Emergency referrals during COVID-19
Pre-COVID-19, the median number of new acute referrals was 31 (range 17–45) per 24 h. During COVID-19, this decreased to 21 (range 10–34) per day. There was a statistically significant reduction in the overall number of referrals from 1847 to 1227 (Table
1;
p < 0.05).
Table 1
Characteristics of emergency referrals and operations
Emergency referrals, total (%) | 1847 (100.0) | 1227 (100.0) | p < 0.01 |
Trauma/vascular | 956 (51.8) | 656 (53.5) | |
Oncology | 210 (11.4) | 171 (13.9) | |
Skull base | 36 (1.9) | 12 (1.0) | |
Spinal | 428 (23.2) | 229 (18.7) | |
Paediatrics | 75 (4.1) | 59 (4.8) | |
Other* | 141 (7.6) | 100 (8.1) | |
Emergency transfer, total (%) | 190 (100.0) | 119 (100.0) | p > 0.05 |
Neurological deficit | 92 (48.4) | 55 (46.2) | |
GCSa ≤ 8 | 12 (6.3) | 10 (8.4) | |
Age > 65 years | 42 (22.1) | 21 (17.6) | |
Surgery, total (%) | 453 (100.0) | 206 (100.0) | |
Emergency | 198 (43.7) | 155 (75.2) | p < 0.00001 |
Elective | 255 (56.3) | 51 (24.8) |
Cranial | 263 (58.1) | 134 (65.0) | ns |
Spinal | 190 (41.9) | 72 (35.0) |
Adult | 408 (90.1) | 173 (84.0) | p < 0.05 |
Paediatric | 45 (9.9) | 33 (16.0) |
Age at operation (years) | p > 0.05 |
Mean ± SD | 50 ± 21 | 47 ± 22 | |
Range | 0–92 | 0–86 | |
Operative age groups (years) | p < 0.01 |
0–17 | 44 | 33 | |
18–65 | 292 | 178 | |
> 65 | 117 | 41 | |
COVID-19 infection |
Pre-operatively | 0 | 4 | |
Post-operatively (during inpatient stay) | 7 | 6 | |
Mortality, total (% of operations) | 5 (1.1) | 4 (2.0) | |
30-day perioperative (emergencies) | 5 (2.5) | 3 (1.9) | |
30-day perioperative (electives) | 0 (0.0) | 1 (2.2) | |
Operations per subspecialty (adult and paediatric) | p < 0.01 |
Trauma/vascular | 75 (16.6) | 44 (21.4) | |
Oncology | 67 (14.8) | 40 (19.4) | |
Skull base | 37 (8.2) | 8 (3.9) | |
Spinal | 149 (32.9) | 55 (26.7) | |
Functional | 43 (9.5) | 8 (3.9) | |
Other* | 82 (18.1) | 51 (24.8) | |
Subspecialty emergency referrals changed to proportionately fewer skull base and spinal referrals, but proportionately increased trauma, vascular, oncology, and paediatric referrals (Table
1;
p < 0.01). Approximately 10% of patients referred as an emergency pre-COVID-19 (
n = 190) and during COVID-19 (
n = 119) were accepted for emergency transfer. There was no change to the definition of what constituted an emergency during or pre-COVID-19, namely being a condition that was life or limb threatening within a matter of days if left untreated. There was no significant change in the proportion of patients with neurological deficit, GCS ≤ 8, or age > 65 years being transferred to our neurosurgical centre (
p > 0.05).
In fact, there was no statistically significant difference in age amongst patients that were admitted pre-COVID-19 (median age 53 (range 0–92) years) and during COVID-19 (median age 51 (range 0–89) years. There was however a change in gender of patients admitted pre-COVID-19 and during COVID-19 with proportionately more males being admitted during COVID-19 (59.67% compared to 52.31% pre-COVID-19, p < 0.05). This may potentially reflect the generally more health averse and risk-prone occupational and non-occupational behaviour amongst men resulting in acute admissions. The distribution of ethnic minority patients admitted pre-COVID-19 (8.15% Black, 3.94% Asian, 0.41% Hispanic) and during COVID-19 (9.54% Black, 3.54% Asian, 0.54% Hispanic) remained stable, albeit in a higher proportion of patients the ethnicity was not recorded during COVID-19 (24.73% pre-COVID-19, 36.24% during COVID-19), possibly reflecting the limited availability of hospital administrative support staff to record these during COVID-19.
