Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

PURPOSE: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS: This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION: Within available resources, dedicated COVID-19-free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Elective cancer surgery in COVID-19-free surgical pathways during the SARS-CoV-2 pandemic: An international, multicenter, comparative cohort study

PURPOSE As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19–free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. PATIENTS AND METHODS This international, multicenter cohort study included patients who underwent elective surgery for 10 solid cancer types without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19–free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). RESULTS Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19–free surgical pathways. Patients who underwent surgery within COVID-19–free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19–free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score–matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19–free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). CONCLUSION Within available resources, dedicated COVID-19–free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

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

Evaluation of appendicitis risk prediction models in adults with suspected appendicitis

Background Appendicitis is the most common general surgical emergency worldwide, but its diagnosis remains challenging. The aim of this study was to determine whether existing risk prediction models can reliably identify patients presenting to hospital in the UK with acute right iliac fossa (RIF) pain who are at low risk of appendicitis. Methods A systematic search was completed to identify all existing appendicitis risk prediction models. Models were validated using UK data from an international prospective cohort study that captured consecutive patients aged 16–45 years presenting to hospital with acute RIF in March to June 2017. The main outcome was best achievable model specificity (proportion of patients who did not have appendicitis correctly classified as low risk) whilst maintaining a failure rate below 5 per cent (proportion of patients identified as low risk who actually had appendicitis). Results Some 5345 patients across 154 UK hospitals were identified, of which two‐thirds (3613 of 5345, 67·6 per cent) were women. Women were more than twice as likely to undergo surgery with removal of a histologically normal appendix (272 of 964, 28·2 per cent) than men (120 of 993, 12·1 per cent) (relative risk 2·33, 95 per cent c.i. 1·92 to 2·84; P < 0·001). Of 15 validated risk prediction models, the Adult Appendicitis Score performed best (cut‐off score 8 or less, specificity 63·1 per cent, failure rate 3·7 per cent). The Appendicitis Inflammatory Response Score performed best for men (cut‐off score 2 or less, specificity 24·7 per cent, failure rate 2·4 per cent). Conclusion Women in the UK had a disproportionate risk of admission without surgical intervention and had high rates of normal appendicectomy. Risk prediction models to support shared decision‐making by identifying adults in the UK at low risk of appendicitis were identified

European ring-test on the chemical analyse of total dietary fibre and soluble fibre of compounds diets and raw materials for rabbits

International audienceDue to the role of soluble fibre (SF) on the digestive physiology and gut health of post-weaning rabbits and to the lack of reference methods for SF determination, in the framework of the harmonization activity on rabbit science methodologies carried out by EGRAN (European Group on Rabbit Nutrition), a collaborative study was achieved on the determination of total dietary fibre (TDF), aNDF corrected for protein and ash (aNDFcorr) and SF calculated as the difference between TDF and aNDFcorr. Five EGRAN laboratories analysed nine samples: four compound diets and five raw materials (alfalfa meal, wheat bran, grape marc, sunflower meal, sugarbeet pulp) with different levels of fibre fractions and SF. Each sample was analysed 3 runs for TDF and aNDFcorr. TDF was analysed according to the AOAC Method 991.43 using the kit and the procedure of Megazyme®. TDF averaged 48.2% DM, with one laboratory having higher values (49.3% vs 47.9%; P<0.001). The TDF values varied among samples (P<0.001), from about 40% DM for diets to 60% DM for grape marc and sugarbeet pulp. Repeatability (SR=0.95% DM) and reproducibility of TDF (SL=1.68% DM) were good with a low coefficient of variation among laboratory: CVL= 3.9%. The aNDFcorr (mean 37.1% DM) significantly differed from laboratories that used Ankom system (36.4% DM) to laboratories that used Fibertech equipment (38.3% DM). The differences among laboratories due to the equipment and to the corrections for ash and protein explained the poorer repeatability and reproducibility of aNDFcorr determination, with CVL=6.6%. SF values differed (P<0.001) among laboratories (from 9.6% to 12.0% DM) and samples (from 4.0% DM of wheat bran to 8-11% DM of diets and alfalfa meal to 24.3% DM of sugarbeet pulp). The among-laboratory variability of SF was higher (SL=2.97% DM; CVL=26.8%), due to the variability of both TDF and aNDFcorr analyses. In conclusion, TDF analysis was characterized by good repeatability and reproducibility, but it was less reproducible in case of raw materials with high SF levels. The among laboratory variation increased with aNDFcorr, because of the differences in analytical equipment and the procedure for protein and ash corrections. Finally SF reproducibility appeared rather good for complete diets and raw materials with low or medium concentration (SF4-10% DM), but it was affected by the analytical errors of both TDF and aNDFcorr and needs a better harmonization

