Impact of COVID-19 on Neurosurgery in Brazil's Health System: The Reality of a Developing Country Affected by the Pandemic.
COVID-19
Developing countries
Neurosurgery
Socioeconomic factors
Journal
World neurosurgery
ISSN: 1878-8769
Titre abrégé: World Neurosurg
Pays: United States
ID NLM: 101528275
Informations de publication
Date de publication:
11 2021
11 2021
Historique:
received:
12
05
2021
revised:
05
08
2021
accepted:
06
08
2021
pubmed:
18
8
2021
medline:
18
11
2021
entrez:
17
8
2021
Statut:
ppublish
Résumé
The coronavirus disease identified in 2019 (COVID-19) pandemic changed neurosurgery protocols to provide ongoing care for patients while ensuring the safety of health care workers. In Brazil, the rapid spread of the disease led to new challenges in the health system. Neurooncology practice was one of the most affected by the pandemic due to restricted elective procedures and new triage protocols. We aim to characterize the impact of the pandemic on neurosurgery in Brazil. We analyzed 112 different types of neurosurgical procedures, with special detail in 11 neurooncology procedures, listed in the Brazilian Hospital Information System records in the DATASUS database between February and July 2019 and the same period in 2020. Linear regression and paired t-test analyses were performed and considered statistically significant at P < 0.05. There was an overall decrease of 21.5% (28,858 cases) in all neurosurgical procedures, impacting patients needing elective procedures (-42.46%) more than emergency surgery (-5.93%). Neurooncology procedures decreased by 14.89%. Nonetheless, the mortality rate during hospitalization increased by 21.26%. Linear regression analysis in hospitalizations (Slope = 0.9912 ± 0.07431; CI [95%] = 0.8231-1.159) and total cost (Slope = 1.03 ± 0.03501; CI [95%] = 0.9511-1.109) in the 11 different types of neurooncology procedures showed a P < 0.0001. The mean cost per type of procedure showed an 11.59% increase (P = 0.0172) between 2019 and 2020. The COVID-19 pandemic has increased mortality, decreased hospitalizations, and therefore decreased overall costs, despite increased costs per procedure for a variety of neurosurgical procedures. Our study serves as a stark example of the effect of the pandemic on neurosurgical care in settings of limited resources and access to care.
Sections du résumé
BACKGROUND
The coronavirus disease identified in 2019 (COVID-19) pandemic changed neurosurgery protocols to provide ongoing care for patients while ensuring the safety of health care workers. In Brazil, the rapid spread of the disease led to new challenges in the health system. Neurooncology practice was one of the most affected by the pandemic due to restricted elective procedures and new triage protocols. We aim to characterize the impact of the pandemic on neurosurgery in Brazil.
METHODS
We analyzed 112 different types of neurosurgical procedures, with special detail in 11 neurooncology procedures, listed in the Brazilian Hospital Information System records in the DATASUS database between February and July 2019 and the same period in 2020. Linear regression and paired t-test analyses were performed and considered statistically significant at P < 0.05.
RESULTS
There was an overall decrease of 21.5% (28,858 cases) in all neurosurgical procedures, impacting patients needing elective procedures (-42.46%) more than emergency surgery (-5.93%). Neurooncology procedures decreased by 14.89%. Nonetheless, the mortality rate during hospitalization increased by 21.26%. Linear regression analysis in hospitalizations (Slope = 0.9912 ± 0.07431; CI [95%] = 0.8231-1.159) and total cost (Slope = 1.03 ± 0.03501; CI [95%] = 0.9511-1.109) in the 11 different types of neurooncology procedures showed a P < 0.0001. The mean cost per type of procedure showed an 11.59% increase (P = 0.0172) between 2019 and 2020.
CONCLUSIONS
The COVID-19 pandemic has increased mortality, decreased hospitalizations, and therefore decreased overall costs, despite increased costs per procedure for a variety of neurosurgical procedures. Our study serves as a stark example of the effect of the pandemic on neurosurgical care in settings of limited resources and access to care.
Identifiants
pubmed: 34400327
pii: S1878-8750(21)01200-6
doi: 10.1016/j.wneu.2021.08.030
pmc: PMC8548285
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e142-e149Informations de copyright
Copyright © 2021 Elsevier Inc. All rights reserved.
Références
World Neurosurg. 2020 Aug;140:198-207
pubmed: 32474101
Acta Neurochir (Wien). 2020 Sep;162(9):2221-2233
pubmed: 32642834
World Neurosurg. 2019 Mar;123:e330-e337
pubmed: 30500574
World Neurosurg. 2020 Nov;143:e179-e187
pubmed: 32702490
Surg Neurol Int. 2020 Nov 06;11:372
pubmed: 33408906
Mayo Clin Proc Innov Qual Outcomes. 2020 Oct;4(5):557-564
pubmed: 32838202
Cad Saude Publica. 2006 Jan;22(1):19-30
pubmed: 16470279
World Neurosurg. 2020 Aug;140:e360-e366
pubmed: 32442732
J Clin Neurosci. 2018 Dec;58:34-41
pubmed: 30366782
Anaesthesia. 2020 Oct;75(10):1350-1363
pubmed: 32344456
Int J Surg. 2020 Jul;79:168-179
pubmed: 32407799
Neurosurg Rev. 2021 Jun;44(3):1371-1389
pubmed: 32770298
JAMA Surg. 2020 Aug 1;155(8):691-702
pubmed: 32530453
Ann R Coll Surg Engl. 2020 May;102(5):323-332
pubmed: 32352836
Indian J Plast Surg. 2013 May;46(2):239-46
pubmed: 24501460
World Neurosurg. 2020 Dec;144:e710-e713
pubmed: 32949798
Pulmonology. 2020 Jul - Aug;26(4):241-244
pubmed: 32371054
World Neurosurg. 2020 Nov;143:e561-e566
pubmed: 32791222
World Neurosurg. 2020 Dec;144:e204-e209
pubmed: 32827748
Neurosurgery. 2003 May;52(5):1056-63; discussion 1063-5
pubmed: 12699547
World Neurosurg. 2020 Jul;139:519-525
pubmed: 32426070
World Neurosurg. 2021 Apr;148:93
pubmed: 33453426
Mayo Clin Proc Innov Qual Outcomes. 2020 Dec;4(6):736-744
pubmed: 33324948
World Neurosurg. 2019 Sep;129:e686-e694
pubmed: 31181361
World Neurosurg. 2020 Jul;139:e877-e884
pubmed: 32461176
Neurosurg Focus. 2020 Nov;49(5):E13
pubmed: 33130629
Surg Neurol Int. 2020 Sep 25;11:310
pubmed: 33093987
World Neurosurg. 2020 Jul;139:e812-e817
pubmed: 32360733
Neurosurgery. 2017 Dec 1;81(6):972-979
pubmed: 28402457