Emergency and elective neurosurgical operations performed before and during COVID-19
The total number of operations decreased from
n = 453 (pre-COVID-19) to
n = 206 (Table
1;
p < 0.0001) with the daily median number of operations decreasing from 8 to 3. A higher percentage of emergency operations was performed during COVID-19 (75.2% of total,
n = 155) compared to pre-COVID-19 (
n = 198, 43.7% of total,
p < 0.00001). There was no significant change in the proportion of cranial versus spinal operations (Table
1). Overall, significantly fewer patients aged > 65 years underwent an operation during COVID-19 (
p < 0.01). The operations for adults and paediatrics per neurosurgical subspecialty changed significantly (
p < 0.01) with subspecialties with a high proportion of elective work, such as functional, skull base, and spinal neurosurgery, being affected the most.
Tables
2 and
3 summarize the data on patients undergoing neurosurgery in adult and paediatric cases, respectively. The total number of adult operations performed dropped from
n = 408 to
n = 173 during COVID-19, with a significant amount of functional and degenerative spinal neurosurgical work being deferred or cancelled (
p < 0.01; Table
2). The number of operations amongst the emergency subspecialties, such as trauma and vascular neurosurgery, also decreased during COVID-19 by approximately 50%; however, the case mix remained similar. The most common traumatic pathologies requiring emergency operation were chronic subdural hematoma (pre-COVID-19
n = 26, COVID-19
n = 19), vertebral fracture (pre-COVID-19
n = 11, COVID-19
n = 5), and acute subdural hematoma (pre-COVID-19
n = 9, COVID-19
n = 3). Although all the numbers decreased, the smallest drop in cases was amongst surgeries for chronic subdural haematomas, possibly related to their relatively more chronic presentation. Similarly, vascular operations decreased with fewer aneurysms being clipped during COVID-19 (
n = 1) compared to pre-COVID-19 (
n = 9).
Table 2
Number and composition of adult operations performed by subspecialty
Number of operations in N (% of total) | 408 (100.0) | 173 (100.0) | |
Functional | 37 (9.1) | 8 (4.6) | p < 0.01 |
DBSa for Parkinson’s disease/tremor | 8 (2.0) | 0 (0.0) | |
Intractable epilepsy/VNSb | 18 (4.4) | 1 (0.6) | |
Peripheral nerve | 3 (0.7) | 1 (0.6) | |
Baclofen pump/other | 2 (0.4) | 1 (0.6) | |
DBS battery change | 5 (2.7) | 5 (2.9) | |
Spinal | 145 (35.5) | 51 (29.5) | p < 0.01 |
Myelopathy | 28 ( 6.9) | 8 (4.6) | |
Radiculopathy | 73 (17.9) | 13 (7.5) | |
Cauda equina syndrome | 26 (6.4) | 14 (8.1) | |
MSCCd and spinal tumour | 14 (3.4) | 15 (8.7) | |
Spinal haematoma and other | 4 (1.0) | 1 (0.6) | |
Trauma | 50 (12.3) | 31 (17.9) | p > 0.05 |
