20 research outputs found

    Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

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    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

    Understanding Local Perceptions of Management and Values of Long Distance Trails

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    Long distance trails provide immeasurable benefits far beyond a challenging hike. Their corridors and the ecosystems within them give economic, environmental, and social benefits to human and natural communities. Local communities can enjoy economic support and ecosystem services, such as clean water and clean air. Trails may mitigate floods, storms, and drought or provide veterans a chance to ‘walk off the war’ (Small, 2009). Whether it be a rural community utilizing outdoor recreation as an income, or an individual finding peace with life, long distance trails provide something for all of us. Our population will keep growing. Our resources will not. Increased development breeds increased demands for energy, food, and infrastructure, which will continue to threaten the connected greenways that many treasure. Those living in the vicinity of a long distance trail have the most to lose if the protection, land use, or environmental integrity is degraded. Those communities and regional voices also have the most power to advocate for the trails’ protection. It is vital that trailside communities care for, understand, and become partners in the management of these significant trails and to assist in protection and promotion of these national treasures. This research project investigates local perceptions, values, attitudes, and knowledge of selected trailside communities neighboring two national, long distance trails. The paper explores 1) What local trailside communities value about long distance trails, and the negative impacts of those trails on those communities; 2) The communities' knowledge, understanding, and interest in management of the trails; and 3) How the differences in historical context influence the values and attitudes of two national trails in separate countries
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