Perioperative Complications of Patients with SARS-CoV-2 Infection in Neurosurgery

Abstract

Background: The outbreak of coronavirus disease 2019 (COVID-19) has been rapidly evolving, resulting in a pandemic, with 270,031,622 infections according to the World Health Organization. Patients suffering from COVID-19 have also been described to suffer from neurologic and coagulopathic symptoms apart from the better-known flu-like symptoms. Some studies showed that patients suffering from COVID-19 were likely to developed intracranial hemorrhages. To our knowledge, only a few studies have investigated postoperative complications in COVID-19-positive neurosurgical patients and investigated the perioperative complications, either thrombotic or hemorrhagic, in patients with SARS-CoV-2 undergoing a neurosurgical intervention. Methods: We conducted a retrospective cohort study including patients from March 2020 to March 2021 undergoing neurosurgical interventions and suffering from COVID-19. Our primary outcome parameter was a hemorrhagic or thrombotic complication within 30 days after surgery. These outcomes were compared to those for a COVID-19-negative cohort of patients using propensity score matching. Results: We included ten COVID-19-positive patients with a mean age of 56.00 (±14.91) years. Twelve postoperative complications occurred in five patients. Three thrombotic complications (30%) were observed, with two cerebral sinus vein thromboses and one pulmonary embolus. Two patients suffered from a postoperative hemorrhagic complication (20%). The mean postoperative GCS was 14.30 (±1.57). COVID-19-positive patients showed a significantly higher rate of overall postoperative complications ((6 (60.0%) vs. 10 (19.2%), p = 0.021), thrombotic complications (3 (30.0%) vs. 1 (1.9%), p = 0.009), and mortality (2 (20.0%) vs. 0 (0.0%), p = 0.021) compared to the matched cohort of COVID-19-negative patients, treated at our institute before the SARS-CoV-2 pandemic. Conclusion: Patients undergoing neurosurgical operations with concomitant COVID-19 infection have higher rates of perioperative complications.

Postoperative Outcomes in Patients Undergoing Orthopedic Surgery Within 90 Days of Coronavirus Disease 2019

“…4,19,20 Several studies examining postoperative complications in patients with COVID-19 found increased rates of thromboembolism when compared with patients without COVID-19. 6,7,21 In a study by Deng et al 8 that examined postoperative outcomes by time from COVID-19 infection to the surgical procedure found an increased risk of pulmonary embolism in patients undergoing surgery 0 to 4 weeks after COVID-19 diagnosis, but no difference at 4 to 8 weeks or > 8 weeks, and no difference in deep vein thrombosis at any time point. This study found an increased risk of thromboembolic events in all subspecialties analyzed.…”

The impact of SARS-CoV-2 measures on patient samples and complication rates in spine surgery – A single center analysis

“…A study conducted by the COVIDSurg Collaborative reported that routine preoperative testing for SARS CoV2 is associated with lower postoperative pulmonary complications in major surgeries ( 22 ).. In addition, Greuter et al reported a higher rate of postoperative thrombotic complications in patients undergoing neurosurgical procedures ( 8 ). This is explained by the state of hypercoagulation with increased rate of heparin-binding proteins, which led to an increased rate of thrombotic complications.…”

“…While Chacon-Quesada et al reported a significant reduction of surgical site infections in their neurosurgical department due to the implemented measures; Abduljawwaad et al did not note any relevant changes in patient characteristics, duration of hospital stay and mortality rates in a nationwide network of spine care centers ( 6 , 7 ). An increased rate of complications in patients undergoing neurosurgery with concomitant SARS-CoV-2 infection has been by described by a group in Switzerland ( 8 ).…”