Decompressive surgery in the treatment of acute ischemic stroke during the first four waves of the COVID-19 pandemic in Germany - a nationwide observational cohort study.

Background and Study Aims The COVID-19 pandemic has significantly affected acute ischemic stroke (AIS) care. We examined the pandemic's effects on neurosurgical AIS care by means of decompressive surgery (DS). Patients and Methods In this retrospective observational study, we compared characteristics, in-hospital processes, and in-hospital mortality rates among patients hospitalized for AIS during the first 4 waves of the pandemic (between January 1, 2020, and October 26, 2021) versus corresponding periods in 2019 (pre-pandemic). We used administrative data from a nationwide hospital network in Germany. Results Of the 177 included AIS cases with DS, 60 were from 2019 and 117 from the first 4 pandemic waves. Compared to pre-pandemic levels, there were no changes in weekly admissions for DS during the pandemic. The same was true for patient age (range: 51.7 to 60.4 years), the proportion of female sex (range: 33.3 to 57.1%) and the prevalence of comorbidity, as measured by the Elixhauser comorbidity index (range: 13.2 to 20.0 points). Also, no alterations were observed in transfer to intensive care unit (range: 87.0 to 100%), duration of in-hospital stay (range: 14.6 to 22.7 days), and in-hospital mortality rates (range: 11.8 to 55.6%). Conclusion In Germany, compared to pre-pandemic levels, AIS patients undergoing DS showed no changes in demographics, rates of comorbidity, and in-hospital mortality rates. This is in contrast to previous evidence on patients with less critical types of AIS not requiring DS and underlines the uniqueness of the subgroup of AIS patients requiring DS. Our findings suggests that these patients, in contrast to AIS patients in general, were unable to forgo hospitalization during the COVID-19 pandemic. Maintaining the delivery of DS is an essential aspect of AIS care in times of a pandemic.