Avaliação e natureza administrativa das instituições de ensino superior Evaluación y naturaleza administrativa de las instituciones de enseñanza superior Evaluation and administrative nature of the institutions of higher education

Objetiva-se, com o presente trabalho, o estudo das normas referentes à heterogeneidade das Instituições de Ensino Superior (IES), ou seja, dos seus diversos níveis de abrangência e especialização, existentes na Constituição da República brasileira de 1988 (BRASIL, 1988), no ordenamento infraconstitucional e em atos administrativos normativos, já que o ensino superior foi reconfigurado várias vezes, dentro do sistema educacional brasileiro. É necessário apresentar classificações adequadas a um ensino superior tão diverso e heterogêneo quanto o brasileiro, bem como discutir a concepção de universidade. Ademais, devem ser analisados a natureza, o regime jurídico das IES, a partir dos setores público e privado, e seus níveis de abrangência ou especialização. Este artigo é preponderantemente teórico-documental, sob uma perspectiva dogmática, empregada como forma de análise dos resultados. Como conclusão, verificou-se a inconstitucionalidade parcial dos Decretos nºs 5.773 (BRASIL, 2006b) e 5.786 (BRASIL, 2006c), expedidos pela Presidência da República brasileira, no tópico relativo aos diversos níveis de abrangência ou especialização das IES, especialmente nas denominações de centros universitários e faculdades. A discriminação formulada pelos atos administrativos normativos não se limita a organizar as IES do sistema federal de ensino, posto que cria formas de organização institucional, sem disposição legal anterior e em sentido oposto ao do art. 45 Lei nº 9.394 (BRASIL, 1996). Finalmente, o Projeto de Lei de Reforma Universitária, em trâmite no Congresso Nacional brasileiro, apresenta, em seu texto, elementos que possibilitam regularizar as inconstitucionalidades apontadas por este estudo.<br>Se desea, con el presente trabajo, el estudio de las normas relativas a la heterogeneidad de las Instituciones de Enseñanza Superior (IES), o sea, sus diversos niveles de especialización, existentes en la Constitución de la República brasileña de 1988 (BRASIL, 1988), en el ordenamiento infraconstitucional y en actos administrativos normativos, ya que la enseñanza superior fue reconfigurada varias veces en el sistema educacional brasileño. Es necesario presentar clasificaciones adecuadas a una enseñanza superior tan plural y heterogénea como la brasileña, además de discutir la concepción de universidad. Deben analizarse la naturaleza, el régimen jurídico de las IES, desde los sectores público y privado, y sus niveles de especialización. Se trata de un trabajo preponderantemente teórico-documental, en una perspectiva dogmática, empleada como forma de análisis de los resultados. Como conclusión, se ha verificado la inconstitucionalidad parcial de los Decretos nº 5.773 (BRASIL, 2006) y 5.786 (BRASIL, 2006), expedidos por la Presidencia de la República brasileña, en el tópico referente a los diversos niveles de especialización de las IES, especialmente en las denominaciones de centros universitarios y facultades. La discriminación formulada por los actos administrativos normativos no se limita a organizar las IES del sistema federal de enseñanza, puesto que crea formas de organización institucional, sin disposición legal anterior y en sentido opuesto al del artículo 45 Ley nº 9.394 (BRASIL, 1996). Finalmente, el Proyecto de Ley de Reforma Universitaria, en trámite en el Congreso Nacional brasileño, presenta, en su texto, elementos que posibilitan regularizar las inconstitucionalidades indicadas en este estudio.<br>It is desired, with the present work, the study of the norms relative to the heterogeneity of the Institutions of Higher Education (IES), that is, of its diverse levels of specialization, existing in the Constitution of the Brazilian Republic of 1988 (CR/88), under the constitutional ordering and normative administrative acts, since superior education was reshaped several times, in the Brazilian educational system. It is necessary to present classifications adapted to such a diverse and heterogeneous higher education system of the Brazilian, as well as to discuss the conception of university. The nature and the legal regime of the IES must be analyzed, from the public and private sectors, and their levels of specialization. This one is a preponderantly theoretical-documentary work, in a dogmatic perspective, employed as a form of analysis of the results. As conclusion, the partial unconstitutionality of Decrees nº 5.773/06 and 5.786/06, sent by the Presidency of the Brazilian Republic, has been verified in the topic referring to the diverse levels of specialization of the IES, especially in the denominations of university centers and faculties. The discrimination formulated by the normative administrative acts is not limited to organize the IES of the federal system of education, since it creates forms of institutional organization, without previous legal disposition and in sense opposed to the article 45, of the Law nº 9.394/96 (LDB). Finally, the Project of Law of the University Reformation, proceeding in the Brazilian National Congress, presents, in its text, elements that make it possible to regularize unconstitutionalities indicated in this study