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

Three Essays on the Economics of Corruption

In this dissertation, I explore topics involving the measurement of political corruption and its effect on economic outcomes both across and within countries. The first chapter of this dissertation provides an introduction to the economics of corruption and summarizes the crucial existing research. This chapter describes how this dissertation contributes to the existing research and provides an outline for the following chapters. Chapter 2 examines the conditional effect of corruption on growth across a sample of countries. In this second chapter, I argue that the effect corruption has on economic growth depends on the uncertainty involved. Employing data on a cross-section of counties, this paper uses an interaction between the frequency of bribery payments and the uncertainty regarding the delivery of the service in exchange for these bribes, to show that, overall, corruption has a negative impact on growth, unless the uncertainty is minimal. Chapter 3 examines the effect of corruption and informal sector employment on income across 476 Brazilian municipalities to estimate whether corruption impacts GDP or income levels once variation in informal economic activity is taken into account. Overall, I find that higher levels of corruption and a larger informal economy are generally associated with poor economic outcomes. However, only the size of the informal economy has a statistically significant effect. Chapter 4 examines the most commonly used measure of corruption in the U.S. and shows how this measure is influenced by political factors. Lastly, Chapter 5 summarizes the findings from Chapter 2 through Chapter 4. Additionally, Chapter 5 discusses policy recommendations and future research projects involving the economics of corruption

A Spatial Analysis of Entrepreneurship and Institutional Quality: Evidence from U.S. Metropolitan Areas

This paper uses the Stansel (2013) economic freedom index for a maximum of 375 U.S. metropolitan areas to estimate the effect of economic freedom on entrepreneurship while con-trolling for spatial dependence. This paper finds statistically significant evidence that increas-es in economic freedom in one area result in increases in entrepreneurial activity in neighbor-ing areas. Furthermore, the total (direct plus indirect) effects of an increase in economic free-dom on entrepreneurship are positive and statistically significant, indicating that a positive-sum game is present. However, these effects are small in magnitude. In order to explain a cumulative one standard deviation increase in either one of the entrepreneurial measures pre-sented in this paper, there would have to be an increase in the freedom index equivalent to moving from the least-free area to the most-free area

Is the Devil in the Shadow? A Reexamination of the Relationship between Institutions and Income

The positive relationship between institution quality and “official” income is well-documented. It is unclear, however, if this relationship holds once the “unofficial” economy is accounted for. An improvement in institutional quality tends to shift production out of the shadow and into the official sector. This can result in an increase in official income, at the expense of the shadow economy. This paper uses data from 4,954 Brazilian municipalities to explore the effects of institutional quality on formal, informal, and total income per-worker. The results indicate that an improvement in institutional quality leads to a positive change in total income per-worker. Importantly, the effect of improved institutional quality on income per-worker in the informal sector is neutral to positive, contradicting the findings of previous models. It seems that while positive institutional change does reallocate production from the shadows to the official sector, the reallocation increases overall productivity in the economy

The Impact of a Sorghum-Based Ethanol Plant on Local Sorghum Basis and Cotton Acreage: A Spatial Approach

This study examines the impacts of a sorghum-based ethanol plant established in a major cotton-producing area on local sorghum basis and cotton acreage distribution using county-level panel data from 2002 to 2014. Spatial econometric models are employed to account for any spatial dependence. Our results support the conclusion that sorghum basis and cotton acreage within a county depends on characteristics of its neighbors. Specifically, the findings indicate that the sorghum basis increased by 1.5 cents per bushel in the short run resulting from hosting a 40-million-gallon ethanol plant, and a short-run increase by 0.2% in cotton acres over all counties