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

Impact of opioid-free analgesia on pain severity and patient satisfaction after discharge from surgery: multispecialty, prospective cohort study in 25 countries

Background: Balancing opioid stewardship and the need for adequate analgesia following discharge after surgery is challenging. This study aimed to compare the outcomes for patients discharged with opioid versus opioid-free analgesia after common surgical procedures.Methods: This international, multicentre, prospective cohort study collected data from patients undergoing common acute and elective general surgical, urological, gynaecological, and orthopaedic procedures. The primary outcomes were patient-reported time in severe pain measured on a numerical analogue scale from 0 to 100% and patient-reported satisfaction with pain relief during the first week following discharge. Data were collected by in-hospital chart review and patient telephone interview 1 week after discharge.Results: The study recruited 4273 patients from 144 centres in 25 countries; 1311 patients (30.7%) were prescribed opioid analgesia at discharge. Patients reported being in severe pain for 10 (i.q.r. 1-30)% of the first week after discharge and rated satisfaction with analgesia as 90 (i.q.r. 80-100) of 100. After adjustment for confounders, opioid analgesia on discharge was independently associated with increased pain severity (risk ratio 1.52, 95% c.i. 1.31 to 1.76; P < 0.001) and re-presentation to healthcare providers owing to side-effects of medication (OR 2.38, 95% c.i. 1.36 to 4.17; P = 0.004), but not with satisfaction with analgesia (beta coefficient 0.92, 95% c.i. -1.52 to 3.36; P = 0.468) compared with opioid-free analgesia. Although opioid prescribing varied greatly between high-income and low- and middle-income countries, patient-reported outcomes did not.Conclusion: Opioid analgesia prescription on surgical discharge is associated with a higher risk of re-presentation owing to side-effects of medication and increased patient-reported pain, but not with changes in patient-reported satisfaction. Opioid-free discharge analgesia should be adopted routinely

A case report of malignant obesity hypoventilation syndrome: A weighty problem in our ICUs

Introduction: The obesity epidemic is reflected by increasing numbers of morbidly obese patients being admitted to intensive care units (ICUs). These are complicated patients whose care involves many diagnostic and treatment challenges. We are presenting a fatal case of super obesity, hypoventilation, and multi-organ failure known as malignant obesity hypoventilation syndrome (MOHS). Case presentation: 35 year old African American gentleman with a body mass index (BMI) of 115 kg/m2 presented to the hospital with respiratory distress. On admission he was noted to have multi-organ dysfunction including respiratory failure, renal failure, cardiac and liver abnormalities. His hospital course was remarkable for recurrent cardiac arrest following extubation, complicated tracheostomy, and progressive organ failure despite medical therapy. After a 30 day hospitalization, patient and family decided on terminal extubation owing to worsening medical condition and lack of therapeutic and disposition options. Discussion: The super obese present a number of challenges when admitted to the ICU. Patients with respiratory distress are frequently misdiagnosed and treated for asthma and COPD when obesity hypoventilation syndrome (OHS) is more consistent with the clinical picture. OHS in the superobese is often accompanied by multi-system organ dysfunction, a condition with high morbidity and mortality, with limited treatment options. Standard imaging techniques and procedures are made difficult or impossible by body habitus and often require expert intervention. Surgical options have been used in the treatment of the super obese and resulted in rapid weight loss, improvement in respiratory function, as well as improved metabolism and decreased inflammation. The role of surgery in MOHS remains to be elucidated. Conclusion: Physicians should be aware of MOHS as a common condition with high morbidity and mortality. Optimal management remains to be determined

Science from Science Fiction

Lisa Yaszek, director of the Georgia Tech Science Fiction Lab, and president of the Science Fiction Research Association joins us with some of her students to discuss science fiction. This is a cross-over show, and Pete and Bill will join them on Sci Fi Lab on WREK from 7 to 9pm on Sunday March 7th

Technique [Volume 89, Issue 3]

ACC offers invitation to Miami, Va. TechAdvisory groups help students get involved academicallyA Few Reasons why I love (and hate) Georgia TechAguilera's concert proves to be emotional rollercoasterBoard of Regents makes exemptions in testing policyBreaking the BubbleDisappointed in GTPDFaces in the CrowdGTCN approves new cable channel line upHot or NotHow to prevent the summer doldrumsJackets place at U.S. Track & Field NationalsNews BriefsNew sorority helps Christian women bondOur Views: Consensus OpinionRamblin' Nights unveils fall 2004 scheduleReading encourages the imaginationShuffle at Athletic Association replaces MooreSport ShortsThe Hiss return to Atlanta after touring with Oasi

Technique [Volume 88, Issue 3]

Breaking the BubbleCollege tuition increases statewideDramaTech's new Shakespeare play a "hilarious romp"Intramural NotebookLetter to the EditorNew laws increase penalties for fake IDsNews BriefsObituaryOmaha run ends shortOUR VIEWSParking prepares for fall with renovations and cleaningSports BriefsStaff EditorialSummertime Blues: Adjusting to life at home with the 'rents againTech students exhibit their musical talents at local clubs...Two Bit

Technique [Volume 89, Issue 2]

AA looks at academic changesAbout those athletes...Annual Heroes Awards brings music stars to AtlantaBeesball season ends with fall at regionalBreaking the BubbleCollege writers need fearlessnessGTRI names Cross as new directorHot or NotJoseph to head women's basketballLife and the Importance of Gummi BearsManagement prepares for Tech Square moveMelting Pot offers sizzling entreesNews BriefsOur Views: Consensus OpinionParking renews Stinger contract"Hook up" without ever leaving your roomSport ShortsStudents explore various summer activities on-campusWatson plans for futureWhat happens when ignorance stops being the issue

Technique [Volume 87, Issue 28]

Administrators hold more drinking partiesAssorted Pies: a man's attempt at writing something humorousBoxer BriefsBriefsBush shows disgust over Oscar selections during Tech speechBuzz to forego final year, go proCarter awarded Ivan Allen prizeClough insists "it was a scratch"Clough: "Forget engineering, I wanna dance"Crack dealers should be allowed to recruitCrack discovered in Parking Director's carCrossword scandal rocks TechGranny revealed as real CS 'Cheatfinder'Greeks protest Greek Week-"They aren't real Greeks"Hill makes senior finals optionalINTA prof opens sports bar, invites classLorentzian Distribution Underutilized, UnderappreciatedLucas announces sweeping last-minute changes to Episode IIMassey wins SGA PresidencyMechanical Engineer charters campus "drop the bow" clubNews BriefsNo. 6 GT dominates Dogs 9-1 at home, fall in AthensNo rights for womenOUR VIEWS Consensus OpinionParking to model after MTV's Road RulesPaul Hewitt proclaims self basketball dictator for lifePresident Bush visits GTRI, addresses nationRockapella singer treated for infection after being licked by fan at Ferst Center concertRoz Meyers elected next 'Nica EditorSeclusion in an apartment brings about new revelationsSports BriefsSteaming Pile of BriefsStudent body officially "not very adept" at selecting Oscar winnersTech alums return to finish eligibilityTechs and the City: Everyone can have a good Techs LifeTech students to sit on football field at home gamesTech unveils new 'Master Shaft' planTerrorist squirrels invade abandoned HightowerTony Akins takes coliseum court for final timeTwo Bits Man to hire Spears' publicist in attempt to boost column readershipVandals deface DDR, nerds vow revengeWhat Is Graduation

Technique [Volume 89, Issue 4]

Austen's Pride and Prejudice remembered as timeless classicBenefits of FraternitiesBeyond the White and GoldBreaking the Bubbleby the numbersCourt sodomy ruling could impact policyDante's Down the Hatch certainly a unique experienceEarleywine named interim coachFaces in the CrowdHewitt signs on for 5 more yearsHot or NotIt's Official: Miami and Virginia Tech are inNews BriefsOur Views: Consensus Opinion"Chicken McNuggets made me obese"Sport ShortsStop complaining, enjoy collegeTech community mourns loss of Ivan Allen, Jr.TECHNOLOGY SQUARE: "College town" kicks off with bookstoreTech's international population grows despite restrictionsWhy do we stress about so many choices