Clinical predictors and surgical outcomes following surgical treatment in patients with cervical spondylotic myelopathy, Addis Ababa, Ethiopia: A prospective study

Background: CSM is the most common cause of spinal dysfunction in adults older than 55 years of age and surgery is the mainstay of treatment for patients with CSM.The objective of our study was to assess the outcome of patients operated for CSM by using m-JOA and Recovery rate using Hirabayashi formula and evaluate clinical factors predicting surgical outcomes in patients undergoing decompressive surgeries. Methodology: Adult CSM patients fulfilling inclusion and exclusion criteria were enrolled at two hospitals. Patients were followed prospectively for a minimum of 06 month, with mJOA score, recovery rate (using Hirabayashi formula) and Postoperative complications assessments. Possible clinical predictive factors were also assessed. Results: There were 38 men and 19 women (mean age, 50.63 yr) enrolled in our study. 48 patients had anterior cervical procedure, 9 patients had posterior procedures.The mean mJOA scores at 6 months (13.33) and 1 year(14.74) after surgery were significantly higher than the mean preoperative mJOA (10.44) (P value = 0.01). 42(73.4 %)patients had recovery, 7 patients (11.9 %) remained the same while 8 (13.6 %) patients worsened. Average recovery rate was 36.59 ± 37.12 % in younger patients( 1 year(39.11 % vs 15.54 %) with p-value = 0.035. Six patients had new neurologic deficit in the immediate postoperative period. Conclusions: Surgical treatment of CSM was associated with significant improvement in mJOA and recovery rate at 6 and 12 months. Age and duration of symptom were highly predictive of surgical. Our study showed a high rate of immediate post op neurologic deterioration but other complications in our study were comparable with those in previously reported CSM series

Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study

We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or >= 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care

SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study

Background: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population