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Streamlining brain tumor surgery care during the COVID-19 pandemic: A case-control study
Regin Jay Mallari1, Michael B Avery1, Alex Corlin1
1Pacific Neuroscience Institute, Providence Saint John's Health Center, Santa Monica, California, United States of America.
Plos One
|July 29, 2021
Summary
Implementing a streamlined brain tumor surgery protocol during the COVID-19 pandemic reduced intensive care unit (ICU) utilization and hospital length of stay (LOS) without increasing complications. This optimized care pathway improved patient outcomes and resource management.
Area of Science:
- Neurosurgery
- Surgical Oncology
- Healthcare Management
Background:
- The COVID-19 pandemic necessitated adaptations in surgical patient care due to resource limitations and infection transmission risks.
- Brain tumor surgery management required reevaluation to balance patient safety with operational efficiency.
Purpose of the Study:
- To assess the impact of a streamlined care protocol on patients undergoing brain tumor surgery.
- To evaluate changes in intensive care unit (ICU) utilization and hospital length of stay (LOS).
Main Methods:
- A retrospective case-control review compared pre-pandemic (March 2019-January 2020) and pandemic (March 2020-January 2021) cohorts.
- Patients underwent craniotomy or endoscopic endonasal tumor removal using minimally invasive techniques, total intravenous anesthesia (TIVA), and early post-operative imaging.
- Data included demographics, American Society of Anesthesiologists (ASA) status, tumor pathology, resection rates, ICU utilization, LOS, complications, readmissions, and reoperations.
Main Results:
- ICU utilization decreased significantly from 54% pre-pandemic to 29% during the pandemic (p<0.001).
- Hospital length of stay (LOS) of 1 day or less increased from 12.2% to 41.4% (p<0.001).
- Craniotomy cohort showed decreased median ICU LOS (1 to 0 days) and ICU use (80% to 33%). Endonasal cohort showed decreased median LOS (2 to 1 days). No significant differences in complications, readmissions, or reoperations were observed.
Conclusions:
- A streamlined brain tumor care protocol, including enhanced patient education and early mobilization, safely reduced ICU utilization and accelerated discharge.
- The protocol, combined with minimally invasive surgery and early imaging, improved efficiency without compromising patient safety or increasing adverse events.
- This study demonstrates the feasibility of optimizing neurosurgical care pathways in response to external pressures like a pandemic.
