Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries : an international, prospective, cohort study

Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restrictions. Methods This international, prospective, cohort study enrolled 20 006 adult (>= 18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10middot0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0middot6% non-operation rate (26 of 4521), moderate lockdowns with a 5middot5% rate (201 of 3646; adjusted hazard ratio [HR] 0middot81, 95% CI 0middot77-0middot84; p Funding National Institute for Health Research Global Health Research Unit, 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, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research. Copyright (c) 2021 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY-NC-ND 4.0 license.Peer reviewe

SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study

This article is accompanied by an editorial by Marshall and Duggan. Anaesthesia 2022; 77: 3–6.SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARSCoV- 2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARSCoV- 2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.COVIDSurg Collaborative and GlobalSurg Collaborative (Australia: Daniel Cox ... Hidde M Kroon ... Christina McVeay ... Matheesha Herath ... Luke Traeger ... Robert Fitridge ... Tarik Sammour ... et al.

Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic

BACKGROUND: This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic./ METHODS: We prospectively included adults aged ≥18 years who underwent surgery for a malignant or benign intracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients’ location by World Bank income groups (high [HIC], upper-middle [UMIC], and low- and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality./ RESULTS: Among 1016 patients, the number of patients in each income group was 765 (75.3%) in HIC, 142 (14.0%) in UMIC, and 109 (10.7%) in LLMIC. The management of 200 (19.8%) patients changed from usual care, most commonly delayed surgery. Within 30 days after surgery, 14 (1.4%) patients had a COVID-19 diagnosis and 39 (3.8%) patients died. In the multivariable model, LLMIC was associated with increased mortality (odds ratio 2.83, 95% credible interval 1.37–5.74) compared to HIC./ CONCLUSIONS: The first wave of the pandemic had a significant impact on surgical decision-making. While the incidence of SARS-CoV-2 infection within 30 days after surgery was low, there was a disparity in mortality between countries and this warrants further examination to identify any modifiable factors

Outcomes of gynecologic cancer surgery during the COVID-19 pandemic: an international, multicenter, prospective CovidSurg-Gynecologic Oncology Cancer study

Background The CovidSurg-Cancer Consortium aimed to explore the impact of COVID-19 in surgical patients and services for solid cancers at the start of the pandemic. The CovidSurg-Gynecologic Oncology Cancer subgroup was particularly concerned about the magnitude of adverse outcomes caused by the disrupted surgical gynecologic cancer care during the COVID-19 pandemic, which are currently unclear. Objective This study aimed to evaluate the changes in care and short-term outcomes of surgical patients with gynecologic cancers during the COVID-19 pandemic. We hypothesized that the COVID-19 pandemic had led to a delay in surgical cancer care, especially in patients who required more extensive surgery, and such delay had an impact on cancer outcomes. Study Design This was