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CC BY-NC-ND 4.0 · Indian Journal of Neurosurgery 2021; 10(02): 128-135
DOI: 10.1055/s-0041-1729463
Original Article

Perioperative Practices and Outcome of Neurosurgery during the COVID-19 Pandemic: Institutional Experience and Retrospective Observational Analysis

Priyanka Khurana
1   Department of Anaesthesiology and Intensive Care, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
,
Pragati Ganjoo 
1   Department of Anaesthesiology and Intensive Care, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
,
Sakshi Duggal
1   Department of Anaesthesiology and Intensive Care, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
,
Kiran Lata Kiro 
1   Department of Anaesthesiology and Intensive Care, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
,
Lavina Dhanwani
1   Department of Anaesthesiology and Intensive Care, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
,
Monica S. Tandon
1   Department of Anaesthesiology and Intensive Care, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
,
Daljit Singh
2   Department of Neurosurgery, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
,
Anita Jagetia
2   Department of Neurosurgery, G.B. Pant Institute of Postgraduate Medical Education and Research, New Delhi, India
› Author Affiliations Funding None.
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Abstract

Introduction Surgery during the coronavirus disease 2019 (COVID-19) pandemic is a major concern due to possibility of infection transmission among health care workers (HCWs) and patients, and a worsened surgical outcome; most surgeries are thus being deferred. However, we continued with emergency neurosurgeries using our own Neurosurgical Standard Operating Procedures (NS-SOPs). We describe here our institutional neurosurgical experience and observations of a retrospective analysis done to determine the incidence of workplace-acquired COVID infection among the HCWs, and the outcome of neurosurgery performed during the early phase of the on-going pandemic.

Methods Our NS-SOPs included a Screening Proforma, and protocols for the conduct of neurosurgery, starting from the preoperative period till death or postdischarge follow-up of the patients. Protocols to ensure safety and mental well-being of the HCWs were also implemented. Patient and HCW data from April 1 to August 31, 2020 was collected and analyzed for the postsurgical patient outcome and for determining the level of workplace-transmitted COVID infection.

Results Neurosurgeries were performed on 169 patients during this 5-month period. We observed a cumulative mortality of 17/169 (10.1%), with 5 patients having unexplained postoperative respiratory manifestations and rapid deterioration suggestive of COVID illness. Nineteen HCWs (8.83%), mostly nurses, were infected, but only 3 (16.7%) had workplace-acquired infection. The infections were sporadic with no cluster of infections observed.

Conclusion Implementation of standard perioperative protocols and their continuous scrutiny, evaluation, and modification is important to contain infection in HCWs and to improve the neurosurgical outcome during this pandemic.

Keywords

perioperative protocols in COVID-19 - neurosurgery practices and outcome - health care worker infection


Publication History

Article published online:
30 April 2021

© 2021. Neurological Surgeons’ Society of India. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