Acute subdural hematoma | 9 (2.2) | 3 (1.7) | |
Chronic subdural hematoma | 26 (6.4) | 19 (11.0) | |
Extradural hematoma | 4 (1.0) | 2 (1.2) | |
Traumatic brain injury/other | 0 (0.0) | 1 (0.6) | |
Traumatic vertebral fracture | 11 (2.7) | 5 (2.9) | |
Vascular | 22 (5.4) | 9 (5.2) | p > 0.05 |
Aneurysm | 9 (2.2) | 1 (0.6) | |
Intracranial haemorrhage | 5 (1.2) | 5 (2.9) | |
Ischemic stroke | 1 (0.2) | 1 (0.6) | |
Arteriovenous malformation | 7 (1.7) | 0 (0.0) | |
Arteriovenous fistula | 1 (0.2) | 2 (1.2) | |
Oncology | 60 (14.7) | 31 (17.9) | p > 0.05 |
Low-grade glioma | 4 (1.0) | 1 (0.6) | |
High-grade glioma | 31 (7.6) | 12 (6.9) | |
Cerebral metastasis | 6 (1.5) | 6 (3.5) | |
Meningioma | 13 (3.2) | 7 (4.0) | |
Other | 6 (1.5) | 5 (2.9) | |
Skull base | 36 (8.8) | 7 (4.0) | p > 0.05 |
Pituitary adenoma/apoplexy | 16 (3.9) | 3 (1.7) | |
Sphenoid wing meningioma | 5 (1.2) | 2 (1.2) | |
Vestibular schwannoma | 6 (1.2) | 0 (0.0) | |
Chiari malformation | 5 (1.2) | 0 (0.0) | |
Chondrosarcoma | 2 (0.5) | 0 (0.0) | |
Trigeminal neuralgia | 1 (0.2) | 0 (0.0) | |
Craniopharyngioma | 1 (0.2) | 2 (1.2) | |
Other | 58 (14.2) | 37 (21.4) | p > 0.05 |
Hydrocephalus | 30 (7.4) | 18 (10.4) | |
Primary infections | 7 (1.7) | 4 (2.3) | |
Secondary infections | 15 (3.7) | 11 (6.4) | |
Post-operative hematoma | 2 (0.5) | 0 (0.0) | |
CSF leak/pseudomeningocele | 4 (1.0) | 4 (2.3) | |
Table 3
Number and composition of paediatric operations performed by subspecialty
Number of operations in N (% of total) | 45 (100.0) | 33 (100.0) | |
Functional (intractable epilepsy) | 6 (13.3) | 0 (0.0) | |
Spinal | 4 (8.9) | 4 (12.1) | p > 0.05 |
Myelomeningocele | 3 (6.7) | 4 (12.1) | |
Tethered cord | 1 (2.2) | 0 (0.0) | |
Trauma | 2 (4.4) | 5 (15.2) | p > 0.05 |
Acute subdural hematoma | 0 (0.0) | 1 (3.0) | |
Extradural hematoma | 1 (2.2) | 0 (0.0) | |
Traumatic brain injury/intracranial haemorrhage | 0 (0.0) | 3 (9.1) | |
Traumatic vertebral fracture | 1 (1.1) | 1 (3.0) | |
Vascular (cavernoma) | 1 (2.2) | 0 (0.0) | |
Oncology | 7 (15.6) | 9 (27.3) | p > 0.05 |
LGG | 1 (2.2) | 4 (12.1) | |
HGG | 5 (11.1) | 2 (6.1) | |
Medulloblastoma | 1 (2.2) | 2 (6.1) | |
Ependymoma | 0 (0.0) | 1 (3.0) | |
Skull base (chiari malformation) | 1 (2.2) | 1 (3.0) | |
Other | 24 (53.3) | 14 (42.4) | p > 0.05 |
Hydrocephalus | 20 (44.4) | 14 (42.4) | |
Primary infections | 2 (4.4) | 0 (0.0) | |
Secondary infections | 2 (4.4) | 0 (0.0) | |
Within the neuro-oncology service, the overall number of operations decreased from n = 60 (14.7% of total) to n = 31 (17.9% of total) during COVID-19. Similarly, the number of craniotomies for high-grade gliomas decreased from n = 31 (7.6% of total) to n = 12 (6.9% of total) during the pandemic.
