Outcomes and Surgical Considerations for Neurosurgical Patients Hospitalized with COVID-19–A Multicenter Case Series

Abstract

Objective Neurosurgical patients are at a higher risk of having a severe course of Coronavirus disease 2019 (COVID-19). The objective of this study was to determine morbidity, hospital course and mortality of neurosurgical patients during the COVID-19 pandemic in a multi-center health care system. Methods A retrospective, observational study was conducted to identify all hospitalized neurosurgical patients positive for COVID-19 from 3/11/20 to 11/02/20 at Mayo Clinic and the Mayo Clinic Health System. Results Eleven hospitalized neurosurgical patients (0.68%) were positive for COVID-19. Four patients (36.6%) were men and 7 (63.3%) were women. The mean age was 65.7 years (range: 35-81 years). All patients had comorbidities. The mean length of stay was 13.4 days (range: 4-30 days). Seven patients had a central nervous system malignancy (4 metastases, 1 meningioma, 1 glioblastoma, and 1 schwannoma). Three patients presented cerebrovascular complications including two spontaneous intraparenchymal hemorrhages and 1 ischemic large vessel stroke. One patient presented with an unstable traumatic spinal burst fracture. Four patients underwent neurosurgical/neuroendovascular interventions. Discharge disposition was to home in 5, rehabilitation facility in 3 and hospice in 3 patients. Five patients expired on follow-up, three within 30-days from COVID-19 complications and two from progression of their metastatic cancer. Conclusion COVID-19 is rare among the inpatient neurosurgical population. In all cases, patients had multiple comorbidities. All symptomatic patients from the respiratory standpoint had complications during their hospitalization. Three patients, who expired within 30-days of hospitalization were all related to COVID-19 complications. Neurosurgical procedures were only performed if deemed emergent.

A prospective evaluation of postoperative fever in adult neurosurgery patients in the COVID-19 era

“…The other patient acquired the infection >31 days after primary surgery and had an asymptomatic course. While both patients who developed severe ARDS had a recognised risk factor for severe COVID-19 complications, namely advanced age, current data on the outcomes of postoperative COVID-19 infection in neurosurgical patients, though sparse, suggests a similarly high mortality [20] . Our low number of postoperative COVID-19 infections, likely a factor of our rigorous preoperative testing strategy prevents us from drawing more definitive conclusions, however it seems prudent to employ strict measures in the postoperative period to avoid COVID-19 transmission.…”

SARS-CoV-2 M Protein Facilitates Malignant Transformation of Breast Cancer Cells

“…Numerous studies have suggested that, in addition to having a high risk of SARS-CoV-2 infection, cancer patients might have an increased risk of accelerated cancer progression following infection ( 6 – 10 ). In addition, several case reports showed that breast cancer developed worsened outcomes after being infected by SARS-CoV-2, including new metastases and death due to tumor progression ( 8 , 9 ). In the present study, our results demonstrated that SARS-CoV-2 M protein stimulated the migration, invasion and expression of EMT genes in both MDA-MB-231 cells, a TNBC cell line, and MCF-7 cells, a hormone-dependent BCC line ( 28 , 29 ).…”

“…Breast cancer is one of the most frequent cancer types among SARS-CoV-2-infected cancer patients ( 6 , 17 , 18 ). Breast cancer patients infected with SARS-CoV-2 might develop new metastases, progression and death due to tumor progression ( 8 , 9 ). Therefore, in the present study, we aimed to examine the correlation between SARS-CoV-2 infection and breast cancer progression by studying the effects of SARS-CoV-2 proteins on the phenotypes of different types of human breast cancer cells (BCC), including aggressive MDA-MB-231 cells and non-aggressive MCF-7 cells.…”

Association of major postoperative wound and anastomotic complications in thoracic surgery with COVID-19 infection

“…In the paper by Marenco-Hillembrand et al, the authors describe clinical courses of 11 neurosurgical patients infected with COVID-19. One developed wound dehiscence together with pneumonia, deep vein thrombosis and hemothorax, and subsequently required hospitalization in the ICU for 13 days [ 14 ]. Impaired wound healing could be also associated with post COVID syndrome – long-lasting multi organ impairment.…”