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

How to facilitate collaborative continuing and expansive learning?

Change is a constant in many organisations. Combining sustainable change processes with learning for the professionals involved ensures that participants acquire the capacity to transform a given situation and capably steer future change at the workplace. In this conceptual article, we reflect on an approach for designing and investigating change processes where learning and change co-occur: Change-Laboratory. We draw on a case from our empirical work in the Dutch healthcare domain, where participants in a change process discuss, describe and disseminate collaborative patient-care-agreements. The most critical outcome of a Change-Lab is transformative agency, which is an evolving capacity of the collective to seek new possibilities toward change. It is essential for participants’ lifelong continuing development. Universities would benefit from increased attention this outcome in order to learn expansively and facilitate these Change-Lab processes

Improved Ru/Si multilayer reflective coatings for advanced extreme ultraviolet lithography photomasks

Extreme ultraviolet (EUV) lithography with reflective photomasks continues to be a potential patterning technology for high volume manufacturing at the 7 nm technology node and beyond. EUV photomasks with alternative materials to the commonly used Mo/Si multilayer (ML) reflector and patterned Ta-based absorber (both of which are known to require shadow effect corrections and lead to large through-focus pattern placement errors) are being actively explored. Because the reflective bandwidth of a Ru/Si ML is significantly wider than the reflective bandwidth of a Mo/Si ML and the effective reflectance plane in Ru/Si is closer to the ML surface, Ru/Si ML coatings may be viable alternatives to the Mo/Si ML coatings that are commercially available today because they will lead to smaller mask 3D effects. In this paper, increases in the peak reflectivity and the reflective bandwidth of Ru/Si ML reflectors by using B4C interlayers to improve the Ru-Si interfaces are discussed. The conclusions of this paper are supported with the results of both experimental measurements and rigorous simulations.status: publishe