tumor surgeries. Neurosurgical admissions decreased by 25% and 35% for head trauma and spinal trauma, respectively, while surgical procedures for head trauma diminished by 19% and procedures for spinal trauma declined by 26%. Admissions and surgical treatments for degenerative spine were halved. Eleven healthcare workers and 8 patients were infected in the acute phase of the pandemic.CONCLUSIONSThis multicenter study describes the effects of a COVID-19 outbreak on neurosurgical activities in a vast region in Italy. Remodulation of neurosurgical activities has resulted in a significant reduction of elective and emergency surgeries compared to previous years. Most likely this is a combined result of cancellation of elective and postponable surgeries, increase of conservative management, increase in social restrictions, and in patients’ fear of accessing hospitals. Curiously, only endovascular procedures for AIS have increased, possibly due to reduced physical activity or increased thrombosis in SARS-CoV-2. The confounding effect of thrombectomy increase over time cannot be excluded. No conclusion can be drawn on AIS incidence. Active monitoring with nasopharyngeal swabs, wearing face masks, and using separate pathways for infected patients reduce the risk of infection.

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Section: Discussionsupporting

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Neurosurgery in times of a pandemic: a survey of neurosurgical services during the COVID-19 outbreak in the Veneto region in Italy

Raneri

Rustemi

Zambon

et al. 2020

Neurosurgical Focus

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“…Likewise, it was important to ensure that neurosurgical wards and the operating room were maintained free from Covid-19. This requires continuous active surveillance and testing [30].…”

Section: Collateral Damagementioning

confidence: 99%

A snapshot of European neurosurgery December 2019 vs. March 2020: just before and during the Covid-19 pandemic

et al. 2020

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Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or Covid-19), which began as an epidemic in China and spread globally as a pandemic, has necessitated resource management to meet emergency needs of Covid-19 patients and other emergent cases. We have conducted a survey to analyze caseload and measures to adapt indications for a perception of crisis. Methods We constructed a questionnaire to survey a snapshot of neurosurgical activity, resources, and indications during 1 week with usual activity in December 2019 and 1 week during SARS-CoV-2 pandemic in March 2020. The questionnaire was sent to 34 neurosurgical departments in Europe; 25 departments returned responses within 5 days. Results We found unexpectedly large differences in resources and indications already before the pandemic. Differences were also large in how much practice and resources changed during the pandemic. Neurosurgical beds and neuro-intensive care beds were significantly decreased from December 2019 to March 2020. The utilization of resources decreased via less demand for care of brain injuries and subarachnoid hemorrhage, postponing surgery and changed surgical indications as a method of rationing resources. Twenty departments (80%) reduced activity extensively, and the same proportion stated that they were no longer able to provide care according to legitimate medical needs. Conclusion Neurosurgical centers responded swiftly and effectively to a sudden decrease of neurosurgical capacity due to relocation of resources to pandemic care. The pandemic led to rationing of neurosurgical care in 80% of responding centers. We saw a relation between resources before the pandemic and ability to uphold neurosurgical services. The observation of extensive differences of available beds provided an opportunity to show how resources that had been restricted already under normal conditions translated to rationing of care that may not be acceptable to the public of seemingly affluent European countries.

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Aneurysmal subarachnoid hemorrhage in a SARS-CoV-2 positive testing: casual or causal?

Rustemi

Raneri

Iannucci

et al. 2020

British Journal of Neurosurgery

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Covid-19 diffusion in a neurosurgical “clean” department: the asymptomatic Trojan horse

Cited by 3 publications

References 3 publications

Neurosurgery in times of a pandemic: a survey of neurosurgical services during the COVID-19 outbreak in the Veneto region in Italy

Neurosurgery in times of a pandemic: a survey of neurosurgical services during the COVID-19 outbreak in the Veneto region in Italy

A snapshot of European neurosurgery December 2019 vs. March 2020: just before and during the Covid-19 pandemic

Aneurysmal subarachnoid hemorrhage in a SARS-CoV-2 positive testing: casual or causal?

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