Aneurismal subarachnoid hemorrhage during the COVID-19 outbreak in a Hub and Spoke system: observational multicenter cohort study in Lombardy, Italy

• Published in: Acta neurochirurgica 2022-01, Vol.164 (1), p.141-150
• Main Authors: Fiorindi, Alessandro, Vezzoli, Marika, Doglietto, Francesco, Zanin, Luca, Saraceno, Giorgio, Agosti, Edoardo, Barbieri, Antonio, Bellocchi, Silvio, Bernucci, Claudio, Bongetta, Daniele, Cardia, Andrea, Costi, Emanuele, Egidi, Marcello, Fioravanti, Antonio, Gasparotti, Roberto, Giussani, Carlo, Grimod, Gianluca, Latronico, Nicola, Locatelli, Davide, Mardighian, Dikran, Nodari, Giovanni, Poli, Jacopo Carlo, Rasulo, Frank, Roca, Elena, Sicuri, Giovanni Marco, Spena, Giannantonio, Stefini, Roberto, Vivaldi, Oscar, Zoia, Cesare, Calza, Stefano, Fontanella, Marco Maria, Cenzato, Marco
• Format: Article
• Language: English
• Subjects: Cohort analysis; Cohort Studies; Coronaviruses; COVID-19; Demography; Humans; Interventional Radiology; Ischemia; Medicine; Medicine & Public Health; Minimally Invasive Surgery; Neurology; Neuroradiology; Neurosurgery; Original - Vascular Neurosurgery - Aneurysm; Original Article - Vascular Neurosurgery - Aneurysm; Pandemics; Patients; SARS-CoV-2; Severe acute respiratory syndrome coronavirus 2; Statistical analysis; Subarachnoid hemorrhage; Subarachnoid Hemorrhage - epidemiology; Surgical Orthopedics; Treatment Outcome
• ISSN: 0001-6268; 0942-0940; 0942-0940
• DOI: 10.1007/s00701-021-05013-9

Background Lombardy was the most affected Italian region by the first phase of the COVID-19 pandemic and underwent urgent reorganization for the management of emergencies, including subarachnoid hemorrhage from a ruptured cerebral aneurysm (aSAH). The aim of the study was to define demographics, clinical, and therapeutic features of aSAH during the COVID-19 outbreak and compare these with a historical cohort. Methods In this observational multicenter cohort study, patients aged 18 years or older, who were diagnosed with aSAH at the participating centers in Lombardy from March 9 to May 10, 2020, were included (COVID-19 group). In order to minimize bias related to possible SAH seasonality, the control group was composed of patients diagnosed with aSAH from March 9 to May 10 of the three previous years, 2017–2018-2019 (pre-pandemic group). Twenty-three demographic, clinical, and therapeutic features were collected. Statistical analysis was performed. Results Seventy-two patients during the COVID-19 period and 179 in the control group were enrolled at 14 centers. Only 4 patients were positive for SARS-CoV-2. The “diagnostic delay” was significantly increased (+ 68%) in the COVID-19 group vs. pre-pandemic (1.06 vs. 0.63 days, respectively, p -value = 0.030), while “therapeutic delay” did not differ significantly between the two periods (0.89 vs. 0.74 days, p -value = 0.183). Patients with poor outcome (GOS at discharge from 1 to 3) were higher during the COVID-19 period (54.2%) compared to pre-pandemic (40.2%, p  = 0.044). In logistic regression analysis, in which outcome was the dichotomized Glasgow Outcome Scale (GOS), five variables showed p -values