{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,14]],"date-time":"2025-12-14T09:25:17Z","timestamp":1765704317946,"version":"3.48.0"},"reference-count":20,"publisher":"BMJ","issue":"12","license":[{"start":{"date-parts":[[2021,12,9]],"date-time":"2021-12-09T00:00:00Z","timestamp":1639008000000},"content-version":"unspecified","delay-in-days":8,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Open"],"accepted":{"date-parts":[[2021,11,19]]},"published-print":{"date-parts":[[2021,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Settings<\/jats:title>\n                    <jats:p>The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>An exploratory factorial analysis was performed to select the most relevant variables of the sample.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Primary and secondary outcome measures<\/jats:title>\n                    <jats:p>Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases\/10\n                      <jats:sup>5<\/jats:sup>\n                      people\/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade \u22653 (OR 2.5) and preoperative GCS 3\u20138 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test &lt;72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases\/10\n                      <jats:sup>5<\/jats:sup>\n                      people\/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases\/10\n                      <jats:sup>5<\/jats:sup>\n                      people\/week) was a statistically independent predictor of mortality.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial registration number<\/jats:title>\n                    <jats:p>CEIM 20\/217.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2021-053983","type":"journal-article","created":{"date-parts":[[2021,12,10]],"date-time":"2021-12-10T11:37:17Z","timestamp":1639136237000},"page":"e053983","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: a nationwide study in Spain"],"prefix":"10.1136","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3846-4164","authenticated-orcid":false,"given":"Igor","family":"Paredes","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7918-5049","authenticated-orcid":false,"given":"Ana Maria","family":"Casta\u00f1o Leon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alfonso","family":"Lagares","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Jimenez Roldan","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Angel","family":"Perez-Nu\u00f1ez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro","family":"Gonz\u00e1lez-Leon","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4251-8356","authenticated-orcid":false,"given":"Juan","family":"Delgado-Fernandez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Carla","family":"Eiriz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Garc\u00eda-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis Miguel","family":"Moreno-Gomez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Olga","family":"Esteban-Sinovas","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Pedro","family":"Delgado-L\u00f3pez","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario de Burgos, Burgos, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Javier","family":"Mart\u00edn-Alonso","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario de Burgos, Burgos, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ariel","family":"Kaen","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Virgen del Rocio University Hospital, Sevilla, Andaluc\u00eda, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jorge","family":"Tirado-Caballero","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario 12 de Octubre, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Ord\u00f3\u00f1ez Carmona","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Virgen del Rocio University Hospital, Sevilla, Andaluc\u00eda, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francisco","family":"Arteaga Romero","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Virgen del Rocio University Hospital, Sevilla, Andaluc\u00eda, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Gonzalez Pombo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Virgen del Rocio University Hospital, Sevilla, Andaluc\u00eda, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jos\u00e9 F","family":"Al\u00e9n","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ricardo","family":"Gil-Simoes","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cristina V","family":"Torres","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Navas Garcia","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guillermo","family":"Blasco","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Natalia","family":"Frade-Porto","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Hospital Universitario de la Princesa, Madrid, 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Mart\u00edn","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Luis","family":"Torres Carretero","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patricia Alejandra","family":"Garrido Ru\u00edz","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Complejo Asistencial Universitario de Salamanca, Salamanca, Castilla y Leon, Spain"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marta","family":"Calvo","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Ciudad Real General University Hospital, Ciudad Real, Castilla-La Mancha, 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