a multicenter, international, prospective cohort study. Consecutive patients with gynecologic cancers who were initially planned for nonpalliative surgery, were recruited from the date of first COVID-19-related admission in each participating center for 3 months. The follow-up period was 3 months from the time of the multidisciplinary tumor board decision to operate. The primary outcome of this analysis is the incidence of pandemic-related changes in care. The secondary outcomes included 30-day perioperative mortality and morbidity and a composite outcome of unresectable disease or disease progression, emergency surgery, and death. Results We included 3973 patients (3784 operated and 189 nonoperated) from 227 centers in 52 countries and 7 world regions who were initially planned to have cancer surgery. In 20.7% (823/3973) of the patients, the standard of care was adjusted. A significant delay (>8 weeks) was observed in 11.2% (424/3784) of patients, particularly in those with ovarian cancer (213/1355; 15.7%; P<.0001). This delay was associated with a composite of adverse outcomes, including disease progression and death (95/424; 22.4% vs 601/3360; 17.9%; P=.024) compared with those who had operations within 8 weeks of tumor board decisions. One in 13 (189/2430; 7.9%) did not receive their planned operations, in whom 1 in 20 (5/189; 2.7%) died and 1 in 5 (34/189; 18%) experienced disease progression or death within 3 months of multidisciplinary team board decision for surgery. Only 22 of the 3778 surgical patients (0.6%) acquired perioperative SARS-CoV-2 infections; they had a longer postoperative stay (median 8.5 vs 4 days; P<.0001), higher predefined surgical morbidity (14/22; 63.6% vs 717/3762; 19.1%; P<.0001) and mortality (4/22; 18.2% vs 26/3762; 0.7%; P<.0001) rates than the uninfected cohort. Conclusion One in 5 surgical patients with gynecologic cancer worldwide experienced management modifications during the COVID-19 pandemic. Significant adverse outcomes were observed in those with delayed or cancelled operations, and coordinated mitigating strategies are urgently needed

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

The impact of surgical delay on resectability of colorectal cancer:an international prospective cohort study

Abstract Aim: The SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery. Methods: This was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January–April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin. Results: Overall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P < 0.001). After adjustment, delay was not associated with a lower rate of complete resection (OR 1.18, 95% CI 0.90–1.55, P = 0.224), which was consistent in elective patients only (OR 0.94, 95% CI 0.69–1.27, P = 0.672). Longer delays were not associated with poorer outcomes. Conclusions: One in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease.APPENDIX A : List of PubMed citable COVIDSurg collaborators Writing group: Michel Adamina (Switzerland), Adesoji Ademuyiwa (Nigeria), Adewale Adisa (Nigeria), Aneel A Bhangu (UK), Ana Minaya Bravo (Spain), Miguel F Cunha (Portugal), Sameh Emile (Egypt), Dhruva Ghosh (India), James C Glasbey (UK), Benjamin Harris (UK)*, Debby Keller (USA), Samuel Lawday (UK), Hans Lederhuber (Germany), Sezai Leventoglu (Turkey), Elizabeth Li (UK), Maria Marta Modolo (Argentina), Rohin Mittal (India), Helen M Mohan (Ireland), Dmitri Nepogodiev (UK), Marie Dione Parreño-Sacdalan (Philippines), Francesco Pata (Italy), Peter Pockney (Australia), Martin Rutegård (Sweden), Joana FF Simões (Portugal)*, Neil Smart (UK), Chris Varghese (New Zealand). *Joint first authors. Statistical analysis and data handling James C Glasbey, Joana FF Simoes, Benjamin Harris, Aneel A Bhangu. COVIDSurg Operations Committee Dmitri Nepogodiev (Chair), Kwabena Siaw-Acheampong, Ruth A Benson, Edward Bywater, Daoud Chaudhry, Brett E Dawson, Jonathan P Evans, James C Glasbey, Rohan R Gujjuri, Emily Heritage, Conor S Jones, Sivesh K Kamarajah, Chetan Khatri, Rachel A Khaw, James M Keatley, Andrew Knight, Samuel Lawday, Elizabeth Li, Harvinder S Mann, Ella J Marson, Kenneth A McLean, Siobhan C Mckay, Emily C Mills, Gianluca Pellino, Maria Picciochi, Elliott H Taylor, Abhinav Tiwari, Joana FF Simoes, Isobel M Trout, Mary L Venn, Richard JW Wilkin, Aneel Bhangu. International Cancer Leads (*denotes specialty Principal Investigators) James C Glasbey (Chair) Colorectal: Neil J Smart*, Ana Minaya-Bravo*, Jonathan P Evans, Gaetano Gallo, Susan Moug, Francesco Pata, Peter Pockney, Salomone Di Saverio, Abigail Vallance, Dale Vimalchandran. Oesophagogastric: Ewen A Griffiths*, Sivesh K Kamarajah, Richard PT Evans, Philip Townend. Hepatopancreatobiliary: Keith Roberts*, Siobhan McKay*, John Isaac, Sohei Satoi. Thoracic: John Edwards*, Aman S Coonar, Adrian Marchbank, Edward J Caruana, Georgia R Layton, Akshay Patel, Alessandro Brunelli. Sarcoma: Samuel Ford*, Anant Desai*, Alessandro Gronchi*, Marco Fiore*, Max Almond, Fabio Tirotta, Sinziana Dumitra. Neurosurgery: Angelos Kolias*, Stephen J Price, Daniel M Fountain, Michael D Jenkinson, Peter Hutchinson, Hani J Marcus, Rory J Piper, Laura Lippa, Franco Servadei, Ignatius Esene, Christian Freyschlag, Iuri Neville, Gail Rosseau, Karl Schaller, Andreas K Demetriades, Faith Robertson, Alex Alamri. Head and neck: Richard Shaw*, Andrew G Schache, Stuart C Winter, Michael Ho, Paul Nankivell, Juan Rey Biel, Martin Batstone, Ian Ganly. Breast: Raghavan Vidya*, Alex Wilkins, Jagdeep K Singh, Dinesh Thekinkattil. Gynaecology: Sudha Sundar*, Christina Fotopoulou*, Elaine YL Leung, Tabassum Khan, Luis Chiva, Jalid Sehouli, Anna Fagotti, Paul Cohen, Murat Gutelkin, Rahel Ghebre, Thomas Konney, Rene Pareja, Rob Bristow, Sean Dowdy, Shylasree TS, Rajkumar Kottayasamy Seenivasagam, Joe Ng, Keiichi Fujiwara. Urology: Grant D Stewart*, Benjamin Lamb, Krishna Narahari, Alan McNeill, Alexandra Colquhoun, John S McGrath, Steve Bromage, Ravi Barod, Veeru Kasivisvanathan*, Tobias Klatte. Dissemination Committee Joana FF Simoes (Chair); Tom EF Abbott, Sadi Abukhalaf, Michel Adamina, Adesoji O Ademuyiwa, Arnav Agarwal, Murat Akkulak, Ehab Alameer, Derek Alderson, Felix Alakaloko, Markus Albertsmeier, Osaid Alser, Muhammad Alshaar, Sattar Alshryda, Alexis P Arnaud, Knut Magne Augestad, Faris Ayasra, José Azevedo, Brittany K Bankhead-Kendall, Emma Barlow, David Beard, Ruth A Benson, Ruth Blanco-Colino, Amanpreet Brar, Ana Minaya-Bravo, Kerry A Breen, Chris Bretherton, Igor Lima Buarque, Joshua Burke, Edward J Caruana, Mohammad Chaar, Sohini Chakrabortee, Peter Christensen, Daniel Cox, Moises Cukier, Miguel F Cunha, Giana H Davidson, Anant Desai, Salomone Di Saverio, Thomas M Drake, John G Edwards, Muhammed Elhadi, Sameh Emile, Shebani Farik, Marco Fiore, J Edward Fitzgerald, Samuel Ford, Tatiana Garmanova, Gaetano Gallo, Dhruva Ghosh, Gustavo Mendonça Ataíde Gomes, Gustavo Grecinos, Ewen A Griffiths, Magdalena Gruendl, Constantine Halkias, Ewen M Harrison, Intisar Hisham, Peter J Hutchinson, Shelley Hwang, Arda