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Patients awaiting surgery for neurosurgical diseases during the first wave of the COVID-19 pandemic in Spain: a multicentre cohort study

Publicated to:BMJ Open. 12 (8): e061208- - 2022-08-01 12(8), DOI: 10.1136/bmjopen-2022-061208

Authors: Castano-Leon, Ana M; Paredes, Igor; Lagares, Alfonso; Gomez, Pedro A; Gonzalez-Leon, Pedro; Perez-Nunez, Angel; Jimenez-Roldan, Luis; Delgado-Fernandez, Juan; Eiriz Fernandez, Carla; Garcia-Perez, Daniel; Moreno-Gomez, Luis M; Esteban-Sinovas, Olga; Delgado-Lopez, Pedro D; Martin-Alonso, Javier; Kaen, Ariel; Tirado-Caballero, Jorge; Ordonez-Carmona, Marta; Arteaga-Romero, Francisco; Gonzalez-Pombo, Marta; Alen, Jose F; Gil-Simoes, Ricardo; Torres, Cristina, V; Navas-Garcia, Marta; Garcia de Andoain, Guillermo Blasco; Frade-Porto, Natalia; Gonzalez-Tarno, Patricia; Martin Segura, Adrian; Gelabert-Gonzalez, Miguel; Menendez-Cortezon, Beatriz; Rodriguez-Botana, Brais; Perez-Alfayate, Rebeca; Fernandez-Garcia, Carla; Ferrandez-Pujante, Borja; Vargas-Jimenez, Andres C; Cotua, Carlos; de la Lama, Adolfo; Calero Felix, Lourdes; Ruiz-Juretschke, Fernando; Garcia-Leal, Roberto; Valera-Mele, Marc; Casitas Hernando, Vicente; Rivero, Belen; Orduna-Martinez, Javier; Casado Pellejero, Juan; Fustero De Miguel, David; Diaz Molina, Jorge; Moles Herbera, Jesus; Castello-Ruiz, Maria J; Gomar-Alba, Mario; Garcia-Perez, Fernando; Hernandez-Garcia, Borja J; Villasenor-Ledezma, Jorge J; Otero-Rodriguez, Alvaro; Ailagas de las Heras, Juan J; Goncalves-Estella, Jesus; Sousa-Casasnovas, Pablo; Pascual-Argente, Daniel; Ruiz Martin, Laura; Montes de Oca, Juan C Roa; Arandia Guzman, Daniel; Garcia Martin, Andoni; Torres Carretero, Luis; Garrido Ruiz, Alejandra; Calvo, Marta; Miranda-Lloret, Pablo; Rodriguez-Cadarso, Miguel; Anton, Joan; Roca Barber, Amparo; Quiroz-Tejada, Arnold; Carbayo-Lozano, Guillermo; Bermudez, Garazi; Paternain Martin, Clara; Fuente Villa, Pablo De la; Fidalgo De la Rosa, Marina; Sistiaga-Gracia, Inigo L; Zabalo, Gorka

Affiliations

Complejo Asistencial Univ Salamanca, Neurosurg Dept, Salamanca, Spain - Author
Complejo Hosp Univ Santiago de Compostela, Neurosurg Dept, Santiago De Compostela, Spain - Author
Complejo Hosp Univ Torrecardenas, Neurosurg Dept, Almeria, Spain - Author
Complejo Hosp Vigo Alvaro Cunqueiro, Neurosurg Dept, Vigo, Spain - Author
Hosp Clin Univ San Carlos, Neurosurg Dept, Madrid, Spain - Author
Hosp Gen Univ Ciudad Real, Neurosurg Dept, Ciudad Real, Spain - Author
Hosp Gen Univ Gregorio Maranon, Neurosurg Dept, Madrid, Spain - Author
Hosp Infantil Univ Nino Jesus, Neurosurg Dept, Madrid, Spain - Author
Hosp Politecn & Univ La Fe, Neurosurg Dept, Valencia, Spain - Author
Hosp Univ 12 Octubre, Neurosurg Dept, Madrid, Spain - Author
Hosp Univ Burgos, Neurosurg Dept, Burgos, Spain - Author
Hosp Univ Cruces, Neurosurg Dept, Baracaldo, Spain - Author
Hosp Univ La Paz, Neurosurg Dept, Madrid, Spain - Author
Hosp Univ Miguel Servet, Neurosurg Dept, Zaragoza, Spain - Author
Hosp Univ Princesa, Neurosurg Dept, Madrid, Spain - Author
Hosp Univ Virgen Rocio, Neurosurg Dept, Seville, Spain - Author
Inst Invest Sanitaria Hosp 12 Octubre imas12, Madrid, Spain - Author
Univ Complutense Madrid, Fac Med, Dept Cirugia, Madrid, Spain - Author
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Abstract

