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Published on: January 18, 2018
Changes in Cerebrovascular Procedures and Outcomes During COVID-19 Using the National Surgery Quality Improvement
Hangil Lee1, Enoch Kim1, Martin McCandless2
1Department of Neurosurgery, Wayne State University, Detroit, Michigan, USA.
Insights
The COVID-19 pandemic worsened outcomes for patients with cerebrovascular disease, increasing stroke severity and mortality risk, particularly for minority groups. Deferred care and healthcare system strain contributed to these negative impacts.
Area of Science:
- Neurology
- Public Health
- Health Services Research
Background:
- The COVID-19 pandemic significantly disrupted healthcare systems globally.
- Cerebrovascular disorders require timely and specialized medical interventions.
Purpose of the Study:
- To investigate the impact of the COVID-19 pandemic on patients with cerebrovascular disorders.
- To analyze changes in diagnoses, procedures, and patient outcomes before and during the pandemic.
Main Methods:
- Utilized the National Surgical Quality Improvement Program database (2018-2021).
- Classified cerebrovascular diseases and procedures using ICD-10 and CPT codes.
- Analyzed variations in demographics, mortality/morbidity scores, and outcomes using R statistical software.
Main Results:
- Increased cerebrovascular accidents (CVAs) and carotid stenting; decreased elective carotid endarterectomies.
- Elevated mortality probability scores and prolonged operative times observed.
- Disproportionate negative impact on ethnic and racial minorities, with higher mortality/morbidity for Hispanic patients.
Conclusions:
- Pandemic-related screening delays led to more severe disease progression and deferred care.
- Staff shortages likely contributed to prolonged operative times, increased complications, and worse outcomes.
- Urgent policy development is needed to mitigate harm to cerebrovascular patients during future health crises.
Objective:
Explore the consequences of the coronavirus pandemic (COVID-19) on patients suffering from cerebrovascular disorders necessitating interventions.
Methods:
Using the National Surgical Quality Improvement Program database, patients with cerebrovascular disease who underwent procedures before (2018-2019) and during (2020-2021) COVID-19 were identified. ICD-10 and Current Procedure Terminology codes were employed to classify diseases and elective cases, respectively. Our study analyzed variations in diagnoses, procedures, demographics, mortality and morbidity likelihood scores, and outcomes. Analysis was conducted using R 4.2.1 with tidyverse, haven, and Ime4 packages. Statistical significance was defined as P < 0.05.
Results:
There was a significant rise in cerebrovascular accidents (CVAs) (9.96% vs. 12.28%) and a decrease in elective carotid endarterectomies (92.30% vs. 87.22%). Carotid stenting increased significantly (7.63% vs. 12.62%), and mortality probability scores rose for CVAs and carotid interventions. Ethnic (Hispanic) and racial minorities (Asians and Black/African American) were disproportionately affected (P < 0.001). Conditions from delayed care increased, and total operative times rose (117.46 vs. 124.33 minutes). Various patient outcomes worsened (P < 0.05), and multivariate analyses showed Hispanic patients had higher mortality and morbidity probability scores (P < 0.05).
Conclusions:
The pandemic led to more severe disease progression and reduced diagnoses due to screening delays, indicating deferred care. Prolonged operative times, extended hospital stays, and worsening outcomes, including infections and thrombotic events, hint at the repercussions of persistent staff shortages in health care facilities. Ethnic and racial minorities faced disproportionate impacts. To minimize harm to patients with cerebrovascular disease in future public health crises, it is crucial to develop policies that address these findings.