Our skull base service was severely affected during COVID-19 with only 3 operations for pituitary adenoma/apoplexy being performed during COVID-19 (1.7% of total) from a previous number of 16 operations pre-COVID-19 (3.9% of total). No operations for trigeminal neuralgia, vestibular schwannoma, or chiari malformation were performed during COVID-19.
In functional neurosurgery, no new implantations for deep brain stimulation (DBS), spinal cord stimulation, or occipital nerve stimulation were performed. The battery change service for patients with movement disorders, however, continued albeit in the day case setting (DBS battery change n = 5 in both periods). All spinal surgeries decreased during COVID-19; however, notably, operations for cauda equina syndrome (pre-COVID-19 n = 26, COVID-19 n = 14) and myelopathies (pre-COVID-19 n = 28, COVID-19 n = 8) were reduced by ≥ 50% during COVID-19, whereas operations within spinal oncology category remained stable (pre-COVID-19 n = 14, COVID-19 n = 15).
Neurovascular referral service
The total number of referrals to the vascular MDT decreased from
n = 245 to
n = 161 during COVID-19 (
p < 0.05). The total number of patients referred with an intracranial aneurysm decreased from
n = 185 (75.5% of total pre-COVID-19) to
n = 132 (82.0% of total during COVID-19; Table
4). Within that group, referred unruptured symptomatic aneurysms remained approximately stable (~ 2.5 of total). The number of AVMs referred decreased from
n = 34 (13.9% of total pre-COVID-19) to
n = 8 (5.0% of total during COVID-19).
Table 4
Referrals to neurovascular and spinal multidisciplinary teams
Vascular referral age groups (years) | p < 0.01 |
0–17 | 7 | 5 | |
18–65 | 183 | 97 | |
> 65 | 55 | 59 | |
Vascular diagnosis, total (%) | 245 (100.0) | 161 (100.0) | p < 0.01 |
Aneurysm(s) | 185 (75.5) | 132 (82.0) | |
Previously ruptured | 79 (32.2) | 22 (13.7) | |
Unruptured symptomatic | 6 (2.4) | 4 (2.5) | |
Unruptured incidental | 100 (40.8) | 106 (65.8) | |
AVMa | 34 (13.9) | 8 (5.0) | |
Previously ruptured cranial | 12 (4.9) | 1 (0.6) | |
Unruptured cranial | 20 (44.4) | 7 (4.3) | |
Spinal | 2 (0.8) | 0 (0.0) | |
Cavernoma | 1 (0.4) | 5 (3.1) | |
Other* | 25 (10.2) | 17 (10.6) | |
Vascular treatment |
Emergency, clip/coil | 6/10 | 1/17 | p > 0.05 |
Ruptured or dissecting intracranial aneurysm | 4/6 | 1/13 | |
Ruptured or symptomatic AVMa or AVFb | 2/4 | 0/4 | |
Elective, clip/coil | 8/9 | 0/0 | |
Intracranial aneurysms | 5/8 | 0/0 | |
AVMa or AVFb | 3/1 | 0/0 | |
Spinal MDTc referrals, total (%) | 526 (100.0) | 248 (100.0) | p < 0.001 |
Cauda equina syndrome | 21 (4.0) | 26 (10.5) | |
Degenerative spine | 505 (96.0) | 222 (89.5) | |
Spinal treatment recommendation (% of total) | p > 0.05 |
Routine outpatient | 334 (63.5) | 151 (60.9) | |
Urgent outpatient | 24 (4.6) | 7 (2.8) | |
Conservative or other | 168 (31.9) | 90 (36.3) | |
Sixteen patients underwent emergency treatment pre-COVID-19, 6 of those underwent open surgery and 10 underwent endovascular treatment. During COVID-19, only 1 patient underwent emergency open surgery and 17 patients underwent emergency endovascular treatment. All elective surgery was halted during COVID-19 (Table
4).
