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

Seed Reserve Hot Spots for the Sub-Tropical Seagrass Halodule wrightii (Shoal Grass) in the Northern Gulf of Mexico

© 2020, Coastal and Estuarine Research Federation. Halodule wrightii (shoal grass) is a dioecious seagrass with a widespread tropical and subtropical distribution. Like all seagrass species, H. wrightii has the ability to expand asexually through rhizome elongation and to reproduce sexually through seed. To better understand H. wrightii sexual recruitment dynamics in the northern Gulf of Mexico, we investigated seed bank densities at 815 sites from south Texas to the Florida Panhandle. H. wrightii seed reserves were spatially variable across the region, with seed densities ranging from 0 to 5290 seeds m−2. Spatial analysis revealed clusters of high seed densities (“hot spots”) in Upper Laguna Madre, TX, and Santa Rosa Sound, FL, and clusters of low seed densities (“cold spots”) in Lower Laguna Madre and Aransas Bay, TX. Hot spots were dominated by H. wrightii, whereas cold spots were dominated by Thalassia testudinum (turtle grass). We frequently found intact seed coat halves, suggesting germination; however, we also encountered broken seed coat pieces, characteristic of seed predation. Genotypic surveys within and adjacent to seed hot spots revealed genetically diverse adult populations 6 years post seed bank sampling. Our data show that H. wrightii seed reserves are heterogeneous across the northern Gulf of Mexico and that the factors driving variation in seed bank density, viability, and germination remain poorly understood. Information on the spatial heterogeneity of H. wrightii seed densities has relevance for seagrass management, including targeting meadows with high levels of reproductive effort for protection or designation as marine reserves