Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic
Author:
Poon Michael T C12ORCID, Piper Rory J3, Thango Nqobile4, Fountain Daniel M5, Marcus Hani J67ORCID, Lippa Laura8, Servadei Franco9, Esene Ignatius N10, Freyschlag Christian F11, Neville Iuri S12, Rosseau Gail13, Schaller Karl14, Demetriades Andreas K2, Robertson Faith C15, Hutchinson Peter J16, Price Stephen J17, Baticulon Ronnie E18, Glasbey James C19, Bhangu Aneel20, Jenkinson Michael D21, Kolias Angelos G17, Burtscher J22, Trivik-Barrientos F22, Bauer M23, Freyschlag C23, Lemos Vieira da Cunha M24, Persad A25, Pham H25, Wood M25, Christensen P26, Haldrup M26, Iversen L H26, Kristensen H Ø26, Mekhael M26, Mikic N26, Crespo A27, Díaz P27, Tactuk N27, Abdelsamed A28, Azzam A Y28, Salem H28, Seleim A28, Abd-elsalam S29, Badr H29, Elbahnasawy M29, Essa M29, Gamal Badr S29, Ghoneim A29, Hamad O29, Hamada M29, Hawila A29, Morsy M S29, Sarsik S29, Ballouhey Q30, Salle H30, Barrios Duarte A31, Lopez Muralles I31, Lowey M31, Portilla A L31, Recinos G31, Arora R32, Kottayasamy Seenivasagam R32, Sadhasivam S32, Babu N33, Kheni Y33, Kommu V33, Rao S33, Moiyadi A34, Pandey D34, Pramesh C S34, Shetty P34, Singh V34, Islam A A35, Kembuan G35, Pajan H35, Safari H36, Bàmbina F37, D’Andrea G37, Familiari P37, Picotti V37, Bruzzaniti P38, Chiarella V38, Di bartolomeo A38, Frati A38, Giugliano M38, Lapolla P38, Salvati M38, Santoro A38, Scafa A K38, Gagliardi F39, Medone M39, Mortini P39, Piloni M39, Belvedere A40, Droghetti M40, Frio F40, Neri J40, Pezzuto A P40, Poggioli G40, Rottoli M40, Russo I S40, Aquila F41, Gambacciani C41, Lippa L41, Pieri F41, Santonocito O S41, Al Abdallah M42, Ayasra F42, Ayasra Y42, Qasem A42, Abu Za’nouneh F J43, Al_shraideh A A43, Fahmawee T43, Ibrahim A43, Abou Chaar M K44, Al-Najjar H44, Elayyan M44, Abusannoga M45, Alawami A45, Alawami M45, Albashri M45, Malek A45, Abdulwahed E46, Biala M46, Ghamgh R46, Arkha Y47, Bechri H47, El Ouahabi A47, Oudrhiri M Y47, El Azhari A48, Louraoui S M48, Rghioui M48, Bougrine M49, Derkaoui Hassani F49, El Abbadi N49, Akinmade A50, Fayose S50, Okunlola A51, Dawang Y52, Obande J52, Olori S52, Abdur-Rahman L53, Adeleke N53, Adeyeye A53, Javed S54, Yaqoob E54, Al-Slaibi I55, Alzeerelhouseini H I A55, Jobran F55, Alshahrani M56, Alsharif F56, Azab M A57, Al Otaibi F58, AlDahash H58, Alhazzaa N58, Alhefdhi A58, AlSumai T58, Farrash F58, Spangenberg P58, Ajlan A59, Al-Habib A59, Alatar A59, Bin Nasser A59, Elwatidy S59, Nouh T59, Abdulfattah F60, Alanazi F60, Albaqami F60, Alsowaina K60, Bascarevic V61, Bogdanovic I61, Grujičić D61, Ilic R61, Milićević M61, Milisavljević F61, Miljković A61, Paunovic A61, Šćepanović V61, Stanimirovic A61, Todorovic M61, Castaño-Leon A M62, Delgado Fernandez J62, Eiriz Fernandez C62, Esteban Sinovas O62, Garcia Perez D62, Gomez P62, Jimenez-Roldan L62, Lagares A62, Moreno-Gomez L62, Paredes I62, Pérez Núñez A62, Aldecoa Ansorregui I63, Di Somma A63, Enseñat Nora J63, Fabregas N63, Ferrés A63, Gonzalez Sanchez J J63, Gracia I63, Hoyos Castro J A63, Langdon C63, Oleaga L63, Pedrosa L63, Poblete Carrizo J63, Reyes Figueroa L A63, Roldan Ramos P63, Rumia-Arboix J63, Tercero-Uribe A I63, Topczewski T E63, Torales J63, Torné R63, Valero R63, Mahfoud M64, Bekheit M65, Ashcroft J66, Coughlin P66, Davies R J66, Hutchinson P66, Khan D Z66, Kolias A66, Mannion R66, Mohan M66, Price S66, Santarius T66, Singh A66, Yordanov S66, Ganau M67, Jeyaretna D67, Piper R67, Sravanam S67, McSorley N68, Solth A68, Chowdhury Y69, Karia K69, Solomou G69, Soon W C69, Stevens A69, Topham C69, Ughratdar I69, Alakandy L70, Bhattathiri P70, Brown J70, Canty M70, Grivas A70, Hassan S70, Lammy S70, Littlechild P70, Maseland C70, Mathieson C70, O’Kane R70, George E St70, Suttner N70, Taylor W70, Al-Tamimi Y71, Bacon A71, Crank M71, Rominiyi O71, Sinha S71, Brennan P M72, Pasricha R72, Anzak A73, Leal Silva I73, Sohrabi C73, Thakur B73, Patkar P74, Phang I74, Colombo F75, Fountain D75, Hasan M T75, Karabatsou K75, Laurente R75, Pathmanaban O75, Choi D76, Hutchison R76, Jain A76, Luoma V76, Marcus H76, May R76, Menon A76, Pramodana B76, Webber L76, Elmoslemany T77, Jenkinson M77, Millward C P77, Zakaria R77, Bigelow B78, Etchill E78, Gabre-Kidan A78, Jenny H78, Ladd M78, Long C78, Malapati H78, Margalit A78, Rapaport S78, Rose J78, Tsai L78, Vervoort D78, Yesantharao P78, Arzumanov G79, Glass N79, Zhao K79, Aoun S80, Ban V S80, Batjer H H80, Caruso J80, Ruzgar N M81, Sion M81, Ullrich S81,