Isik, Michael D Jenkinson, Pascal Jonker, Haytham MA Kaafarani, Debby Keller, Angelos Kolias, Schelto Kruijff, Ismail Lawani, Hans Lederhuber, Sezai Leventoglu, Andrey Litvin, Andrew Loehrer, Markus W Löffler, Maria Aguilera Lorena, Maria Marta Modolo, Piotr Major, Janet Martin, Hassan N Mashbari, Dennis Mazingi, Symeon Metallidis, Ana Minaya-Bravo, Helen M Mohan, Rachel Moore, David Moszkowicz, Susan Moug, Joshua S Ng-Kamstra, Mayaba Maimbo, Ionut Negoi, Milagros Niquen, Faustin Ntirenganya, Maricarmen Olivos, Kacimi Oussama, Oumaima Outani, Marie Dione Parreño-Sacdalan, Francesco Pata, Carlos Jose Perez Rivera, Thomas D Pinkney, Willemijn van der Plas, Peter Pockney, Ahmad Qureshi, Dejan Radenkovic, Antonio Ramos-De la Medina, Toby Richards, Keith Roberts, April C Roslani, Martin Rutegård, Juan José Segura-Sampedro, Irène Santos, Sohei Satoi, Raza Sayyed, Andrew Schache, Andreas A Schnitzbauer, Justina O. Seyi-Olajide, Neil Sharma, Catherine A Shaw, Richard Shaw, Sebastian Shu, Kjetil Soreide, Antonino Spinelli, Grant D Stewart, Malin Sund, Sudha Sundar, Stephen Tabiri, Philip Townend, Georgios Tsoulfas, Gabrielle H van Ramshorst, Raghavan Vidya, Dale Vimalachandran, Oliver J Warren, Duane Wedderburn, Naomi Wright, EuroSurg, European Society of Coloproctology (ESCP), Global Initiative for Children’s Surgery (GICS), GlobalSurg, GlobalPaedSurg, ItSURG, PTSurg, SpainSurg, Italian Society of Colorectal Surgery (SICCR), Association of Surgeons in Training (ASiT), Irish Surgical Research Collaborative (ISRC), Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG), Italian Society of Surgical Oncology (SICO). Collaborators (*denotes hospital leads) Argentina: Valenzuela JI* (Hospital Velez Sarsfield, City of Buenos Aires); Alurralde C, Caram EL, Eskinazi DG* (Sanatorio 9 De Julio Sa, Tucuman); Badra R, García JS, Lucchini SM* (Sanatorio Allende, Cordoba). Australia: Vasey C*, Watson E (Ballarat Base Hospital, Ballarat Central); Cecire J, Salindera S*, Sutherland A (Coffs Harbour Health Campus, Coffs Harbour NSW); Ahn JH, Chen S, Gauri N, Jang S, Jia F, Mulligan CS, Yang W, Ye G, Zhang H (Concord Repatriation General Hospital, Concord West, Sydney); Moss J*, Richards T, Thian A, Vo UG* (Fiona Stanley Hospital, Perth); Bagraith K, Chan E, Ho D, Jeyarajan E, Jordan S, Nolan GJ, Von Papen M, Wullschleger M (Gold Coast University Hospital, Southport); Dawson AC*, Drane A (Gosford Hospital, Gosford); Egoroff N, Gani J, Lott N, Pockney P* (John Hunter Hospital, Newcastle); Phan D, Townend D* (Lismore Base Hospital, Lismore); Bong C, Gundara J* (Logan Hospital, Brisbane); Bowman S*, Guerra GR (Queen Elizabeth II Jubilee Hospital, Brisbane); Gerns N, Riddell A* (Redcliffe Hospital, Redcliffe); Dudi-Venkata NN, Kroon HM*, Sammour T (Royal Adelaide Hospital, Adelaide); Mitchell D*, Swinson B (Royal Brisbane and Women’s Hospital, Brisbane); Waldron A, Walker P* (St John of God Midland Public and Private Hospital, Perth); Dawson AC*, Drane A*, Lun EWY* (Wyong Public Hospital, Wyong). Austria: Messner F, Öfner D* (Medical University of Innsbruck, Innsbruck); Emmanuel K, Grechenig M, Gruber R, Harald M, Jäger T, Öhlberger L, Presl J*, Wimmer A (Paracelsus Medical University Salzburg, Salzburg). Azerbaijan: Namazov İ, Samadov E (Leyla Medical Centerl, Baku). Barbados: Barker D, Boyce R, Doyle A, Eastmond A, Gill R, O’Shea M, Padmore G*, Paquette N, Phillips E, St John S, Walkes K (Queen Elizabeth Hospital, Bridgetown). Belgium: Flamey N, Pattyn P* (Az Delta, Roeselare); Ceelen W, Pattyn P, Van de Putte D, Van Nieuwenhove Y, Van Ramshorst G*, Willaert W (University Hospital of Ghent, Gent); Oosterlinck W*, Van den Eynde J, Van den Eynde R (Uz Leuven, Leuven). Brazil: Aguiar Júnior S*, Marques T (A.c. Camargo Cancer Center, São Paulo); Camara P*, De Lima RK, Della Giustina E, Hoffmann PV (Fundação Hospitalar De Blumenau, Blumenau); Nacif L* (Hospital Nove De Julho, Sao Paulo); Carvalho Ferro C, Gomes GMA, Lima Buarque I, Lira dos Santos Leite A, Pol-Fachin L, Santos Bezerra T, Silva A, Silvestre D, Vieira Barros A* (Hospital Santa Casa De Misericordia De Maceio, Maceio); Laporte G*, Salem M (Irmandade Da Santa Casa De Misericórdia De Porto Alegre, Porto Alegre); Barakat Awada J, Ijichi TR, Kim NJ, Marreiro A, Muller B, Nunes R* (Notre Dame Intermédica—Hospital Salvalus, São Paulo); Bodanese B, Isoton JC, Regina de Sampaio L, Vendrame C* (Supera Oncologia—Hospital Regional Do Oeste, Chapeco). Bulgaria: Sokolov M*, Gribnev P (University Hospital Alexandrovska, Sofia). Canada: Boutros M*, Caminsky N, Ghitulescu G (Jewish General Hospital, Montreal); Groot G*, Persad A, Pham H, Wood M (Saskatoon City Hospital/Royal University Hospital/St Paul’s Hospital, Saskatoon Sk); Boutros M*, Demyttenaere S*, Garfinkle R (St Mary’s Hospital, Montreal); Brown C*, Karimuddin A, Lee N, Liu J, Madani Kia T, Phang PT, Raval M, Tom K (St Paul’s Hospital, Vancouver, BC); Martel A, Nessim C*, Stevenson J (The Ottawa Hospital, Ottawa); Al Riyami S, Bali K, Bigam D*, Dajani K, Dell A (University of Alberta Hospital, Edmonton). Chile: Bellolio F*, Besser N, Grasset E*, Inzunza M, Quintana Martinic M, Riquoir Altamirano C, Ruiz Esquide M (Hospital Clinico Universidad Católica, Santiago). Colombia: Arias-Amézquita F*, Cétares C, Cortes Murgueitio N, Gomez-Mayorga JL (Fundacion Santa Fe De Bogota, Bogota); Abadia M, Bonilla A, Facundo H, Guevara O*, Herrera Mora DR, Jimenez Ramirez LJ, Manrique E, Pinilla Morales RE*, Rey Ferro M, Velasquez Cuasquen BG (Instituto Nacional De Cancerologia, Bogota). Croatia: Bačić G, Karlović D, Kršul D, Zelić M* (University Hospital Center Rijeka, Rijeka); Bakmaz B, Ćoza I, Dijan E, Katusic Z, Mihanovic J*, Rakvin I (Zadar General Hospital, Zadar). Cyprus: Almezghwi H, Arslan K, Özant A, Özçay N* (Near East University Hospital, Nicosia); Frantzeskou K, Gouvas N*, Kokkinos G, Papatheodorou P, Pozotou I, Stavrinidou O, Yiallourou A* (Nicosia General Hospital, Nicosia). Czechia: Martinek L, Skrovina M*, Szubota I (Hospital and Oncological Centre Novy Jicin, Novy Jicin); Peteja M, Žatecký J* (Slezská Nemocnice V Opavě, P.o., Opava). Denmark: Avlund T, Christensen P*, Harbjerg JL, Iversen LH, Kjaer DW, Kristensen HØ, Mekhael M (Aarhus University Hospital, Aarhus); Ebbehøj AL, Krarup P, Schlesinger N, Smith H* (Bispebjerg Hospital, Copenhagen). Dominican Republic: Crespo A, Díaz P, Rivas R, Tactuk N (Cedimat—Centro De Diagnóstico, Medicina Avanzada, Laboratorio Y Telemedicina, Santo Domingo). Egypt: El Kassas M*, Omar W, Tawheed A (15th May Hospital—Helwan University, Cairo); Talaat M (Ain Shams University Specialized Hospital, Cairo); Abdelsamed A, Azzam AY*, Salem H*, Seleim A (Al Azhar University Hospitals, Cairo); AL Sayed M, Ashoush F*, Elazzazy E, Essam E, Ewedah M, Hassan E, Metwalli M, Mourad M, Qatora MS, Sabry A*, Samih A, Samir Abdelaal A, Shehata S*, Shenit K (Alexandria Main University Hospital, Alexandria); Attia D, Kamal N, Osman N* (Alexandria Medical Research Institute, Alexandria); Alaa S, Hamza HM, M.elghazaly S, Mohammed MM*, Nageh MA, Saad MM*, Yousof EA (Assiut