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

Directions in Gender Research in American Indian Societies: Two Spirits and Other Categories

Indigenous social role categories that represent third and fourth gender characteristics, such as the Lakota (Sioux) winkte and the Dino (Navajo) n and other Native terms, mark the status of these individuals. However, they are often blanketed by the term, berdache, in social science literature. Contextualization in an ethnographic frame is essential to greater comprehension of these roles. A critical review of contemporary research and the writings of the Native occupants of these categories has resulted in an all encompassing term: Two Spirits. Coterminously, Native terms for lesbians are also emerging. However, all Native gay males and lesbians have not accepted the term. This article discusses the concerns of indigenous researchers and others or non-indigenous researchers in this discourse

Review of Madonna Swan: A Lakota Woman\u27s Story

This book joins the burgeoning personal document data on Lakota women. The book, another as-told-to life history on Lakota women as in Lakota Woman by Mary Crow Dog and Richard Erdoes and Cante ohitika Win (Bravehearted Women) by Carolyn Reyer, centers upon life on Cheyenne River reservation and presents another facet of feminine experiences. Collections of this genre-though often getting rave reviews in publications of the dominant society-evoke certain cautionary appraisals from persons in their natal communities. Perhaps many collectors of biography/ autobiography forget that the so-called target populations from which their subjects stem are literate

Review of The Medicine Men: Oglala Sioux Ceremony and Healing.

As a Lakota person, it seems more pertinent to me that those publications that deal with specific groups, i.e., Oglala, be reviewed by persons from that band. Tribally controlled colleges on reservations could possibly be sources for the reviews

North American Indigenous Women and Cultural Domination

Many immigrant groups in the United States celebrated a quincentennial of the "discovery" of a New World in 1992. However, most of the 1.5 million native peoples in the United States who live in isolated reservation areas or the 50 percent of the native population who live in urban areas are rejoicing in their survival. Their cultural survival against centuries of genocide, legal restrictions on religion and language, and superimposed systems of law that were meant to completely obliterate native law-ways and customary systems of marriage and kinship, and, more devastatingly, demolish belief systems that were considered "pagan" is indeed remarkable. This pattern of conquest and domination exists in many areas of colonization by European powers. At present, it is agreed that there are approximately 325 distinct tribal groups in the United States. Their viability in cultural lifestyles and linguistic persistence lends credence to adaptiveness and tenacity. This contradicts the common view of policy-makers and religious practitioners that American Indians would inevitability join a mythical "melting pot." American Indians of all tribes have been the focus of administered human relations since the beginning of contact with a dominant and domineering governmental system that prevails to the present day. American Indians and Alaska Natives (not Native Americans!) have a comprehensive system of laws, federal statutes, and rules stipulated by Congress that distinguishes them from other so-called minority peoples. Thus they have a constant need for lobbyists and self help associations to carefully monitor every session of Congress to apprise them of and, in some cases, circumvent legal actions that would erode the special status of tribes as ”domestic nations” and abrogate treaties on which tribal sovereignty is based. The need for eternal vigilance as each session of Congress convenes has established watchdog groups such as the National Congress of American Indians (founded in 1944) and the politically astute Native American Rights Fund, which is composed of indigenous lawyers of both genders. Besides these pan-tribal organizations, many tribal governments maintain offices in Washington, D.C. to monitor legislation and inform their tribal constituencies