Coronavirus disease-19 is associated with decreased treatment access and worsened outcomes in malignant brain tumor patients

Kristie Qwan-Ting Liu; Jonathan Dallas; Talia A Wenger; Hunter Richards; Li Ding; Frances Elaine Chow; Gabriel Zada; William J Mack; Frank J Attenello

doi:10.25259/SNI_440_2023

Coronavirus disease-19 is associated with decreased treatment access and worsened outcomes in malignant brain tumor patients

Surg Neurol Int. 2023 Aug 18:14:292. doi: 10.25259/SNI_440_2023. eCollection 2023.

Authors

Kristie Qwan-Ting Liu¹, Jonathan Dallas¹, Talia A Wenger¹, Hunter Richards², Li Ding³, Frances Elaine Chow¹, Gabriel Zada¹, William J Mack¹, Frank J Attenello¹

Affiliations

¹ Department of Neurological Surgery, Keck School of Medicine of University of Southern California, Los Angeles, California, United States.
² Kaiser Permanente Bernard J. Tyson School of Medicine, Pasadena, California, United States.
³ Department of Preventive Medicine, Keck School of Medicine of University of Southern California, Los Angeles, California, United States.

Abstract

Background: The global coronavirus disease-19 (COVID-19) pandemic has resulted in procedural delays around the world; however, timely and aggressive surgical resection for malignant brain tumor patients is essential for outcome optimization. To investigate the association between COVID-19 and outcomes of these patients, we queried the 2020 National Inpatient Sample (NIS) for differences in rates of surgical resection, time to surgery, mortality, and discharge disposition between patients with and without confirmed COVID-19 infection.

Methods: Patient data were taken from the NIS from April 2020 to December 2020. COVID-19 diagnosis was determined with the International Classification of Diseases, Tenth Revision, Clinical Modification code U07.1.

Results: A total of 30,671 malignant brain tumor patients met inclusion criteria and 738 (2.4%) patients had a confirmed COVID-19 diagnosis. COVID-19-positive patients had lower likelihood of receiving surgery (Odds ratio [OR] 0.43, 95% confidence interval [CI] 0.29-0.63, P < 0.0001), increased likelihood of mortality (OR 2.18, 95% CI 1.78-2.66, P < 0.0001), and increased likelihood of non-routine discharge (OR 1.25, 95% CI 1.13-1.39, P < 0.0001). Notably, COVID patients receiving surgery were not associated with surgical delay (P = 0.17).

Conclusion: COVID-19 infection was associated with worse patient outcome in malignant brain tumor patients, including decreased likelihood of receiving surgery, increased likelihood of mortality, and increased likelihood of non-routine discharge. Our study highlights the need to balance the risks and benefits of delaying surgery for malignant brain tumor patients with COVID-19. Although the COVID-19 pandemic is no longer a public health emergency, understanding the pandemic's impact on outcome provides important insight in effective triage for these patients in the situations where resources are limited.

Keywords: Brain tumor; Coronavirus; Coronavirus disease-19; Malignant; National inpatient sample.