Neurospine.
2023 Dec;20(4):1431-1442. 10.14245/ns.2346726.363.
Delay of Surgery for Spinal Metastasis due to the COVID-19 Outbreak Affected Patient Outcomes
- Hsieh CJ
1,2 - Wu CY2,3,4
- Lin YH2,5
- Huang YC2,5
- Yang WC2,6
- Chen TWW2,7,8
- Ma WL2,7,8
- Lin WH2,9
- Hsu FM2,6,8
- Xiao F2,10
- Yang SH2,10
- Lai DM2,10
- Chen CM2,10
- Chao SY10
- Tsuang FY2,10
- Affiliations
-
- 1Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu County, Taiwan
- 2Spine Tumor Center, National Taiwan University Hospital, Taipei City, Taiwan
- 3Department of Anesthesiology, National Taiwan University Hospital, Taipei City, Taiwan
- 4Department of Anesthesiology, National Taiwan University Hospital Hsin-Chu Branch, Hsinchu County, Taiwan
- 5Department of Medical Imaging, National Taiwan University Hospital, Taipei City, Taiwan
- 6Division of Radiation Oncology, Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
- 7Department of Oncology, National Taiwan University Hospital, Taipei City, Taiwan
- 8Graduate Institute of Oncology, National Taiwan University College of Medicine, Taipei City, Taiwan
- 9Department of Orthopaedic Surgery, National Taiwan University Hospital, Taipei City, Taiwan
- 10Division of Neurosurgery, Department of Surgery, National Taiwan University Hospital, Taipei City, Taiwan
- KMID: 2549866
- DOI: http://doi.org/10.14245/ns.2346726.363
Abstract
Objective
The present study is to analyze the effects of the coronavirus disease 2019 (COVID 2019) outbreak and the subsequent lockdown on the outcomes of spinal metastasis patients.
Methods
The study was a retrospective analysis of data from a prospective cohort study. All patients underwent surgical intervention for spinal metastases between January 2019 and December 2021 and had at least 3 months of postoperative follow-up. The primary outcome was overall mortality during the 4 different stages (pre-COVID-19 era, COVID-19 pandemic except in Taiwan, national lockdown, lifting of the lockdown). The secondary outcomes were the oncological severity scores, medical/surgical accessibility, and patient functional outcome during the 4 periods as well as survival/mortality.
Results
A total of 233 patients were included. The overall mortality rate was 41.20%. During the Taiwan lockdown, more patients received palliative surgery than other surgical methods, and no total en bloc spondylectomy was performed. The time from surgeon visit to operation was approximately doubled after the COVID-19 outbreak in Taiwan (75.97, 86.63, 168.79, and 166.91 hours in the 4 periods, respectively). The estimated survival probability was highest after the national lockdown was lifted and lowest during the lockdown. In the multivariate analysis, increased risk of mortality was observed with delay of surgery, with emergency surgery having a higher risk with delays above 33 hours, urgent surgery (below 59 and above 111 hours), and elective surgery (above 332 hours).
Conclusion
The COVID-19 pandemic and related policies have altered daily clinical practice and negatively impacted the survival of patients with spinal metastases.
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