Neuro-oncology and skull base referral service
The total number of referrals to the neuro-oncology MDT decreased from
n = 443 to
n = 275 during COVID-19 (
p < 0.05) with the median number of referrals per MDT dropping from 53 ± 11.63 to 37 ± 9.58. There was no significant change in the ratio of new to follow-up referrals during these periods. Equally, there was no significant change in the treatment recommendation provided for patients with high-grade gliomas (HGG), low-grade gliomas (LGG), and cerebral metastases (CM) (
p > 0.05; Table
5). However, there was a significant treatment delay (surgery or adjuvant therapy),
n = 4 patients (0.9% of total) pre-COVID-19 versus
n = 32 patients (11.6% of total,
p < 0.00001) during COVID-19, with patients with a meningioma affected more severely (
n = 16 overall) compared to patients with gliomas or malignant tumours (
n = 7 HGG,
n = 2 LGG,
n = 3 CM). The most common reasons for treatment delay were surgery delay due to COVID-19 because of resource limitations (
n = 26), secondly unrelated reasons (
n = 7), patient preference due to fear of infection (
n = 2) and chemotherapy delay due to COVID-19 (
n = 2).
Table 5
Referrals to neuro-oncology and skull base multidisciplinary teams
Neuro-oncology diagnosis, total (%) | 443 (100.0) | 276 (100.0) | p > 0.05 |
New referrals | 298 (67.3) | 185 (67.0) | |
High-grade glioma | 65 (14.7) | 33 (12.0) | |
Low-grade glioma | 22 (5.0) | 9 (3.3) | |
Cerebral metastasis | 80 (18.1) | 60 (21.7) | |
Meningioma | 59 (13.3) | 37 (13.4) | |
Other* | 72 (16.3) | 46 (16.7) | |
Follow-up (including post-operative) | 145 (32.7) | 91 (33.0) | |
High-grade glioma | 34 (7.7) | 26 (9.4) | |
Low-grade glioma | 11 (2.5) | 8 (2.9) | |
Cerebral metastasis | 41 (9.3) | 32 (11.6) | |
Meningioma | 35 (7.9) | 17 (6.2) | |
Other* | 24 (5.4) | 8 (2.9) | |
Treatment recommendation |
High-grade glioma, total | 99 | 59 | p > 0.05 |
Surgery, % | 32 (32.3) | 12 (20.3) | |
Monitoring, conservative or other, % | 67 (67.7) | 47 (79.7) | |
Low-grade glioma, total | 33 | 17 | p > 0.05 |
Surgery, % | 6 (18.2) | 4 (23.5) | |
Monitoring, conservative or other, % | 27 (81.8) | 13 (76.5) | |
Cerebral metastasis, total | 121 | 92 | p > 0.05 |
Intervention (surgery/SRSa), % | 30 (7/23) (24.8) | 32 (6/26) (34.8) | |
Monitoring, conservative or other, % | 91 (75.2) | 60 (65.2) | |
Skull base diagnosis, total (%) | 329 (100.0) | 101 (100.0) | p < 0.05 |
New referrals | 112 (34.0) | 48 (47.5) | |
Meningioma | 25 (7.6) | 14 (13.9) | |
Vestibular schwannoma | 17 (5.2) | 7 (6.9) | |
Pituitary adenoma and/or apoplexy | 29 (8.8) | 14 (13.9) | |
Chiari malformation | 11 (3.3) | 2 (2.0) | |
Other& | 30 (9.1) | 11 (10.9) | |
Follow-up (incl. post-operative) | 217 (66.0) | 53 (52.5) | |
Meningioma | 68 (20.7) | 20 (19.8) | |
Vestibular schwannoma | 56 (17.0) | 10 (9.9) | |
Pituitary adenoma and/or apoplexy | 51 (15.5) | 17 (16.8) | |
Chiari malformation | 3 (0.9) | 0 (0.0) | |
Other& | 39 (11.9) | 6 (5.9) | |
Treatment recommendation |
Meningioma, total | 93 | 34 | p < 0.05 |
Intervention (surgery/SRSa), % | 9 (5/4) (9.7) | 9 (7/2) (26.5) | |
Interval imaging, % | 84 (90.3) | 25 (73.5) | |
Vestibular schwannoma, total | 73 | 17 | p > 0.05 |
