Changes in Cerebrovascular Procedures and Outcomes During COVID-19 Using the National Surgery Quality Improvement Project

Abstract

Explore the consequences of the Coronavirus pandemic (COVID-19) on patients suffering from cerebrovascular disorders necessitating interventions. Using the National Surgical Quality Improvement Program database, patients with cerebrovascular disease who underwent procedures before (2018-2019) and during (2020-2021) COVID-19 were identified. ICD-10 and CPT codes were employed to classify diseases and elective cases, respectively. Study analyzed variations in diagnoses, procedures, demographics, mortality and morbidity likelihood scores, and outcomes. Analysis was conducted using R 4.2.1 with tidyverse, haven, and Ime4 packages. Statistical significance was defined as p < 0.05. There was a significant rise in cerebrovascular accidents (CVAs) (9.96% vs. 12.28%) and a decrease in elective carotid endarterectomies (92.30% vs. 87.22%). Carotid stenting increased significantly (7.63% vs. 12.62%), and mortality probability scores rose for CVAs and carotid interventions. Ethnic (Hispanic) and racial minorities (Asians and Black/African American) were disproportionately affected (p < 0.001). Conditions from delayed care increased, and total operative times rose (117.46 vs. 124.33 min). Various patient outcomes worsened (p < 0.05), and multivariate analyses showed Hispanic patients had higher mortality and morbidity probability scores (p < 0.05). The pandemic led to more severe disease progression and reduced diagnoses due to screening delays, indicating deferred care. Prolonged operative times, extended hospitals stays, and worsening outcomes, including infections and thrombotic events, hint at the repercussions of persistent staff shortages in healthcare facilities. Ethnic and racial minorities faced disproportionate impacts. To minimize harm to patients with cerebrovascular disease in future public health crises, it is crucial to develop policies that address these findings.