Affiliation:
1. Usher Institute, University of Edinburgh , Edinburgh , UK 2. Department of Clinical Neurosciences, Royal Infirmary of Edinburgh , Edinburgh , UK 3. Department of Neurosurgery, John Radcliffe Hospital , Oxford , UK 4. Department of Surgery, Division of Neurosurgery , University of Cape Town, Cape Town , South Africa 5. Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust , Salford , UK 6. National Hospital for Neurology and Neurosurgery , London , UK 7. UCL Queen Square Institute of Neurology , London , UK 8. Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda Milan , Italy 9. Department of Biomedical Sciences, Humanitas University and IRCCS Humanitas Research Hospital , Milano , Italy 10. Neurosurgery Division, Faculty of Health Sciences, University of Bamenda , Bambili , Cameroon 11. Department of Neurosurgery, Medical University of Innsbruck , Anichstr. 35, 6020 Innsbruck , Austria 12. Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo , Sao Paulo , Brazil 13. George Washington University School of Medicine and Health Sciences , Washington, DC , United States 14. Department of Clinical Neurosciences, Geneva University Medical Center , Geneva , Switzerland 15. Department of Neurosurgery, Massachusetts General Hospital , Boston, Massachusetts , United States 16. Academic Division of Neurosurgery, Addenbrooke's Hospital , Cambridge , UK 17. Department of Clinical Neurosciences, Division of Neurosurgery , Cambridge , UK 18. Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila , Manila , Philippines 19. NIHR Global Health Research Unit on Global Surgery, University of Birmingham , Birmingham , UK 20. University of Birmingham , Birmingham , UK 21. Department of Neurosurgery, Walton Centre & University of Liverpool , Liverpool , UK 22. Landesklinikum Wiener Neustadt , Wiener Neustadt Austria 23. Medical University Of Innsbruck , Innsbruck Austria 24. Supera Oncologia - Hospital Regional Do Oeste , Chapeco Brazil 25. Saskatoon City Hospital/Royal University Hospital/St. Paul’s Hospital , Saskatoon Sk Canada 26. Aarhus University Hospital , Aarhus Denmark 27. Cedimat - Centro De Diagnóstico , Medicina Avanzada, Laboratorio Y Telemedicina, Santo Domingo Dominican Republic 28. Al Azhar University Hospitals , Cairo Egypt 29. Tanta University Hospital , Tanta Egypt 30. Chu Limoges , Limoges France 31. Hospital General De Enfermedades , Guatemala City Guatemala 32. All India Institute Of Medical Sciences , Rishikesh India 33. Basavatarakam Indo American Cancer Hospital & Research Institute , Hyderabad India 34. Tata Memorial Hospital , Mumbai India 35. Rsud Wahidin Sudirohusodo , Makassar Indonesia 36. Golestan Hospital , Ahvaz Iran 37. Fabrizio Spaziani , Frosinone 03100 Italy 38. Policlinico Umberto I Sapienza University of Rome , Rome Italy 39. San Raffaele Scientific Institute , Milan, Milan Italy 40. Sant’orsola Hospital, Alma Mater Studiorum University Of Bologna , Italy, Bologna Italy 41. Spedali Riuniti Di Livorno , Livorno Italy 42. Al-Basheer Hospital , Amman Jordan 43. King Abdullah University Hospital , Ar Ramtha Jordan 44. King Hussein Cancer Center , Amman Jordan 45. Medical Care Clinic , Tripoli Libya 46. Tripoli Central Hospital , Tripoli Libya 47. Centre Hospitalier Universitaire Ibn Sina Rabat , Rabat Morocco 48. Cheikh Khalifa International University Hospital , Casablanca