Intervention (surgery/SRSa), % | 9 (6/3) (12.3) | 2 (1/1) (11.8) | |
Interval imaging, % | 64 (87.7) | 15 (88.2) | |
Pituitary adenoma/apoplexy, total | 80 | 31 | p > 0.05 |
Surgery, % | 16 (20.0) | 3 (9.7) | |
Interval imaging, % | 64 (80.0) | 28 (90.3) | |
Within the skull base service, the number of referrals was significantly reduced from
n = 329 to
n = 101 during COVID-19 (
p < 0.001). Notably, the overall number of patients referred for a pituitary adenoma reduced from
n = 80 to
n = 31 (
p < 0.001). Out of those,
n = 11 were referred with pituitary apoplexy pre-COVID-19 and
n = 3 during COVID-19. There was no statistically significant difference in treatment recommendation between patients referred pre-COVID-19 and during COVID-19 for patients with vestibular schwannoma and pituitary adenoma/apoplexy. However, in a higher proportion of patients referred with a meningioma during COVID-19, active treatments such as surgery or SRS, instead of monitoring were recommended, possibly indicating that larger or more clinically symptomatic lesions were being referred during the COVID-19 period (
p < 0.05; Table
5). All meningioma cases, where specialist intervention was recommended, were located in the medial sphenoid wing. Surgery was recommended to 3 patients with pituitary adenomas during COVID-19: 1 had pituitary apoplexy, 1 had progressively deteriorating vision, and in 1 patient, the pituitary mass had progressed over a short period of time and turned out to be a metastasis. Surgical intervention was deferred in
n = 5 for sphenoid wing meningiomas, and
n = 15 for pituitary adenoma.
Functional and paediatric neurosurgery
The number of functional neurosurgery MDTs was reduced from twice-weekly pre-COVID-19 to 3 during COVID-19. No elective functional neurosurgery took place during COVID-19 although battery replacement for movement disorder patients continued (Table
2).
In the paediatric service, the total number of operations performed was not as severely affected as the adult service (pre-COVID-19
n = 45, during COVID-19
n = 33) but the case load amongst the subspecialties changed (Table
3). In particular, trauma cases increased from
n = 2 (4.4% of total pre-COVID-19) to
n = 5 (15.2% of total during COVID-19). Oncology operations also increased from
n = 7 (15.6% of total) to
n = 9 (27.3% of total) during COVID-19. No functional or neurovascular operations were performed during COVID-19 within our paediatric cohort.
Surgical outcomes and COVID-19 infections in neurosurgical patients
Overall, 30-day perioperative mortality remained low during COVID-19 (
n = 4, 2.0%) compared to pre-COVID-19 (
n = 5, 1.1%; Table
1). Within emergency operations, 30-day perioperative mortality was lower during COVID-19 (1.9%,
n = 3) compared to pre-COVID-19 (2.5%,
n = 5), partly reflecting the process of patient selection with higher threshold for transfer and surgery in critically ill patients during the COVID-19 period. The single elective mortality in the COVID-19 period related to a 28-year-old patient with a solitary CM who subsequently passed away due to leptomeningeal disease (Table
1; 30-day perioperative elective mortality during COVID-19
n = 1, 2.2%).