Objectives The large number of infected patients requiring mechanical ventilation has led to the postponement of scheduled neurosurgical procedures during the first wave of the COVID-19 pandemic. The aims of this study were to investigate the factors that influence the decision to postpone scheduled neurosurgical procedures and to evaluate the effect of the restriction in scheduled surgery adopted to deal with the first outbreak of the COVID-19 pandemic in Spain on the outcome of patients awaiting surgery. Design This was an observational retrospective study. Settings A tertiary-level multicentre study of neurosurgery activity between 1 March and 30 June 2020. Participants A total of 680 patients awaiting any scheduled neurosurgical procedure were enrolled. 470 patients (69.1%) were awaiting surgery because of spine degenerative disease, 86 patients (12.6%) due to functional disorders, 58 patients (8.5%) due to brain or spine tumours, 25 patients (3.7%) due to cerebrospinal fluid (CSF) disorders and 17 patients (2.5%) due to cerebrovascular disease. Primary and secondary outcome measures The primary outcome was mortality due to any reason and any deterioration of the specific neurosurgical condition. Second, we analysed the rate of confirmed SARS-CoV-2 infection. Results More than one-quarter of patients experienced clinical or radiological deterioration. The rate of worsening was higher among patients with functional (39.5%) or CSF disorders (40%). Two patients died (0.4%) during the waiting period, both because of a concurrent disease. We performed a multivariate logistic regression analysis to determine independent covariates associated with maintaining the surgical indication. We found that community SARS-CoV-2 incidence (OR=1.011, p<0.001), degenerative spine (OR=0.296, p=0.027) and expedited indications (OR=6.095, p<0.001) were independent factors for being operated on during the pandemic. Conclusions Patients awaiting neurosurgery experienced significant collateral damage even when they were considered for scheduled procedures.

Keywords

Adult surgeryCovid-19NeurosurgeryPaediatric neurosurgeryPublic health

Quality index

Bibliometric impact. Analysis of the contribution and dissemination channel

The work has been published in the journal BMJ Open due to its progression and the good impact it has achieved in recent years, according to the agency Scopus (SJR), it has become a reference in its field. In the year of publication of the work, 2022, it was in position , thus managing to position itself as a Q1 (Primer Cuartil), in the category Medicine (Miscellaneous).

From a relative perspective, and based on the normalized impact indicator calculated from the Field Citation Ratio (FCR) of the Dimensions source, it yields a value of: 1.03, which indicates that, compared to works in the same discipline and in the same year of publication, it ranks as a work cited above average. (source consulted: Dimensions Jun 2025)

Specifically, and according to different indexing agencies, this work has accumulated citations as of 2025-06-27, the following number of citations:

  • WoS: 1
  • Scopus: 2

Impact and social visibility

From the perspective of influence or social adoption, and based on metrics associated with mentions and interactions provided by agencies specializing in calculating the so-called "Alternative or Social Metrics," we can highlight as of 2025-06-27:

  • The use, from an academic perspective evidenced by the Altmetric agency indicator referring to aggregations made by the personal bibliographic manager Mendeley, gives us a total of: 29.
  • The use of this contribution in bookmarks, code forks, additions to favorite lists for recurrent reading, as well as general views, indicates that someone is using the publication as a basis for their current work. This may be a notable indicator of future more formal and academic citations. This claim is supported by the result of the "Capture" indicator, which yields a total of: 29 (PlumX).

With a more dissemination-oriented intent and targeting more general audiences, we can observe other more global scores such as:

  • The Total Score from Altmetric: 1.
  • The number of mentions on the social network X (formerly Twitter): 1 (Altmetric).

It is essential to present evidence supporting full alignment with institutional principles and guidelines on Open Science and the Conservation and Dissemination of Intellectual Heritage. A clear example of this is:

  • The work has been submitted to a journal whose editorial policy allows open Open Access publication.