City Morocco 49. Cheikh Zaid International University Hospital , Rabat Morocco 50. Afe Babalola University Multi-System Hospital , Ido Ekiti Nigeria 51. Federal Teaching Hospital , Ido Ekiti, Ido Ekiti Nigeria 52. University of Abuja Teaching Hospital , Gwagwalada Nigeria 53. University of Ilorin Teaching Hospital , Ilorin Nigeria 54. Holy Family Hospital , Rawalpindi Pakistan 55. Al-Ahli Hospital , Hebron, West Bank Palestine 56. Aseer Central Hospital , Abha Saudi Arabia 57. King Abdullah Medical City Makkah , Makkah Saudi Arabia 58. King Faisal Specialist Hospital , Riyadh Saudi Arabia 59. King Saud University , Riyadh Saudi Arabia 60. Prince Sultan Military Medical City , Riyadh Saudi Arabia 61. Clinic for Neurosurgery , Clinical Center of Serbia, Belgrade Serbia 62. 12 De Octubre University Hospital , Madrid Spain 63. Hospital Clinic Barcelona , Barcelona Spain 64. Tishreen University Hospital , Latakia Syrian Arab Republic 65. Aberdeen Royal Infirmary , Aberdeen United Kingdom 66. Addenbrooke’s Hospital , Cambridge United Kingdom 67. John Radcliffe Hospital , Oxford United Kingdom 68. Ninewells Hospital , Dundee United Kingdom 69. Queen Elizabeth Hospital Birmingham , Birmingham United Kingdom 70. Queen Elizabeth University Hospital , Glasgow United Kingdom 71. Royal Hallamshire Hospital , Sheffield United Kingdom 72. Royal Infirmary Of Edinburgh , Edinburgh United Kingdom 73. Royal London Hospital , London United Kingdom 74. Royal Preston Hospital , Preston United Kingdom 75. Salford Royal Hospital , Salford United Kingdom 76. The National Hospital for Neurology and Neurosurgery , London United Kingdom 77. The Walton Centre NHS Foundation Trust , Liverpool United Kingdom 78. Johns Hopkins Hospital , Baltimore, MD United States of America 79. The University Hospital , Newark, NJ United States of America 80. University Of Texas Southwestern , Dallas United States of America 81. Yale New Haven Hospital , New Haven, CT United States of America
Abstract
Abstract
Background
This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic.
Methods
We prospectively included adults aged ≥18 years who underwent surgery for a malignant or benign intracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients’ location by World Bank income groups (high [HIC], upper-middle [UMIC], and low- and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality.
Results
Among 1016 patients, the number of patients in each income group was 765 (75.3%) in HIC, 142 (14.0%) in UMIC, and 109 (10.7%) in LLMIC. The management of 200 (19.8%) patients changed from usual care, most commonly delayed surgery. Within 30 days after surgery, 14 (1.4%) patients had a COVID-19 diagnosis and 39 (3.8%) patients died. In the multivariable model, LLMIC was associated with increased mortality (odds ratio 2.83, 95% credible interval 1.37–5.74) compared to HIC.
Conclusions
The first wave of the pandemic had a significant impact on surgical decision-making. While the incidence of SARS-CoV-2 infection within 30 days after surgery was low, there was a disparity in mortality between countries and this warrants further examination to identify any modifiable factors.
Funder
National Institute for Health Research Cancer Research UK Brain Tumour Centre of Excellence Award Wellcome/EPSRC Centre National Institute for Health Research Global Health Research Unit Association of Coloproctology of Great Britain and Ireland Bowel and Cancer Research Bowel Disease Research Foundation Association of Upper Gastrointestinal Surgeons British Association of Surgical Oncology British Gynaecological Cancer Society European Society of Coloproctology Sarcoma UK The Urology Foundation Vascular Society for Great Britain and Ireland Yorkshire Cancer Research
Publisher
Oxford University Press (OUP)
Subject
Cancer Research,Neurology (clinical),Oncology
Cited by
3 articles.
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