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  • References

  • 1 Vetter P, Vu DL, L’Huillier AG, Schibler M, Kaiser L, Jacquerioz F. Clinical features of COVID-19. BMJ 2020; 369: m1470
    CrossrefPubMedGoogle Scholar
  • 2 Tsermoulas G, Zisakis A, Flint G, Belli A. Challenges to neurosurgery during the coronavirus disease 2019 (COVID-19) pandemic. World Neurosurg 2020; 139: 519-525
    CrossrefPubMedGoogle Scholar
  • 3 Lei S, Jiang F, Su W. et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine 2020; 21: 100331
    CrossrefPubMedGoogle Scholar
  • 4 Nahshon C, Bitterman A, Haddad R, Hazzan D, Lavie O. Hazardous postoperative outcomes of unexpected COVID-19 infected patients: a call for global consideration of sampling all asymptomatic patients before surgical treatment. World J Surg 2020; 44 (08) 2477-2481
    CrossrefPubMedGoogle Scholar
  • 5 Khatoon F, Prasad K, Kumar V. Neurological manifestations of COVID-19: available evidences and a new paradigm. J Neurovirol 2020; 26 (05) 619-630
    CrossrefPubMedGoogle Scholar
  • 6 Ellul MA, Benjamin L, Singh B. et al. Neurological associations of COVID-19. Lancet Neurol 2020; 19 (09) 767-783
    CrossrefPubMedGoogle Scholar
  • 7 Malhotra N, Bajwa SJ, Joshi M, Mehdiratta L, Trikha A. COVID operation theatre- advisory and position statement of Indian Society of Anaesthesiologists (ISA National). Indian J Anaesth 2020; 64 (05) 355-362
    CrossrefPubMedGoogle Scholar
  • 8 Nedunchezhian AS, Ajayan N, APH P, Prathapadas U, Sethuraman M, Koshy T. Finding the calm in the chaos: an institutional protocol for anesthetic management of a patient for neurosurgery during coronavirus disease 2019 pandemic. J Neurosci Rural Pract 2020; 11 (03) 369-374
    Article in Thieme ConnectPubMedGoogle Scholar
  • 9 Singh SK, Abhijit V, Jha VC. Modification of neurosurgical practice during corona pandemic: our experience at AIIMS Patna and long term guidelines. Interdiscip Neurosurg 2021; 23: 100895
    CrossrefPubMedGoogle Scholar
  • 10 Thapa A, Sharma K, Shrestha P. Standard operating protocol: operating on COVID-19 patients. Nepal J Neurosci 2020; 17 (01) 66-71
    CrossrefPubMedGoogle Scholar
  • 11 Coccolini F, Perrone G, Chiarugi M. et al. Surgery in COVID-19 patients: operational directives. World J Emerg Surg 2020; 15 (01) 25
    CrossrefPubMedGoogle Scholar
  • 12 Muhammad S, Tanikawa R, Lawton MT, Niemelä M, Hänggi D. Letter: safety instructions for neurosurgeons during COVID-19 pandemic based on recent knowledge and experience. Neurosurgery 2020; 87 (02) E220-E221
    CrossrefPubMedGoogle Scholar
  • 13 Srinivasaiah B, Deora H. Anesthetic management of neurosurgery patients in COVID-19 pandemic in an emergency setting. J Neurosci Rural Pract 2020; 11 (04) 514-516
    Article in Thieme ConnectPubMedGoogle Scholar
  • 14 Burke JF, Chan AK, Mummaneni V. et al. Letter: the coronavirus disease 2019 global pandemic: a neurosurgical treatment algorithm. Neurosurgery 2020; 87 (01) E50-E56
    CrossrefPubMedGoogle Scholar
  • 15 Gupta P, Muthukumar N, Rajshekhar V. et al. Neurosurgery and neurology practices during the novel COVID-19 pandemic: a consensus statement from India. Neurol India 2020; 68 (02) 246-254
    CrossrefPubMedGoogle Scholar
  • 16 Yang Y, Yang M, Shen C. et al. Evaluating the accuracy of different respiratory specimens in the laboratory diagnosis and monitoring the viral shedding of 2019-nCoV infections. The Innovation. 2020; 1 (03) DOI: 10.1016/j.xinn.2020.10006.
    CrossrefPubMedGoogle Scholar
  • 17 Nguyen LH, Drew DA, Joshi AD. et al. Risk of COVID-19 among frontline healthcare workers and the general community: a prospective cohort study. medRxiv 2020; DOI: 10.1101/2020.04.29.20084111.
    CrossrefPubMedGoogle Scholar
  • 18 Flexman AM, Abcejo AS, Avitsian R. et al. Neuroanesthesia practice during the COVID-19 pandemic: recommendations from Society for Neuroscience in Anesthesiology and Critical Care (SNACC). J Neurosurg Anesthesiol 2020; 32 (03) 202-209
    CrossrefPubMedGoogle Scholar
  • 19 Alajmi J, Jeremijenko AM, Abraham JC. et al. COVID-19 infection among healthcare workers in a national healthcare system: the Qatar experience. Int J Infect Dis 2020; 100: 386-389
    CrossrefPubMedGoogle Scholar
  • 20 Jeremias A, Nguyen J, Levine J. et al. Prevalence of SARS-CoV-2 infection among health care workers in a tertiary community hospital. JAMA Intern Med 2020; e204214 DOI: 10.1001/jamainternmed.2020.4214.
    CrossrefPubMedGoogle Scholar
  • 21 Wong LY, Tan AL, Leo YS, Lee VJM. Toh MPHS. Healthcare workers in Singapore infected with COVID-19: 23 January-17 April 2020. Influenza Other Respir Viruses 2020. 10.1111/irv.12803
    PubMed
  • 22 Kluytmans-van den Bergh MFQ, Buiting AGM, Pas SD. et al. Prevalence and clinical presentation of health care workers with symptoms of coronavirus disease 2019 in 2 Dutch hospitals during an early phase of the pandemic. JAMA Netw Open 2020; 3 (05) e209673
    CrossrefPubMedGoogle Scholar
  • 23 Muhi S, Irving LB, Buising KL. COVID-19 in Australian health care workers: early experience of the Royal Melbourne Hospital emphasises the importance of community acquisition. Med J Aust 2020; 213 (01) 44-44.e1
    CrossrefPubMedGoogle Scholar
  • 24 Zheng L, Wang X, Zhou C. et al. Analysis of the infection status of healthcare workers in Wuhan during the COVID-19 outbreak: a cross-sectional study. Clin Infect Dis 2020; 71 (16) 2109-2113
    CrossrefPubMedGoogle Scholar
  • 25 Doglietto F, Vezzoli M, Gheza F. et al. Factors associated with surgical mortality and complications among patients with and without coronavirus disease 2019 (COVID-19) in Italy. JAMA Surg 2020; 155 (08) 1-14
    CrossrefPubMedGoogle Scholar
  • 26 COVIDSurg Collaborative. Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. Lancet 2020; 396 (10243) 27-38
    CrossrefPubMedGoogle Scholar
  • 27 Guleria R, Madan K. Pulmonary complications in neurosurgical patient. Indian J of Neurosurg 2012; 1: 175-180
    Article in Thieme ConnectPubMedGoogle Scholar
  • 28 Lin CM, Lin MC, Huang SJ. et al. A prospective randomized study of brain tissue oxygen pressure-guided management in moderate and severe traumatic brain injury patients. BioMed Res Int 2015; 2015: 529580
    PubMedGoogle Scholar