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

Manager la santé sécurité Environnement : rôle et responsabilité du responsable SST

L'évolution de la législation, la demande sociale contraignent l'entreprise à relever le défi permanent que représente la prévention des risques pour la santé et la sécurité et l'environnement. Le responsable SST, est un métier avec des facettes multiples et certaines responsabilités Initier une dynamique de prévention des risques au sein d'un organisme ou d'une entreprise, conseiller la direction de l'organisme, structurer la démarche, garantir l'implication de chacun dans la sécurité, voici certaines des missions d'un Responsable Santé-Sécurité Environnement

Proposal of a new risk assessment method for the handling of powders and nanomaterials

A new approach to assess the risks inherent in the implementation of powders, including nanomaterials, has been developed, based on the OHB (Occupational Hazard Band) method which is widely spread in the chemical industry. Hazard classification has not been modified; only the control of exposure has been worked at. The method applies essentially to the prevention of the exposures to airborne materials, whatever their particle size. The method considers exposure based on seven parameters which take into account the characteristics of the materials used, their emission potential, the conditions of use, as well as classic parameters of exposure characterization like duration and frequency. The method is a pragmatic exploitation of the state-of-art and of available data, bearing in mind that a lot of them are not easily accessible to factory operators. The result of the reflection is then positioned on a hazard versus exposure matrix from which 4 levels of priority of action are defined, as in the classical OHB method used to manage pure chemical risk. This approach fills a gap in terms of risk assessment and avoids jeopardizing all that has been set up for years, while introducing new elements of decision making accessible to all operators

Risk assessment method for the implementation of materials divided up to the nanometric scale

International audienceA new approach of assessing the risks inherent in the implementation of powders, including nanomaterials has been developed. This tool is based on the method of the OHB (Occupational Hazard Band) widely spread in the chemical industry. The European classification and CLP scales of toxicity have not been modified; only the control of exposure has been worked at. The method applies essentially to the prevention of the exposures by airborne materials, whatever their particle size. The skin exposure is not treated there specifically for the time being. The method considers exposure based on seven parameters to take into account the characteristics of the materials used, their emission potential, the conditions of use, as well as classic parameters of the characterization of the exposure as the duration and the frequency. The method stresses on a pragmatic exploitation of the current knowledge and of the available data, bearing in mind that a lot of them are not easily accessible to plant operators. The product of the reflection is then positioned on a hazard x exposure matrix from which 3 levels of priority of action are defined, as in the classical OHB method applied to pure chemical risk. This approach fills in a gap in term of risk assessment and avoids jeopardizing all that had been set up for years, while introducing newelements of reflection accessible to all operators

Occupational health and hazards in construction and civil-engineering workers handling engineered nanomaterials : challenges in designing epidemiological studies in france

Engineered nanomaterials (ENMs) induce groundbreaking impacts by endowing unique properties to materials. However, uncertainties remain on their biological aftereffects. Entrusted by health and labour ministries, the French Public Health Institute launched since 2014 the EpiNano epidemiological surveillance program of workers potentially exposed to ENMs. The 2016–2020 national occupational health (OH) action plan inscribed the ENMs topic as of priority, with an enlargement to the construction and civil-engineering (CCE) sector. A scientific consortium was therefore established in order elaborate a standardised methodology to identify ENMs-exposed CCE workers. A comprehensive, structured PubMed review and web-search of technical documents was undertaken, complemented by in-depth experts’ interviews to collect contextual information regarding CCE nanoproducts. Several methodological challenges were primarily revealed, pertaining primarily to : (i) Demarcating the target population: Involvement of a large number of companies (400,000) of all sizes and activities; Massive delegation to subcontractors; Heterogeneity of socioprofessional categories (from engineers to operators) and occupations (around 22); (ii) Unknown exposures’ circumstances: no CCE nanoproducts inventories neither detailed composition information; Unawareness of CCE actors of nanoproducts’ use; Heterogeneity of ENMs incorporated in various matrices (cement, coatings, paints…) with unknown ENM release/exposure potential; Potentially passive occupational exposures; Myriad of confusion factors with interactions with other risks at workplace; (iii) Capturing and following the eligible population: a complex topic to be addressed with a lot of pedagogy for adhering workers; epidemiological follow-up hampered by high turnovers, duration of construction sites and language barrier. Discussions are ongoing to overcome these methodological challenges. As a first step, an awareness campaign and the establishment of CCE nanoproducts’ inventory will be launched soon. An increase in CCE nanoproducts’ use is expected in the context of sustainable development and energy saving. This underscores the urgency to implement a specific surveillance system, by circumventing designing complexity

Surveillance of occupational health in construction and civil-engineering workers handling engineered nanomaterials

Rationale: Entrusted by the Ministries of Health and of Labour, the French Public Health Agency have established, since 2014, the Epinano epidemiological surveillance system of workers potentially exposed in industries to engineered nanomaterials (ENMs) released during their synthesis or incorporation in matrices. The governmental national occupational health action plan 2016–2020 has dedicated a special attention to the question of ENMs exposure in workers in the construction and civil-engineering (CCE) sector. Thus, a steering committee was established to adapt the methodology to efficiently capture exposed workers on sites. Objectives: Beforehand, epidemiological and contextual components were collected in order to apprehend the methodological challenges in designing longitudinal studies on the topic of exposure to ENMs on CCE sites. Methods: A structured PubMed review and web-search of scientific and technical documents regarding ENM-based CCE products was undertaken, completed by in-depth experts’ interviews. Results: Three groups of methodological challenges were primarily identified: (i) Definition of the scope of the population, with involvement of enterprises of all sizes and activities; Heterogeneity of the population occurring on sites. (ii) Circumstances of exposures: No inventory identifying all the products incorporating ENMs; Lack of detailed information on product composition; Heterogeneity of ENMs incorporated in various matrices; Diversity of activities generating exposure variability in terms of product types, duration and intensity of exposure; Passive exposures of workers operating nearby activities involving ENMs and generating dust and aerosolisation; Possible interactions with other risk exposures in light of the multitude of chemicals used on construction sites. (iii) Defining the organizational arrangements to capture efficiently the study population and optimize data collection and monitoring procedures: Lability of the population, influenced by the duration of projects, a known high turnover generated mainly by the engagement of temporary, independent or foreign labourers, and intervention of multiple subcontractors; Regarding small, medium or micro-sized businesses, no service Health Safety Environment (HSE) and relocation of the occupational medicine. Conclusions: Implementing of such a study can be deeply influenced by the political context as well as the product marketing strategies along with the industrial secrecy. The use of ENM-based products would be probably increased in the current green economy context. This underscores the need to implement a specific surveillance system, despite the methodological complexity. Discussions are underway within the steering committee in order to find out strategies

Dispositif de surveillance EpiNano : inclusion des travailleurs manipulant des nanomatériaux manufacturés sur les chantiers du secteur du bâtiment et des travaux publics (BTP)

Le dispositif EpiNano pour la surveillance de l’état de santé des travailleurs potentiellement exposés aux nano-objets, leurs agrégats et agglomérats (NOAA) manufacturés a été déployé dès 2014 au niveau national. Dans le cadre du troisième plan santé travail, l’utilisation de produits à base de NOAA (nanoproduits) dans le BTP reçoit une attention particulière du fait de leur abondance croissante et une méconnaissance des risques potentiels. Un partenariat entre santé publique France et l’INRS, le CEA, l’Ineris et l’OPPBTP, est en cours de mise en place pour étendre EpiNano aux travailleurs du BTP