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


Michael T. Poon, Usher Institute, University of Edinburgh, Edinburgh, UK.
Rory J. Piper, Department of Neurosurgery, John Radcliffe Hospital, Oxford, UK.
Nqobile Thango, Department of Surgery, Division of Neurosurgery, University of Cape Town, Cape Town, South Africa.
Daniel M. Fountain, Manchester Centre for Clinical Neurosciences, Salford Royal NHS Foundation Trust, Salford, UK.
Hani J. Marcus, National Hospital for Neurology and Neurosurgery, London, UK.
Laura Lippa, Department of Neurosurgery, Grande Ospedale Metropolitano Niguarda Milan, Italy.
Franco Servadei, Department of Neurosurgery, Humanitas University, Milano, Italy.
Ignatius N. Esene, Neurosurgery Division, Faculty of Health Sciences, University of Bamenda, Bambili, Cameroon.
Christian F. Freyschlag, Department of Neurosurgery, Medical University of Innsbruck, Anichstr. 35, 6020 Innsbruck, Austria.
Iuri S. Neville, Instituto do Cancer do Estado de Sao Paulo, Hospital das Clinicas da Faculdade de Medicina da Universidade de Sao Paulo, Sao Paulo, Brazil.
Gail Rosseau, George Washington University School of Medicine and Health Sciences, Washington, DC, United States.
Karl Schaller, Department of Clinical Neurosciences, Geneva University Medical Center, Geneva, Switzerland.
Andreas K. Demetriades, Department of Clinical Neurosciences, Royal Infirmary of Edinburgh, Edinburgh, UK.
Faith C. Robertson, Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts, United States.
Peter J. Hutchinson, Academic Division of Neurosurgery, Addenbrooke's Hospital, Cambridge, UK.
Stephen J. Price, Department of Clinical Neurosciences, Division of Neurosurgery, Cambridge, UK.
Ronnie E. Baticulon, Division of Neurosurgery, Department of Neurosciences, Philippine General Hospital, University of the Philippines Manila, Manila, Philippines.
James C. Glasbey, NIHR Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, UK.
Aneel Bhangu, University of Birmingham, Birmingham, UK.
Michael D. Jenkinson, Department of Neurosurgery, Walton Centre & University of Liverpool, Liverpool, UK.
Angelos G. Kolias, Department of Clinical Neurosciences, Division of Neurosurgery, Cambridge, UK.

Document Type

Journal Article

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collaborative research; global neurosurgery; neuro-oncology


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.


Neurological Surgery