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. 2023 Jul 6;25(7):1299-1309.
doi: 10.1093/neuonc/noad019.

Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic

Michael T C Poon  1   2 , Rory J Piper  3 , Nqobile Thango  4 , Daniel M Fountain  5 , Hani J Marcus  6   7 , Laura Lippa  8 , Franco Servadei  9 , Ignatius N Esene  10 , Christian F Freyschlag  11 , Iuri S Neville  12 , Gail Rosseau  13 , Karl Schaller  14 , Andreas K Demetriades  2 , Faith C Robertson  15 , Peter J Hutchinson  16 , Stephen J Price  17 , Ronnie E Baticulon  18 , James C Glasbey  19 , Aneel Bhangu  20 , Michael D Jenkinson  21 , Angelos G Kolias  17 ; Writing Group of the COVIDSurg-Cancer neurosurgery investigators on behalf of the COVIDSurg Collaborative; British Neurosurgical Trainee Research Collaborative; WFNS Young Neurosurgeons Committee; NIHR Global Health Research Group on Acquired Brain and Spine Injury
Collaborators, Affiliations

Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic

Michael T C Poon et al. Neuro Oncol. .

Erratum in

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.

Keywords: collaborative research; global neurosurgery; neuro-oncology.

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Conflict of interest statement

All authors declare no conflict of interest.

Figures

Figure 1.
Figure 1.
Change in treatment and postoperative outcomes by income groups. Each panel represents the proportion of patients in which the event occurred. Respiratory complications included pneumonia, acute respiratory distress syndrome, and unplanned mechanical ventilation postoperatively. The numbers to the right of each bar are the percentage and number of events over the number of patients in each income groups.
Figure 2.
Figure 2.
Bayesian multilevel logistic regression models on 30-day postoperative mortality in 1010 patients. (A) Forest plot of odds ratios from the Bayesian multilevel logistic regression on 30-day postoperative mortality using informative priors. (B) Forest plot showing odds ratios from sensitivity analysis using weakly informative priors to assess the influence of informative priors on the posterior distributions of the odds ratios.
See this image and copyright information in PMC

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