Neurosurgical activity during COVID-19 pandemic: an experts' opinion from China, South Korea, Italy, the USA, Colombia, and the UK

Fontanella, Marco Maria; Saraceno, Giorgio; Lei, Ting; Bederson, Joshua B.; You, Nam Kyu; Rubiano, Andrés M.; Hutchinson, Peter J.; Wiemeijer-Timmer, Frédérique; Servadei, Franco

doi:10.23736/s0390-5616.20.04994-2

Cited by 24 publications

(10 citation statements)

References 5 publications

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“…In the most extreme case, entire hospitals were designated for each patient group, as was done by Singapore during SARS 16 and Italy during COVID-19. 17 …”

Section: Resultsmentioning

confidence: 99%

Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services

et al. 2021

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ObjectivesTo understand how surgical services have been reorganised during and following public health emergencies, particularly the first wave of the COVID-19 pandemic, and the consequences for patients, healthcare providers and healthcare systems.DesignA rapid scoping review.SettingWe searched the MEDLINE, Embase and grey literature sources for documents and press releases from governments and surgical organisations or associations.ParticipantsStudies examining surgical service delivery during public health emergencies including COVID-19, and the impact on patients, providers and healthcare systems were included.Primary and secondary outcome measuresPrimary outcomes were strategies implemented for the reorganisation of surgical services. Secondary were the impacts of reorganisation and resuming surgical services, such as: adverse events (including morbidity and mortality), primary care and emergency department visits, length of hospital and ICU stay, and changes to surgical waitlists.ResultsOne hundred and thirty-two studies were included in this review; 111 described reorganisation of surgical services, 55 described the consequences of reorganising surgical services; and 6 reported actions taken to rebuild surgical capacity in public health emergencies. Reorganisations of surgical services were grouped under six domains: case selection/triage, personal protective equipment (PPE) regulations and practice, workforce composition and deployment, outpatient and inpatient patient care, resident and fellow education, and the hospital or clinical environment. Service reorganisations led to large reductions in non-urgent surgical volumes, increases in surgical wait times and impacted medical training (ie, reduced case involvement) and patient outcomes (eg, increases in pain). Strategies for rebuilding surgical capacity were scarce but focused on the availability of staff, PPE and patient readiness for surgery as key factors to consider before resuming services.ConclusionsReorganisation of surgical services in response to public health emergencies appears to be context dependent and has far-reaching consequences that must be better understood in order to optimise future health system responses to public health emergencies.

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“…In the most extreme case, entire hospitals were designated for each patient group, as was done by Singapore during SARS 16 and Italy during COVID-19. 17 …”

Section: Resultsmentioning

confidence: 99%

Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services

et al. 2021

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“…Neurological surgery was particularly affected by the ICU reorganization, as it often requires a period of intensive monitoring in ICUs. 22,60–62 All the cases of elective neurological surgery were deferred, while urgent neurosurgical pathologies (above all traumas) and non-deferrable tumour cases were transferred to hubs. 27,29–33,61,67,68 A specific urgency classification for tumour cases was developed based on symptoms, radiological findings, and suspected malignancy of the lesion.…”

Section: Resultsmentioning

confidence: 99%

“…Arduino et al described a worrying delay in the diagnosis of oral cancer in north-west Italy during the Covid pandemic. 62 Moreover, the cessation of elective activities, screening programs 63 , and the drastic reduction in services regarding breast cancer restricted evaluations to only clinical observations of palpable lesions with the elevated risk of missing new diagnoses. 64 , Although not requiring a structural reorganization, palliative care was forced to find a new balance between family member visits and patients’ needs.…”

Section: Resultsmentioning

confidence: 99%

The impact of the SARS-CoV-2 pandemic on healthcare provision in Italy to non-COVID patients: a systematic review