There were 17 neurosurgical patients who were diagnosed with COVID-19 either pre-operatively (
n = 4) or post-operatively (operation pre-COVID-19
n = 7, operation during COVID-19
n = 6; all patients tested negative before surgery; Table
1), representing 2.6% of total neurosurgical operations. Out of these 17 patients, 6 (35.3%) were from a black and minority ethnic (BAME) background (Table
6) and one of these BAME patients died of post-operative COVID-19 infection (accounting for 20.0% of all deaths after emergency operation). This was an 86-year-old Asian man with hypertension who underwent burr hole drainage of a chronic subdural hematoma but developed COVID-19 infection 15 days post-operatively and died 6 days later of COVID-19-related pneumonia. This was the only single mortality of a neurosurgical patient with COVID-19 infection within our cohort. There was no difference in the ethnic mix of our patients between the pre-COVID and COVID periods. The median age amongst these 17 patients was 63 ± 15.44 years and male:female ratio was 10:7. Overall,
n = 4 patients (23.5%) were admitted to ITU because of COVID-19-related complications. The majority of patients who were infected with COVID-19 had underlying co-morbidities such as hypertension and diabetes mellitus, and all patients admitted to ITU had underlying health problems. Out of the 13 patients who developed post-operative COVID-19 infection, 53.8% (
n = 7) had suffered from a post-operative complication (
n = 6 wound infection,
n = 1 hematoma,
n = 1 CSF leak) with a median time to post-operative infection of 18 ± 9.5 days. The median length of stay for the 17 patients diagnosed with COVID-19 was 36 ± 23.97 days; 4 (23.5%) were discharged to a rehabilitation unit, and 11 (64.7%) were discharged home.
Table 6
Characteristics of neurosurgical patients with COVID-19 infection
1 | 54, M | White | Em | d0 | HTN | Pineal lesion | Endoscopic third ventriculostomy + biopsy | None | Yes | Home | 46 days |
2 | 38, M | Black | Em | d0 | Illicit drugs | Subarachnoid haemorrhage | External ventricular drain | None | Yes | Home | 15 days |
3 | 54, M | White | Em | d0 | Pancytopaenia | Colloid cyst | Endoscopic resection | None | No | Home | 27 days |
4 | 41, M | White | Em | d0 | HTN, NIDDM, asthma | Intracranial haemorrhage | Craniotomy | None | Yes | Home | 55 days |
5 | 59, M | White | Elec | d16 | Metastatic cancer | Cerebral metastasis | Craniotomy | None | No | Home | 24 days |
6 | 67, M | White | Em | d34 | HTN, NIDDM, Cholesterol↑ | Meningitis | External ventricular drain | None | Yes | Rehab | 90 days |
7 | 51, M | White | Em | d20 | None | Degenerative spine | Lumbar fixation | Cerebrospinal fluid leak, wound infection | No | Home | 36 days |
8 | 72, M | White | Elec | d31 | None | Parkinson’s | Deep brain stimulation | Wound infection | No | Inpatient | 94 days |
9 | 72, F | Asian | Elec | d42 | HTN, NIDDM | Meningioma | Craniotomy | Wound infection | No | Home | 65 days |
10 | 86, M | Asian | Em | d15 | HTN, dementia | Subdural hematoma | Burr hole evacuation | None | No | RIP | 21 days |
11 | 64, F | White | Em | d14 | None | Meningioma | Craniotomy/cranioplasty | Wound infection | No | Rehab | 29 days |
12 | 86, F | White | Em | d18 | HTN, AF, cholesterol↑ | Spinal hematoma | Decompression | Wound infection | Yes | Rehab | 31 days |
13 | 48, F | Black | Elec | d21 | Asthma, cholesterol↑ | Meningioma | Craniotomy | Haematoma | Yes | Rehab | 67 days |
14 | 66, M | White | Em | d14 | Metastatic cancer | Metastatic cord compression | Decompression + fixation | None | No | Home | 22 days |
15 | 33, F | Hispanic | Elec | d11 | None | High-grade glioma | Craniotomy | Wound infection | No | Home | 23 days |
16 | 81, F | Black | Em | d11 | HTN, NIDDM, AF | Cauda equina syndrome | Laminectomy + discectomy | None | No | Home | 37 days |
17 | 63, F | White | Em | d24 | None | Meningitis | Endoscopic third ventriculostomy + Rickham | None | No | Home | 47 days |