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

Granite-related overpressure and volatile release in the mid crust: fluidized breccias from the Cloncurry District, Australia

The source and transport regions of fluidized (transported) breccias outcrop in the Cloncurry Fe-oxide–Cu–Au district. Discordant dykes and pipes with rounded clasts of metasedimentary calc–silicate rocks and minor felsic and mafic intrusions extend several kilometres upwards and outwards from the contact aureole of the 1530 Ma Williams Batholith into overlying schists and amphibolites. We used analytical equations for particle transport to estimate clast velocities (≥20 m sec−1), approaching volcanic ejecta rates. An abrupt release of overpressured magmatic-hydrothermal fluid is suggested by the localization of the base of the breccias in intensely veined contact aureoles (at around 10 km, constrained by mineral equilibria), incorporation of juvenile magmatic clasts, the scale and discordancy of the bodies, and the wide range of pressure variation (up to 150 MPa) inferred from CO2 fluid inclusion densities and related decrepitation textures. The abundance of clasts derived from depth, rather than from the adjacent wallrocks, suggests that the pressure in the pipes was sufficient to restrict the inwards spalling of fragments from breccia walls; that is, the breccias were explosive rather than implosive, and some may have vented to the surface. At these depths, such extreme behaviour may have been achieved by release of dissolved fluids from crystallizing magma, in combination with a strongly fractured and fluid-laden carapace, sitting under a strong, low permeability barrier. The relationship of these breccias to the Ernest Henry iron-oxide–Cu–Au deposit suggests they may have been sources of fluids or mechanical energy for ore genesis, or alternately provided permeable pathways for later ore fluids

Monitoring fluid chemistry in iron oxide–copper–gold-related metasomatic processes, eastern Mt Isa Block, Australia

Most researchers in the Proterozoic eastern Mt Isa Block, NW Queensland, Australia, favour magmatic fluid and salt sources for sodic-(calcic) alteration and iron oxide-copper-gold mineralization. Here we compare spatial, mineralogic and stable isotope data from regional alteration assemblages with magmatic and magmatic-hydrothermal interface rocks in order to track chemical and isotopic variations in fluid composition away from inferred fluid sources. Tightly clustered δ~(18)O values for magnetite, quartz, feldspar and actinolite for igneous-hosted samples reflect high temperature equilibration in the magmatic-hydrothermal environment. In contrast, these minerals record predominantly higher δ~(18)O values in regional alteration and Cu-Au mineralization. This dichotomy reflects partial equilibration with isotopically heavier wallrocks and slightly lower temperatures. Increases in Si concentrations of metasomatic amphiboles relative to igneous amphiboles in part reflect cooling of metasomatic fluids away from igneous rocks. Variations in X_(Mg) for metasomatic amphiboles indicate local wallrock controls on amphibole chemistry, while variations in X_(Cl)/X_(OH) ratios for amphiboles (at constant X_(Mg)) indicate variable aH_2O/aHCl ratios for metasomatic fluids. Biotite geochemistry also reflects cooling and both increases and decreases in aH_2O/aHCl for fluids away from plutonic rocks. Decreased aH_2O/aHCl ratios for metasomatic fluids reflect in part scavenging of chlorine out of meta-evaporite sequences, although this process requires already saline fluids. Local increases in aH_2O/aHCl ratios, as well as local decreases in δ~(18)O values for some minerals (most notably haematite and epithermal-textured quartz), may indicate ingress of low salinity, low δ~(18)O fluids of possible meteoric origin late in the hydrothermal history of the region. Taken together, our observations are most consistent with predominantly magmatic sources for metasomatic fluids in the eastern Mt Isa Block, but record chemical and isotopic variations along fluid flow paths that may be important in explaining some of the diversity in alteration and mineralization styles in the district

Mixed messages in iron oxide-copper-gold systems of the Cloncurry district, Australia: insights from PIXE analysis of halogens and copper in fluid inclusions

Proterozoic rocks of the Cloncurry district in NW Queensland, Australia, are host to giant (tens to hundreds of square kilometers) hydrothermal systems that include (1) barren regional sodic–calcic alteration, (2) granite-hosted hydrothermal complexes with magmatic–hydrothermal transition features, and (3) iron oxide–copper–gold (IOCG) deposits. Fluid inclusion microthermometry and proton-induced X-ray emission (PIXE) show that IOCG deposits and the granite-hosted hydrothermal complexes contain abundant high temperature, ultrasaline, complex multisolid (type 1) inclusions that are less common in the regional sodic–calcic alteration. The latter is characterized by lower salinity three-phase halite-bearing (type 2) and two-phase (type 3) aqueous inclusions. Copper contents of the type 1 inclusions (>300 ppm) is higher than in type 2 and 3 inclusions (<300 ppm), and the highest copper concentrations (>1,000 ppm) are found both in the granite-hosted systems and in inclusions with Br/Cl ratios that are consistent with a magmatic source. The Br/Cl ratios of the inclusions with lower Cu contents are consistent with an evaporite-related origin. Wide ranges in salinity and homogenization temperatures for fluid inclusions in IOCG deposits and evidence for multiple fluid sources, as suggested by halogen ratios, indicate fluid mixing as an important process in IOCG genesis. The data support both leaching of Cu by voluminous nonmagmatic fluids from crustal rocks, as well as the direct exsolution of Cu-rich fluids from magmas. However, larger IOCG deposits may form from magmatic-derived fluids based on their higher Cu content

Mineralogical and chemical evolution of the Ernest Henry Fe oxide-Cu-Au ore system, Cloncurry district, northwest Queensland, Australia

The Ernest Henry Cu–Au deposit was formed within a zoned, post-peak metamorphic hydrothermal system that overprinted metamorphosed dacite, andesite and diorite (ca 1740–1660 Ma). The Ernest Henry hydrothermal system was formed by two cycles of sodic and potassic alteration where biotite–magnetite alteration produced in the first cycle formed ca 1514±24 Ma, whereas paragenetically later Na–Ca veining formed ca 1529 +11/−8 Ma. These new U–Pbtitanite age dates support textural evidence for incursion of hydrothermal fluids after the metamorphic peak, and overlap with earlier estimates for the timing of Cu–Au mineralization (ca 1540–1500 Ma). A distal to proximal potassic alteration zone correlates with a large (up to 1.5 km) K–Fe–Mn–Ba enriched alteration zone that overprints earlier sodic alteration. Mass balance analysis indicates that K–Fe–Mn–Ba alteration—largely produced during pre-ore biotite- and magnetite-rich alteration—is associated with K–Rb–Cl–Ba–Fe–Mn and As enrichment and Na, Ca and Sr depletion. The aforementioned chemical exchange almost precisely counterbalances the mass changes associated with regional Na–Ca alteration. This initial transition from sodic to potassic alteration may have been formed during the evolution of a single fluid that evolved via alkali exchange during progressive fluid-rock interaction. Cu–Au ore, dominated by co-precipitated magnetite, minor specular hematite, and chalcopyrite as breccia matrix, forms a pipe-like body at the core of a proximal alteration zone dominated by K-feldspar alteration. Both the core and K-feldspar alteration overprint Na–Ca alteration and biotite–magnetite (K–Fe) alteration. Ore was associated with the concentration of a diverse range of elements (e.g. Cu, Au, Fe, Mo, U, Sb, W, Sn, Bi, Ag, F, REE, K, S, As, Co, Ba and Ca). Mineralization also involved the deposition of significant barite, K(–Ba)–feldspar, calcite, fluorite and complexly zoned pyrite. The complexly zoned pyrite and variable K–(Ba)–feldspar versus barite associations are interpreted to indicate fluctuating sulphur and/or barium supply. Together with the alteration zonation geochemistry and overprinting criteria, these data are interpreted to indicate that Cu–Au mineralization occurred as a result of fluid mixing during dilation and brecciation, in the location of the most intense initial potassic alteration. A link between early alteration (Na–Ca and K–Fe) and the later K-feldspathization and the Cu–Au ore is possible. However, the ore-related enrichments in particular elements (especially Ba, Mn, As, Mo, Ag, U, Sb and Bi) are so extreme compared with earlier alteration that another fluid, possibly magmatic in origin, contributed the diverse element suite geochemically independently of the earlier stages. Structural focussing of successive stages produced the distinctive alteration zoning, providing a basis both for exploration for similar deposits, and for an understanding of ore genesis