Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Background: The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery needs to be understood to inform clinical decision making during and after the COVID-19 pandemic. This study reports 30-day mortality and pulmonary complication rates in patients with perioperative SARS-CoV-2 infection. Methods: This international, multicentre, cohort study at 235 hospitals in 24 countries included all patients undergoing surgery who had SARS-CoV-2 infection confirmed within 7 days before or 30 days after surgery. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The main secondary outcome measure was pulmonary complications, defined as pneumonia, acute respiratory distress syndrome, or unexpected postoperative ventilation. Findings: This analysis includes 1128 patients who had surgery between Jan 1 and March 31, 2020, of whom 835 (74·0%) had emergency surgery and 280 (24·8%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (26·1%) patients. 30-day mortality was 23·8% (268 of 1128). Pulmonary complications occurred in 577 (51·2%) of 1128 patients; 30-day mortality in these patients was 38·0% (219 of 577), accounting for 81·7% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 1·75 [95% CI 1·28–2·40], p\textless0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p\textless0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p\textless0·0001), malignant versus benign or obstetric diagnosis (1·55 [1·01–2·39], p=0·046), emergency versus elective surgery (1·67 [1·06–2·63], p=0·026), and major versus minor surgery (1·52 [1·01–2·31], p=0·047). Interpretation: Postoperative pulmonary complications occur in half of patients with perioperative SARS-CoV-2 infection and are associated with high mortality. Thresholds for surgery during the COVID-19 pandemic should be higher than during normal practice, particularly in men aged 70 years and older. Consideration should be given for postponing non-urgent procedures and promoting non-operative treatment to delay or avoid the need for surgery. Funding: National Institute for Health Research (NIHR), Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, NIHR Academy, Sarcoma UK, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research

Robust estimation of bacterial cell count from optical density

Optical density (OD) is widely used to estimate the density of cells in liquid culture, but cannot be compared between instruments without a standardized calibration protocol and is challenging to relate to actual cell count. We address this with an interlaboratory study comparing three simple, low-cost, and highly accessible OD calibration protocols across 244 laboratories, applied to eight strains of constitutive GFP-expressing E. coli. Based on our results, we recommend calibrating OD to estimated cell count using serial dilution of silica microspheres, which produces highly precise calibration (95.5% of residuals <1.2-fold), is easily assessed for quality control, also assesses instrument effective linear range, and can be combined with fluorescence calibration to obtain units of Molecules of Equivalent Fluorescein (MEFL) per cell, allowing direct comparison and data fusion with flow cytometry measurements: in our study, fluorescence per cell measurements showed only a 1.07-fold mean difference between plate reader and flow cytometry data

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

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.

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

Affective mentalization as beliefs about the controllability and usefulness of emotions. Validation of a German language version of the Emotion Beliefs Questionnaire

Biel HM, Loewe B, Briken P, et al. Affektive Mentalisierung als wahrgenommene Kontrollierbarkeit und Nützlichkeit von Emotionen. Validierung einer deutschsprachigen Version des Emotion Beliefs Questionnaire. Psychotherapie. 2022.Background: Instruments for the investigation of mentalization should consider and specify the multidimensionality of this construct. Indicative for the pole of affective mentalization is, on the one hand, a perceived controllability of emotions due to the understanding of one's own and others' emotions and on the other hand, a perceived usefulness of emotions due to the attributed meaningfulness of one's own and others' emotions. Perceived controllability and usefulness of positive and negative emotions are assessed with the 16 items of the English language Emotion Beliefs Questionnaire (EBQ; Becerra et al. 2020) in a self-report.Objective: The aim of the present study was to develop a German language version of the EBQ as a survey instrument for affective mentalization ability and to determine its reliability and validity.Material and methods: A total of 104 psychotherapists in training and further education as well as students answered the German language EBQ, which we translated according to the translation guidelines of the European Social Survey, as part of an anonymous online survey. We conducted an exploratory factor analysis and determined internal consistencies and concurrent validities with respect to related constructs.Results: As in the original validation study, the EBQ shows a three-factorial structure and good internal consistency of alpha = 0,87 in the overall scale. Furthermore, associations between the perception of positive and negative emotions as uncontrollable and useless (high EBQ scores) and lower emotion regulation and higher psychopathological symptoms (concurrent validity) are evident.Conclusion: The findings are consistent with the results of the original validation study and suggest that the EBQ is also recommended in the German version. Theoretically justified and empirically tested (see online supplementary), the EBQ appears to be a suitable method for assessing affective mentalization.Hintergrund Instrumente zur Untersuchung von Mentalisierung sollten die Multidimensionalität dieses Konstrukts berücksichtigen und spezifizieren. Indikativ für den Pol der affektiven Mentalisierung sind einerseits aufgrund des Verständnisses für eigene und fremde Emotionen eine wahrgenommene Kontrollierbarkeit von Emotionen, andererseits aufgrund der attribuierten Bedeutsamkeit eigener und fremder Emotionen eine wahrgenommene Nützlichkeit von Emotionen. Die wahrgenommene Kontrollierbarkeit und Nützlichkeit positiver und negativer Emotionen wird mit den 16 Items des englischsprachigen Emotion Beliefs Questionnaire (EBQ; Becerra et al. 2020) im Selbstbericht erfasst. Ziel der Studie Ziele der vorliegenden Studie waren es, eine deutschsprachige Version des EBQ als Erhebungsinstrument für affektive Mentalisierungsfähigkeit zu entwickeln sowie deren Reliabilität und Validität zu ermitteln. Material und Methoden Psychotherapeut:innen in Aus- und Weiterbildung sowie Studierende (n = 104) beantworteten den von uns in Anlehnung an die Translation Guidelines des European Social Survey übersetzten deutschsprachigen EBQ als Teil einer anonymen Online-Befragung. Wir führten eine explorative Faktorenanalyse durch und bestimmten interne Konsistenzen sowie konkurrente Validitäten in Bezug auf verwandte Konstrukte. Ergebnisse Wie in der Originalvalidierungsstudie zeigen sich eine dreifaktorielle Struktur des EBQ sowie eine gute interne Konsistenz von α = 0,87 in der Gesamtskala. Weiterhin zeigen sich Zusammenhänge zwischen der Wahrnehmung von positiven und negativen Emotionen als unkontrollierbar und nutzlos (hohe EBQ-Werte) und einer geringeren Emotionsregulation sowie höheren psychopathologischen Symptomen (konkurrente Validität). Schlussfolgerung Die Befunde decken sich mit den Ergebnissen der originalen Validierungsstudie und legen nahe, dass der EBQ auch in der deutschen Version zu empfehlen ist. Theoretisch begründet und empirisch überprüft (siehe Online-Appendix) erscheint der EBQ als ein geeignetes Verfahren zur Erhebung affektiver Mentalisierung

Near-bed stratification controls bottom hypoxia in ice-covered alpine lakes

In ice-covered lakes, near-bottom oxygen concentration decreases for most of the wintertime, sometimes down to the point that bottom waters become hypoxic. Studies insofar have reached divergent conclusions on whether climate change limits or reinforces the extent and duration of hypoxia under ice, raising the need for a comprehensive understanding of the drivers of the dissolved oxygen (DO) dynamics under lake ice. Using high-temporal resolution time series of DO concentration and temperature across 14 mountain lakes, we showed that the duration of bottom hypoxia under ice varies from 0 to 236 d within lakes and among years. The variability of hypoxia duration was primarily explained by changes in the decay rate of DO above the lake bottom rather than by differences in DO concentration at the ice onset or in the ice-cover duration. We observed that the DO decay rate was primarily linked to physical controls (i.e., deep-water warming) rather than biogeochemical drivers (i.e., proxies for lake or catchment productivity). Using a simple numerical model, we provided a proof-of-concept that the near-bed stratification can be the mechanism tying the DO decay rate to the sediment heat release under the ice. We ultimately showed that the DO decay rate and hypoxia duration are driven by the summer light climate, with faster oxygen decline found under the ice of clearer cryostratified alpine lakes. We derived a framework theorizing how the hypoxia duration might change under the ice of alpine lakes in a warmer climate.ISSN:0024-3590ISSN:1939-559

Head and neck cancer surgery during the COVID-19 pandemic: An international, multicenter, observational cohort study

Background: The aims of this study were to provide data on the safety of head and neck cancer surgery currently being undertaken during the coronavirus disease 2019 (COVID-19) pandemic. Methods: This international, observational cohort study comprised 1137 consecutive patients with head and neck cancer undergoing primary surgery with curative intent in 26 countries. Factors associated with severe pulmonary complications in COVID-19–positive patients and infections in the surgical team were determined by univariate analysis. Results: Among the 1137 patients, the commonest sites were the oral cavity (38%) and the thyroid (21%). For oropharynx and larynx tumors, nonsurgical therapy was favored in most cases. There was evidence of surgical de-escalation of neck management and reconstruction. Overall 30-day mortality was 1.2%. Twenty-nine patients (3%) tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) within 30 days of surgery; 13 of these patients (44.8%) developed severe respiratory complications, and 3.51 (10.3%) died. There were significant correlations with an advanced tumor stage and admission to critical care. Members of the surgical team tested positive within 30 days of surgery in 40 cases (3%). There were significant associations with operations in which the patients also tested positive for SARS-CoV-2 within 30 days, with a high community incidence of SARS-CoV-2, with screened patients, with oral tumor sites, and with tracheostomy. Conclusions: Head and neck cancer surgery in the COVID-19 era appears safe even when surgery is prolonged and complex. The overlap in COVID-19 between patients and members of the surgical team raises the suspicion of failures in cross-infection measures or the use of personal protective equipment. Lay Summary: Head and neck surgery is safe for patients during the coronavirus disease 2019 pandemic even when it is lengthy and complex. This is significant because concerns over patient safety raised in many guidelines appear not to be reflected by outcomes, even for those who have other serious illnesses or require complex reconstructions. Patients subjected to suboptimal or nonstandard treatments should be carefully followed up to optimize their cancer outcomes. The overlap between patients and surgeons testing positive for severe acute respiratory syndrome coronavirus 2 is notable and emphasizes the need for fastidious cross-infection controls and effective personal protective equipment

Delaying surgery for patients with a previous SARS-CoV-2 infection

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Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic.

BACKGROUND: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. METHODS: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. RESULTS: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. CONCLUSION: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas