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

Duress: Postulates and application in the Ongen case

El 6 de septiembre de 2016, la Unidad de víctimas de la CPI puso a consideración ante nosotros la siguiente pregunta que buscaremos responder en este memorial: The Defence of Mr Ongwen has indicated that it will raise at trial grounds for excluding the individual liability of the Accused under article 31 of the Rome Statute and notably the defences of mental disease or defect and duress. Which elements of the two defences must be proven in order to exclude individual liability? How said defences could impact on the interest of victims in the proceedings? Este documento pretende responder la primera pregunta planteada por la Unidad de Víctimas sólo en cuanto a la defensa por duress, de ahora en adelante “Estado de Necesidad”. Para ello se dividirá en dos partes, de manera que se aborde el problema desde la teoría y la práctica: en la primera, explicaremos la defensa de Estado de Necesidad y de cada uno de sus elementos conforme al artículo 31 del Estatuto de Roma, siguiendo las fuentes aplicables según el artículo 21 del mismo , todo esto conforme a las reglas de interpretación de los tratados de la Convención de Viena de 1969. En la segunda parte analizaremos el caso de Dominic Ongwen y la posibilidad de aplicación del Estado de Necesidad como defensa, para posteriormente concluir que como clínica jurídica, estamos de acuerdo con los argumentos de la SCP para rechazar la defensa de estado de necesidad, pues en el caso del Dominic Ongwen no se satisfacen los elementos requeridos para dicha la defensa.On September 6 of 2016, the ICC Office of Public Counsel for the Victims (OPCV) sent the following question that we will attempt to answer in this memorial: The Defense of Mr. Ongwen has indicated that it will rise at trial grounds for excluding the individual liability of the Accused under article 31 of the Rome Statute and notably the defenses of mental disease or defect and duress. Which elements of the two defenses must be proven in order to exclude individual liability? How said defenses could impact on the interest of victims in the proceedings? This document aims to answer the question posed by the Victims Unit only with regard the defense by duress. Therefore, it will be necessary to divide the work in two main parts, in order to have a theoretical and practical approach of the issue: First, we will explain the defense of duress and each of its elements according to Article 31 of the Rome Statute and the applicable sources under Article 21 of the same statute, in accordance with the rules of treaty interpretation of the Vienna Convention on the Law of Treaties of 1969. Secondly, we will analyze specifically the situation of Dominic Ongwen and the possibility of applying duress as a defense; to subsequently conclude, as a legal clinic, that we agree with the arguments given by the PT.Ch to reject the alleged defense of duress, as in the case of Dominic Ongwen the required elements for such a defense are not successfully met