University Hospital, Assiut); Eldaly A* (El-Menshawy Hospital, Tanta); Alrahawy M*, Sakr A*, Soliman H*, Soltan H* (Menofiya University Hospital, Menoufia); Amira G, Sallam I*, Sherief M, Sherif A (Misr Cancer Center, Al Jizah); Ghaly G*, Hamdy R, Morsi A, Salem H*, Sherif G (National Cancer Institute, Cairo); Abdeldayem H, Abdelkader Salama I*, Balabel M, Fayed Y, Ahmed Elshawadfy Sherif* (National Liver Institute, Menoufia University, Shibin Elkom); Elmorsi R*, Refky B* (Oncology Center Mansoura University, Mansoura). Ethiopia: Bekele K* (Maddawalabu University Goba Referral Hospital, Goba). Finland: Kauppila JH*, Sarjanoja E (Länsi-Pohja Central Hospital, Kemi); Helminen O, Huhta H, Kauppila JH* (Oulu University Hospital, Oulu). France: Beyrne C, Jouffret L*, Marie-Macron L (Centre Hospitalier Avignon, Avignon); Fredon F*, Roux A (Centre Hospitalier Roland Mazoin, Saint-Junien); Lakkis Z*, Manfredelli S (University Hospital of Besançon, Besancon); Chebaro A*, El Amrani M, Lecolle K, Piessen G*, Eveno C, Noiret B, Veziant J Pruvot FR, Zerbib P (Chu Lille, Lille); Ballouhey Q*, Barrat B, Taibi A (Chu Limoges, Limoges); Bergeat D, Merdrignac A (Chu Rennes—General Surgery, Rennes); Le Roy B, Perotto LO, Scalabre A* (Chu Saint Etienne, Saint Etienne); Aimé A, Ezanno AC*, Malgras B (Hia Begin, St Mande); Bouché PA*, Tzedakis S* (Hôpital Cochin—Aphp, Paris); Cotte E, Glehen O (Hopital Lyon Sud, Pierre Bénite); Bendjemar L, Braham H, Charre L, El Arbi N, Police A*, Volpin E (Hôpital Simone Veil, Eaubonne); D’Urso A, Mutter D, Seeliger B* (Strasbourg University Hospitals/IHU-Strasbourg, Strasbourg); Bonnet S, Denet C, Fuks D, Laforest A, Pourcher G, Seguin-givelet A*, Tribillon E (Institut Mutualiste Montsouris, Paris); Duchalais E* (Nantes University Hospital, Nantes). Germany: Bork U*, Fritzmann J, Praetorius C, Weitz J, Welsch T ( University Hospital Carl Gustav Carus, TU Dresden, Dresden); Beyer K, Kamphues C*, Lauscher J, Loch FN, Schineis C (Charité University Medicine, Campus Benjamin Franklin, Berlin); Albertsmeier M*, Kappenberger A, Schiergens T, Werner J (Department of General, Visceral and Transplantation Surgery, LMU University Hospital, Ludwig-Maximilians-Universität Munich, Munich); Becker R*, Jonescheit J (Heilig-Geist Hospital Bensheim, Bensheim); Pergolini I, Reim D* (Klinikum Rechts Der Isar, Tum School of Medicine, Munich); Herzberg J*, Honarpisheh H*, Strate T* (Krankenhaus Reinbek St Adolf-Stift, Reinbek); Boeker C, Hakami I*, Mall JW* (KRH Nordstadt-Siloah Hospitals, Hannover); Nowak K*, Reinhard T* (Romed Klinikum Rosenheim, Rosenheim); Kleeff J, Michalski C, Ronellenfitsch U* (University Hospital Halle (Saale), Halle (Saale)); Bertolani E, Königsrainer A*, Löffler MW, Quante M*, Steidle C, Überrück L, Yurttas C (University Hospital Tübingen, Tübingen); Izbicki J, Nitschke C, Perez D, Uzunoglu FG* (University Medical Center Hamburg-Eppendorf, Hamburg). Greece: Antonakis P, Contis I, Dellaportas D, Gklavas A, Konstadoulakis M, Memos N*, Papaconstantinou I*, Polydorou A, Theodosopoulos T, Vezakis A (Aretaieion Hospital, Athens); Antonopoulou MI, Manatakis DK*, Tasis N (Athens Naval and Veterans Hospital, Athens); Arkadopoulos N, Danias N, Economopoulou P, Frountzas M, Kokoropoulos P, Larentzakis A, Michalopoulos N*, Parasyris S, Selmani J, Sidiropoulos T, Vassiliu P (Attikon University General Hospital, Athens); Bouchagier K*, Klimopoulos S, Paspaliari D, Stylianidis G (Evaggelismos General Hospital, Athens); Akrivou D, Baxevanidou K, Bouliaris K, Chatzikomnitsa P, Delinasios G, Doudakmanis C, Efthimiou M, Giaglaras A, Kalfountzos C*, Kolla C, Koukoulis G, Zervas K, Zourntou S (General Hospital of Larissa ‘Koutlimpaneio and Triantafylleio’, Larissa); Baloyiannis I, Diamantis A, Perivoliotis K, Tzovaras G* (General University Hospital of Larissa, Larrisa); Christidis P, Ioannidis O*, Loutzidou L (George Papanikolaou General Hospital of Thessaloniki, Thessaloniki); Karaitianos I. G.*, Geroukalis A. (Henry Dunant Hospital Center), Tsirlis T ); Baili E, Charalabopoulos A, Liakakos T, Schizas D*, Spartalis E, Syllaios A, Zografos C (Laiko University Hospital, Athens); Christou C, Papadopoulos V, Tooulias A, Tsoulfas G* (Papageorgiou General Hospital, Thessaloniki); Athanasakis E, Chrysos E, Tsiaoussis I, Xenaki S*, Xynos E* (University Hospital of Heraklion Crete and Interclinic Hospital of Crete, Heraklion Crete). Hong Kong: Futaba K*, Ho MF, Hon S, Mak TWC, Ng S (Prince of Wales Hospital, Sha Tin); Foo CC* (Queen Mary Hospital, Pok Fu Lam). Hungary: Banky B*, Suszták N (Szent Borbála Kórház, Tatabánya). India: Misra S*, Pareek P, Vishnoi JR* (All India Institute of Medical Sciences (Aiims), Jodhpur, Jodhpur); Jain A, Mishra S, Mishra T, Mitra JK, Muduly D* (All India Institute of Medical Sciences, Bhubhaneshwar); Agrawal A, Garg PK, Kottayasamy Seenivasagam R*, Majumdar KS, Mishra N, Singh MP (All India Institute of Medical Sciences, Rishikesh); Chyau Patnaik S, Rao S*, Reddy P, S RRR, Saksena AR, Y J (Basavatarakam Indo American Cancer Hospital and Research Institute, Hyderabad); Ayloor Seshadri R* (Cancer Institute (Wia) Regional Cancer Centre, Chennai); Haque PD*, Jeyaraj P, Kannummal Veetil S, Mahajan A (Christian Medical College and Hospital, Ludhiana); Devarakonda S, Jesudason MR, Mittal R*, Moorthy M, Yezzaji H (Christian Medical College and Hospital, Vellore); Aggarwal M, Dhamija P, Kumar A* (Government Medical College Patiala, Patiala); Chisthi M, G D, George G, Kollengode VV*, Kuttanchettiyar KG, Yadev I* (Government Medical College Thiruvananthapuram, Thiruvananthapuram); Dharanipragada K*, Kalayarasan R*, Penumadu P* (Jawaharlal Institute of Postgraduate Medical Education and Research, Pondicherry); L B, Mathew S* (Kasturba Medical College Hospital, Manipal, Manipal); Akhtar N, Chaturvedi A, Gupta S, Kumar V, Rajan S* (King George’s Medical University, Lucknow); Agrawal N, Arora A, Chaturvedi H, Jain M, Kumar S*, Singh S (Max Superspeciality Hospital, New Delhi); Bhat GA, Chowdri N, Mehraj A*, Parray F Q, Shah ZA, Wani R (Sher-I-Kashmir Institute of Medical Sciences, Srinagar); Ahmed Z, Bhat MA, Laharwal A, Mahmood M, Mir I, Mohammad Z, Muzamil J, Rashid A*, Singh R (Smhs Hospital, Government Medical College, Srinagar); Ahmed A, Jain D, Pipara A (Tata Medical Center, Kolkata); Desoouza A, Pandey D, Pramesh CS*, Saklani A (Tata Memorial Hospital, Mumbai). Indonesia: Islam AA*, Kembuan G, Pajan H (Rsud Wahidin Sudirohusodo, Makassar). Ireland: Aremu M*, Canas-Martinez A, Cullivan O, Murphy C, Owens P, Pickett L (Connolly Hospital Blanchardstown, Dublin); Corrigan M*, Daly A, Fleming CA*, Jordan P, Kayyal MY, Killeen S, Lynch N, O’Brien S, Syed WAS, Vernon L (Cork University Hospital, Cork); Hanly A, Heneghan H*, Kennelly R, Martin ST, Winter D* (St Vincent’s University Hospital, Dublin); Fahey BA, Larkin J*, Mccormick P, Mehigan BJ, Mohan H, Shokuhi P, Smith J (St James’s Hospital, Dublin); Bashir Y, Bass G, Connelly T, Creavin B, Earley H, Elliott JA*, Gillis AE, Kavanagh D, Neary P, O’Riordan J, Reynolds IS, Rice D, Ridgway PF, Umair M, Whelan M (Tallaght University Hospital, Dublin); Corless K, Finnegan L, Fowler A, Hogan A, Lowery A*, McKevitt K*, Nugent E, Ryan É J (University Hospital Galway, Galway); Coffey JC, Cunningham RM, Devine M, Nally D*, Peirce C (University Hospital Limerick, Limerick); Hardy NP, Neary PM, O’Malley S*, Ryan M (University Hospital Waterford/University College Cork, Waterford). Israel: Gaziants V, Gold- Deutch R, Lavy R, Zmora O* (Shamir Medical Center, Be’er Ya’akov). Italy: Macina S* (Asst Mantua, Mantova); Mariani NM*, Opocher E, Pisani Ceretti A (Asst Santi Paolo E Carlo, Milan); Bianco F* (Asst-Papa Giovanni Xxiii- Bergamo, Bergamo); Marino M*, Marino MV*, Mirabella A, Vaccarella G (Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello, Palermo, Palermo); Sena G* (Azienda Ospedaliera Pugliese-Ciaccio Di Catanzaro, Catanzaro); Agostini C, Alemanno G, Bartolini I, Bergamini C, Bruscino A, De Vincenti R, Di Bella A, Fortuna L, Maltinti G, Muiesan P*, Prosperi P*, Ringressi MN, Risaliti M, Taddei A*, Tucci R (Azienda Ospedaliera Universitaria Careggi, Firenze); Campagnaro T*, Guglielmi A, Pedrazzani C, Rattizzato S, Ruzzenente A, Turri G (Azienda Ospedaliera Universitaria Integrata Di Verona, Verona); Altomare DF, Papagni V, Picciariello A* (Azienda Ospedaliero Universitaria Consorziale Policlinico Di Bari, Bari); Bellora P, D’Aloisio G, Ferrari M, Francone E, Gentilli S*, Nikaj H (Azienda Ospedaliero Universitaria Maggiore Della Carità, Novara); Bia

Mortality and pulmonary complications in emergency general surgery patients with COVID-19:a large international multicenter study

Abstract Objectives: The outcomes of emergency general surgery (EGS) patients with concomitant COVID-19 infection remain unknown. With a multicenter study in 361 hospitals from 52 countries, we sought to study the mortality and pulmonary complications of COVID-19 patients undergoing EGS. Methods: All patients 17 years or older and diagnosed preoperatively with COVID-19 between February and July 2020 were included. Emergency general surgery was defined as the urgent/emergent performance of appendectomy, cholecystectomy, or laparotomy. The main outcomes were 30-day mortality and 30-day pulmonary complications (a composite of acute respiratory distress syndrome, unexpected mechanical ventilation, or pneumonia). Planned subgroup analyses were performed based on presence of preoperative COVID-related respiratory findings (e.g., cough, dyspnea, need for oxygen therapy, chest radiology abnormality). Results: A total of 1,045 patients were included, of which 40.1% were female and 50.0% were older than 50 years; 461 (44.1%), 145 (13.9%), and 439 (42.0%) underwent appendectomy, cholecystectomy, and laparotomy, respectively. The overall mortality rate was 15.1% (158 of 1,045 patients), and the overall pulmonary complication rate was 32.9% (344 of 1,045 patients); in the subgroup of laparotomy patients, the rates were 30.6% (134 of 438 patients) and 59.2% (260 of 439 patients), respectively. Subgroup analyses found mortality and pulmonary complication risk to be especially increased in patients with preoperative respiratory findings. Conclusions: COVID-19 patients undergoing EGS have significantly high rates of mortality and pulmonary complications, but the risk is most pronounced in those with preoperative respiratory findings

SARS-CoV-2 infection and venous thromboembolism after surgery:an international prospective cohort study

Abstract SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly