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

Post-Remediation Biomonitoring of Pesticides in Marine Waters Near the United Heckathorn Site, Richmond, California

Marine sediment remediation at the United Heckathorn Superfund Site was completed in April 1997. Water and mussel tissues were sampled in January 1998 from four stations near Lauritzen Canal in Richmond, California, for the first post-remediation monitoring of marine areas near the United Heckathorn Site. Dieldrin and DDT were analyzed in water samples, tissue samples from resident mussels, and tissue samples from transplanted mussels deployed for 4 months. Concentrations of dieldrin and total DDT in water and total DDT in tissue were compared to pre-remediation data available from the California State Mussel Watch program (tissues) and the Ecological Risk Assessment for the United Heckathorn Superfund Site (tissues and water). Biomonitoring results indicated that pesticides were still bioavailable in the water column, and have not been reduced from pre-remediation levels. Annual biomonitoring will continue to assess the effectiveness of remedial actions at the United Heckathorn Site

POST-REMEDIATION BIOMONITORING OF PESTICIDES AND OTHER CONTAMINANTS IN MARINE WATERS AND SEDIMENT NEAR THE UNITED HECKATHORN SUPERFUND SITE, RICHMOND, CALIFORNIA

Marine sediment remediation at the United Heckathorn Superfund Site was completed in April 1997. Water and mussel tissues were sampled in February 1999 from four stations near Lauritzen Canal in Richmond, California, for Year 2 of post-remediation monitoring of marine areas near the United Heckathorn Site. Dieldrin and dichlorodiphenyl trichloroethane (DDT) were analyzed in water samples, tissue samples from resident mussels, and tissue samples from transplanted mussels deployed for 4 months. Mussel tissues were also analyzed for polychlorinated biphenyls (PCB), which were detected in sediment samples. Chlorinated pesticide concentrations in water samples were similar to preremediation levels and did not meet remediation goals. Biomonitoring results indicated that the bioavailability of chlorinated pesticides has been reduced from preremediation levels both in the dredged area and throughout Richmond Harbor. Total DDT and dieldrin concentrations in mussel tissues were lower than measured levels from preremediation surveys and also lower than Year 1 levels from post-remediation biomonitoring. Sediment analyses showed the presence of elevated DDT, dieldrin, PCB aroclor 1254, and very high levels of polynuclear aromatic hydrocarbons (PAH) in Lauritzen Channel

Success and succession in species and ecosystem recoveries: kelp forest community dynamics following decades of sea otter re-establishment

The recovery of predators has the potential to restore ecosystems and fundamentally alter the services they provide. One of the most iconic examples of this potential comes from keystone predation by sea otters in nearshore habitats of the Northeast Pacific. On the outer coast of Washington state, USA, a population of sea otters re-introduced in 1969-1970 exhibited a more than 10-fold increase during the 1980s and 1990s. This population increase led to a pronounced decline in sea otter prey, particularly kelp-grazing sea urchins. Here we show that the reduction in invertebrate prey coincided with an expansion of kelp beds coastwide until the turn of the century. However, while sea otter and kelp population growth rates were positively correlated prior to 2000, this association diminished substantially in the last 15+ years. A recent 2015 survey of benthic invertebrates shows that sea otter prey have continued to decline as the sea otter population has continued to expand, but kelp abundance is not closely related to these trends. However, variability in kelp abundance has declined in the most recent 15 years of the time series. Altogether these results suggest that initial nearshore community responses to sea otter population expansion follow predictably from trophic cascade theory, but now other factors may be as or more important in influencing community dynamics. Thus, the role of sea otter predation may be context-dependent with shifting environmental conditions strongly affecting their utility in ecosystem restoration

Large-scale impacts of sea star wasting disease (SSWD) on intertidal sea stars and implications for recovery.

Disease outbreaks can have substantial impacts on wild populations, but the often patchy or anecdotal evidence of these impacts impedes our ability to understand outbreak dynamics. Recently however, a severe disease outbreak occurred in a group of very well-studied organisms-sea stars along the west coast of North America. We analyzed nearly two decades of data from a coordinated monitoring effort at 88 sites ranging from southern British Columbia to San Diego, California along with 2 sites near Sitka, Alaska to better understand the effects of sea star wasting disease (SSWD) on the keystone intertidal predator, Pisaster ochraceus. Quantitative surveys revealed unprecedented declines of P. ochraceus in 2014 and 2015 across nearly the entire geographic range of the species. The intensity of the impact of SSWD was not uniform across the affected area, with proportionally greater population declines in the southern regions relative to the north. The degree of population decline was unrelated to pre-outbreak P. ochraceus density, although these factors have been linked in other well-documented disease events. While elevated seawater temperatures were not broadly linked to the initial emergence of SSWD, anomalously high seawater temperatures in 2014 and 2015 might have exacerbated the disease's impact. Both before and after the onset of the SSWD outbreak, we documented higher recruitment of P. ochraceus in the north than in the south, and while some juveniles are surviving (as evidenced by transition of recruitment pulses to larger size classes), post-SSWD survivorship is lower than during pre-SSWD periods. In hindsight, our data suggest that the SSWD event defied prediction based on two factors found to be important in other marine disease events, sea water temperature and population density, and illustrate the importance of surveillance of natural populations as one element of an integrated approach to marine disease ecology. Low levels of SSWD-symptomatic sea stars are still present throughout the impacted range, thus the outlook for population recovery is uncertain

Deviations of daily sea water temperature from long-term means (lines) overlaid on annual (WA, OR, CA North) or semiannual (CA Central, CA South) <i>P</i>. <i>ochraceus</i> abundance (bars) relative to long-term mean.

<p>Temperature deviations were displayed using a weekly smoother to emphasize longer-term patterns (rather than daily fluctuations). Sea star abundance ratios are averaged across all sites within each region for a given season (SP = spring [Feb-Apr], SU = summer [May-Aug], FA = fall [Sep-Nov]). Horizontal lines where ratio = 1 were included to illustrate deviations from long-term mean.</p

Total number of juvenile <i>P</i>. <i>ochraceus</i> (“radius” ≤ 30 mm) counted within long-term permanent plots at each site over time.

<p>For sites that were sampled > 1 time year^-1, the mean total number for that year is displayed. 2013 is indicated by a vertical line, and separates pre-SSWD years from post-SSWD years. Unshaded cells represent years when surveys were not done.</p

Heat map showing annual changes in abundance of <i>P</i>. <i>ochraceus</i> for each site relative to the long-term mean.

<p>The annual relative population size was calculated by dividing the total number of adult <i>P</i>. <i>ochraceus</i> (>30 mm radius) counted within long-term permanent plots for a given year (or mean count in years with >1 survey year^-1) by the long-term annual mean number of stars counted at a given site through 2013. 2013 is indicated by a vertical line, and separates pre-SSWD years from post-SSWD years. Unshaded cells represent years when surveys were not done.</p

Map of study sites along the Pacific coast of North America.

<p>Sites are indicated by dots and study regions by labeled boxes. Refer to <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0192870#pone.0192870.s001" target="_blank">S1A–S1H Fig</a> for more detail.</p

Large-scale impacts of sea star wasting disease (SSWD) on intertidal sea stars and implications for recovery

Disease outbreaks can have substantial impacts on wild populations, but the often patchy or anecdotal evidence of these impacts impedes our ability to understand outbreak dynamics. Recently however, a severe disease outbreak occurred in a group of very well-studied organisms-sea stars along the west coast of North America. We analyzed nearly two decades of data from a coordinated monitoring effort at 88 sites ranging from southern British Columbia to San Diego, California along with 2 sites near Sitka, Alaska to better understand the effects of sea star wasting disease (SSWD) on the keystone intertidal predator, Pisaster ochraceus. Quantitative surveys revealed unprecedented declines of P. ochraceus in 2014 and 2015 across nearly the entire geographic range of the species. The intensity of the impact of SSWD was not uniform across the affected area, with proportionally greater population declines in the southern regions relative to the north. The degree of population decline was unrelated to pre-outbreak P. ochraceus density, although these factors have been linked in other well-documented disease events. While elevated seawater temperatures were not broadly linked to the initial emergence of SSWD, anomalously high seawater temperatures in 2014 and 2015 might have exacerbated the disease's impact. Both before and after the onset of the SSWD outbreak, we documented higher recruitment of P. ochraceus in the north than in the south, and while some juveniles are surviving (as evidenced by transition of recruitment pulses to larger size classes), post-SSWD survivorship is lower than during pre-SSWD periods. In hindsight, our data suggest that the SSWD event defied prediction based on two factors found to be important in other marine disease events, sea water temperature and population density, and illustrate the importance of surveillance of natural populations as one element of an integrated approach to marine disease ecology. Low levels of SSWD-symptomatic sea stars are still present throughout the impacted range, thus the outlook for population recovery is uncertain