Lugli

Ottaviani

Botta

et al. 2020

Preprint

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Background: Italy has been one of the countries most affected by the SARS-CoV-2 pandemic and the regional healthcare system has had to quickly adapt its organization to meet the needs of infected patients. This has led to a drastic change in the routine management of non-communicable diseases with a potential long-term impact on patient health care. We investigated the management of non-COVID-19 patients across all medical specialties during the pandemic in Italy. Methods: A PRISMA guideline-based systematic review of the available literature was performed using PubMed, Embase, and Scopus, restricting the search to the main outbreak period in Italy (from 20 February to 22 June, 2020). We selected articles in English or Italian that detailed changes in the Italian hospital care for non-COVID-19 patients due to the pandemic. Our keywords included all medical specialties in combination with our geographical focus (Italy) and COVID-19. Findings: Of the 4643 potentially eligible studies identified by the search, 247 studies were included in the systematic review. A decrease in the management of emergencies in non-COVID patients was found together with an increase in mortality. Similarly, non-deferrable conditions met a tendency toward decreased diagnosis. All specialties have been affected by the reorganization of healthcare provision in the hub-and-spoke system and have benefited from telemedicine during the pandemic. Interpretation: Our work highlights the changes taking place in the Italian public healthcare system in order to tackle the developing health crisis due to the COVID-19 pandemic. The findings of our review may be useful to analyze future directions for the healthcare system in the case of new pandemic scenarios.

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“…In the most extreme case, entire hospitals were designated for each patient group, as was done by Singapore during SARS 15 and Italy during COVID-19. 16…”

Section: Changes To Patientmentioning

confidence: 99%

Surgery & COVID-19: A rapid scoping review of the impact of COVID-19 on surgical services during public health emergencies

O'Rielly

Ng‐Kamstra

Kania-Richmond

et al. 2020

Preprint

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BackgroundHealthcare systems globally have been challenged by the COVID-19 pandemic, necessitating the reorganization of surgical services to free capacity within healthcare systems.ObjectivesTo understand how surgical services have been reorganized during and following public health emergencies, and the consequences of these changes for patients, healthcare providers and healthcare systems.MethodsThis rapid scoping review searched academic databases and grey literature sources to identify studies examining surgical service delivery during public health emergencies including COVID-19, and the impact on patients, providers and healthcare systems. Recommendations and guidelines were excluded. Screening was completed in partial (title, abstract) or complete (full text) duplicate following pilot reviews of 50 articles to ensure reliable application of eligibility criteria.ResultsOne hundred and thirty-two studies were included in this review; 111 described reorganization of surgical services, 55 described the consequences of reorganizing surgical services and six reported actions taken to rebuild surgical capacity in public health emergencies. Reorganizations of surgical services were grouped under six domains: case selection/triage, PPE regulations and practice, workforce composition and deployment, outpatient and inpatient patient care, resident and fellow education, and the hospital or clinical environment. Service reorganizations led to large reductions in non-urgent surgical volumes, increases in surgical wait times, and impacted medical training (i.e., reduced case involvement) and patient outcomes (e.g., increases in pain). Strategies for rebuilding surgical capacity were scarce, but focused on the availability of staff, PPE, and patient readiness for surgery as key factors to consider before resuming services.ConclusionsReorganization of surgical services in response to public health emergencies appears to be context-dependent and has far-reaching consequences that must be better understood in order to optimize future health system responses to public health emergencies.ARTICLE SUMMARYStrengths and limitations of the studyThis rapid scoping review provides an exhaustive and rigorous summary of the academic and grey literature regarding modifications to surgical services in response to public health emergencies, especially COVID-19.This study did not limit studies based on location or language of publication to ensure a worldwide pandemic had contributions from worldwide voices.Both quantitative and qualitative outcomes were included, with a mix of inductive and deductive data abstraction approaches to provide a comprehensive understanding of surgical services during public health emergencies.Studies with potential relevance to this question are emerging at an unprecedented rate in response to the COVID-19 pandemic and as such, some may not be included in the current review.Original protocol for the studyAs requested, the original unpublished protocol for this study is included as a supplementary file.Funding statementThis study did not receive grant from any funding agency in the public, commercial or not-for-profit sectors.Competing interest statementAll authors declare that they have no competing interests in accordance with the International Committee of Medical Journal Editors uniform declaration of competing interests.

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Neurosurgical activity during COVID-19 pandemic: an experts' opinion from China, South Korea, Italy, the USA, Colombia, and the UK

Cited by 24 publications

References 5 publications

Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services

Surgery and COVID-19: a rapid scoping review of the impact of the first wave of COVID-19 on surgical services

The impact of the SARS-CoV-2 pandemic on healthcare provision in Italy to non-COVID patients: a systematic review

Surgery & COVID-19: A rapid scoping review of the impact of COVID-19 on surgical services during public health emergencies

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