12 research outputs found

    Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

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    PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

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    PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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    Abstract Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

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    Background Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was co-prioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low–middle-income countries. Results In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of ‘single-use’ consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low–middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high– and low–middle–income countries

    Evaluation of the physicochemical and chlorophyll-a conditions of a subtropical aquaculture in Lake Nasser area, Egypt

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    Water quality, nutritional characteristics and phytoplankton biomass in aquaculture of Oreochromis niloticus (L.) simultaneously with its water source supply (Lake Nasser), were monthly investigated over a one-year period (July 2009–2010). Analysis of the results showed that application of fertilizers and environmental conditions appeared to be the principal factors influencing the spatio-temporal variations of water quality and productivity. The data obtained revealed differences between the fish pond and its water supply. Monthly fluctuations in the availability of the major nutrients reflected the occasional supply of the fish pond with different nutrients. Phytoplankton biomass in terms of chlorophyll-a concentrations were always of relatively higher values in the fish pond than those in Lake Nasser's water. Elevation of pH values and dissolved oxygen saturation levels appeared concomitantly with the increase of chlorophyll-a concentrations due to the phytoplankton photosynthetic assimilation activities. The observations of the present study highlighted the chlorophyll-a concentrations as an indicator of phytoplankton biomass reflecting water quality in the Nile tilapia aquaculture ecosystem

    Water quality and potamoplankton evaluation of the Nile River in Upper Egypt

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    Aim: The composition, abundance, community structure of potamoplankton and major physical and chemical variables of the Nile water in Upper Egypt were investigated to assess its status in different seasons during 2007.MethodsWater samples were collected seasonally during 2007 from six investigated sites from variable depths at levels of 0, 2.5 and 5 m. The area of this investigation is defined as the southern 120 Km of the main stream of the Nile in Upper Egypt (24° 04’ – 25° 00’ latitudes and 32° 51’ – 32° 54’ longitudes), downstream of Aswan Old Dam.ResultsAltogether, 121 potamoplankton species, of which 85 related to phytoplankton and 36 appertaining to zooplankton were recorded. Most numerous phytoplankton were Chlorophyceae (42 species) followed by Bacillariophyceae (30 species). Cyanobacteria and Dinophyceae were less numerous with only 11 and 2 species, respectively. Zooplankton species were mainly belonging to three systematic groups namely; Rotifera (24 species), Copepoda (3 species) and Cladocera (9 species). Besides, other rare zooplankton including Platyhelminthes, Nemata and Ciliophora were sparsely encountered. The main hydrological conditions characterizing the investigated area include water level fluctuations (˂82 - ˃85 m above sea level), relatively high current velocity (0.8 - 1.3 m sec–1) and disposal of wastewater. Plankton populations were variably but rather weakly dependent on the major nutrients due to their excessive availability in accessible form for uptake by the producers. For phytoplankton, the community structure was categorized in relation to temperature, pH, SO42– and Mg2+. For zooplankton, the community structure was categorized in relation to conductivity as well as Mg2+. Sampling intervals were inadequate to demonstrate the existing successional pattern of the Nile potamoplankton community. Alterations in the phytoplankton community structure accompanied changes in water temperature represented by the alternate dominance between diatoms and cyanobacteria, while zooplankton community was always dominated by rotifers. Phytoplankton populations were numerically more abundant in autumn and zooplankton peaked in spring.ConclusionsWastewater disposal restricted the abundance of the Nile zooplankton assemblages mainly due to the numerical decline of Rotifera and Cladocera. Otherwise, wastewater did not exert major limits for phytoplankton. The data obtained in this investigation will be crucial to understand potamoplankton regulation and contribute to the knowledge regarding the Limnology of the Nile basin

    Alterations in proteins and amino acids of the Nile cyanobacteria Pseudanabaena limnetica and Anabaena wisconsinense in response to industrial wastewater pollution

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    The effect of industrial wastewater on the Nile cyanobacteria Pseudanabaena limnetica and Anabaena wisconsinense was investigated. The data showed that P. limnetica was more sensitive to pollution than A. wisconsinense. The treatments with different levels of wastewater exerted pronounced reductions in protein and amino acids content. SDS-PAGE analysis revealed that the cyanobacteria grown in the industrial wastewater showed induction in the synthesis of certain polypeptides and repression of others. The treatments of P. limnetica with wastewater stimulated the appearance of six protein bands with molecular masses of 28, 30, 31, 32, 58 and 97 kDa. The same treatments caused the disappearance of 20, 38 and 56 kDa. The structural protein pattern of the treated A. wisconsinense showed appearance of 16, 30, 170 and 230 kDa and disappearance of 56 kDa. The treatment of the two investigated cyanobacteria with different levels of wastewater stimulated the biosyntheses of different amino acids and inhibited others

    Outcomes after perioperative SARS-CoV-2 infection in patients with proximal femoral fractures: an international cohort study

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    Objectives Studies have demonstrated high rates of mortality in people with proximal femoral fracture and SARS-CoV-2, but there is limited published data on the factors that influence mortality for clinicians to make informed treatment decisions. This study aims to report the 30-day mortality associated with perioperative infection of patients undergoing surgery for proximal femoral fractures and to examine the factors that influence mortality in a multivariate analysis. Setting Prospective, international, multicentre, observational cohort study. Participants Patients undergoing any operation for a proximal femoral fracture from 1 February to 30 April 2020 and with perioperative SARS-CoV-2 infection (either 7 days prior or 30-day postoperative). Primary outcome 30-day mortality. Multivariate modelling was performed to identify factors associated with 30-day mortality. Results This study reports included 1063 patients from 174 hospitals in 19 countries. Overall 30-day mortality was 29.4% (313/1063). In an adjusted model, 30-day mortality was associated with male gender (OR 2.29, 95% CI 1.68 to 3.13, p80 years (OR 1.60, 95% CI 1.1 to 2.31, p=0.013), preoperative diagnosis of dementia (OR 1.57, 95% CI 1.15 to 2.16, p=0.005), kidney disease (OR 1.73, 95% CI 1.18 to 2.55, p=0.005) and congestive heart failure (OR 1.62, 95% CI 1.06 to 2.48, p=0.025). Mortality at 30 days was lower in patients with a preoperative diagnosis of SARS-CoV-2 (OR 0.6, 95% CI 0.6 (0.42 to 0.85), p=0.004). There was no difference in mortality in patients with an increase to delay in surgery (p=0.220) or type of anaesthetic given (p=0.787). Conclusions Patients undergoing surgery for a proximal femoral fracture with a perioperative infection of SARS-CoV-2 have a high rate of mortality. This study would support the need for providing these patients with individualised medical and anaesthetic care, including medical optimisation before theatre. Careful preoperative counselling is needed for those with a proximal femoral fracture and SARS-CoV-2, especially those in the highest risk groups. Trial registration number NCT0432364

    Reducing the environmental impact of surgery on a global scale: systematic review and co-prioritization with healthcare workers in 132 countries

    No full text
    Background: Healthcare cannot achieve net-zero carbon without addressing operating theatres. The aim of this study was to prioritize feasible interventions to reduce the environmental impact of operating theatres. Methods: This study adopted a four-phase Delphi consensus co-prioritization methodology. In phase 1, a systematic review of published interventions and global consultation of perioperative healthcare professionals were used to longlist interventions. In phase 2, iterative thematic analysis consolidated comparable interventions into a shortlist. In phase 3, the shortlist was coprioritized based on patient and clinician views on acceptability, feasibility, and safety. In phase 4, ranked lists of interventions were presented by their relevance to high-income countries and low-middle-income countries. Results: In phase 1, 43 interventions were identified, which had low uptake in practice according to 3042 professionals globally. In phase 2, a shortlist of 15 intervention domains was generated. In phase 3, interventions were deemed acceptable for more than 90 per cent of patients except for reducing general anaesthesia (84 per cent) and re-sterilization of 'single-use' consumables (86 per cent). In phase 4, the top three shortlisted interventions for high-income countries were: introducing recycling; reducing use of anaesthetic gases; and appropriate clinical waste processing. In phase 4, the top three shortlisted interventions for low-middle-income countries were: introducing reusable surgical devices; reducing use of consumables; and reducing the use of general anaesthesia. Conclusion: This is a step toward environmentally sustainable operating environments with actionable interventions applicable to both high- and low-middle-income countries
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