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 (740%) had emergency surgery and 280 (248%) had elective surgery. SARS-CoV-2 infection was confirmed preoperatively in 294 (261%) patients. 30-day mortality was 238% (268 of 1128). Pulmonary complications occurred in 577 (512%) of 1128 patients; 30-day mortality in these patients was 380% (219 of 577), accounting for 817% (219 of 268) of all deaths. In adjusted analyses, 30-day mortality was associated with male sex (odds ratio 175 [95% CI 128-240], p<00001), age 70 years or older versus younger than 70 years (230 [165-322], p<00001), American Society of Anesthesiologists grades 3-5 versus grades 1-2 (235 [157-353], p<00001), malignant versus benign or obstetric diagnosis (155 [101-239], p=0046), emergency versus elective surgery (167 [106-263], p=0026), and major versus minor surgery (152 [101-231], p=0047). 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

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

Chlorhexidine versus povidone–iodine skin antisepsis before upper limb surgery (CIPHUR) : an international multicentre prospective cohort study

Introduction Surgical site infection (SSI) is the most common and costly complication of surgery. International guidelines recommend topical alcoholic chlorhexidine (CHX) before surgery. However, upper limb surgeons continue to use other antiseptics, citing a lack of applicable evidence, and concerns related to open wounds and tourniquets. This study aimed to evaluate the safety and effectiveness of different topical antiseptics before upper limb surgery. Methods This international multicentre prospective cohort study recruited consecutive adults and children who underwent surgery distal to the shoulder joint. The intervention was use of CHX or povidone–iodine (PVI) antiseptics in either aqueous or alcoholic form. The primary outcome was SSI within 90 days. Mixed-effects time-to-event models were used to estimate the risk (hazard ratio (HR)) of SSI for patients undergoing elective and emergency upper limb surgery. Results A total of 2454 patients were included. The overall risk of SSI was 3.5 per cent. For elective upper limb surgery (1018 patients), alcoholic CHX appeared to be the most effective antiseptic, reducing the risk of SSI by 70 per cent (adjusted HR 0.30, 95 per cent c.i. 0.11 to 0.84), when compared with aqueous PVI. Concerning emergency upper limb surgery (1436 patients), aqueous PVI appeared to be the least effective antiseptic for preventing SSI; however, there was uncertainty in the estimates. No adverse events were reported. Conclusion The findings align with the global evidence base and international guidance, suggesting that alcoholic CHX should be used for skin antisepsis before clean (elective upper limb) surgery. For emergency (contaminated or dirty) upper limb surgery, the findings of this study were unclear and contradict the available evidence, concluding that further research is necessary

Individual and combined effects of deoxynivalenol and zearalenone on bovine granulosa cell proliferation

Deoxynivalenol (DON) and Zearalenone (ZEA) are fusariotoxins frequently found together in commodities used as animal feed. The estrogenic effects of ZEA in all species are well established whereas the effects of DON on the reproductive system are unclear. The purpose of this study is to evaluate the in vitro effects of DON and \u3b1-Zearalenol (\u3b1-ZEA) on cell proliferation by using bovine granulosa cells (GC). Ovaries from non-pregnant beef cows were collected from a nearby slaughterhouse and large granulosa cells (LGGC) were obtained by aseptically aspirating ovarian follicles (8-22 mm) with an 18-gauge needle. Cells were cultured for 2 days in 5% fetal bovine serum-containing medium followed by 2 days in serum-free medium containing control or mycotoxin treatments. At the end of the experiment, cell numbers were determined using a Coulter counter. The effects of DON and \u3b1-ZEA were tested using various dosages (0.1, 0.33, 3.3 \ub5M and 0.09, 0.31, 3.1 \ub5M respectively) and a concomitant treatment with DON at 0.1 \ub5M and \u3b1-ZEA at 0.09 \ub5M respectively was also carried out. DON at 3.3 \ub5M decreased cell proliferation whereas the other two treatments with DON had no significant effects. After exposure to \u3b1-ZEA, LGGC proliferation was increased by the lowest concentration tested (0.09 \ub5M) while the highest one (3.1 \ub5M) had no effect compared to the control. The combination of these mycotoxins strongly affected LGCC cell growth, increasing cell numbers. The results demonstrate that DON affects cell proliferation mainly at high dosage by decreasing LGGC numbers while \u3b1-ZEA can impact cell numbers more at the lowest dosage causing cell proliferation growth. Finally a synergic effect was observed when the mycotoxins are combined. Further studies are in progress to better understand the mechanism of the effects of DON and ZEA on GC

Individual and combined effects of deoxynivalenol and zearalenone on steroidogenesis in bovine granulosa cells

Zearalenone (ZEA), a phyto-estrogenic molecule, and Deoxynivalenol (DON) are mycotoxins produced by Fusarium spp. and found to co-exist in commodities. Reproductive effects caused by ZEA in ruminants have been reported, while direct effects on fertility related to DON are unknown. The aim of this study is to evaluate steroidogenesis effects of DON and \u3b1-Zearalenol (\u3b1-ZEA), the hydroxilated metabolite, on bovine granulosa cells (GC). Briefly, small bovine granulosa cells (SMGC) from ovarian follicles (1\u20135 mm) were cultured at 2.5 x 105 cells/well for 2 days in 5% fetal bovine serum-containing medium followed by 2 days in serum-free medium containing control (no additions) or mycotoxin treatments. Concentrations of progesterone and estradiol in cell culture medium were determined using radioimmunoassay (RIA). DON and \u3b1-ZEA were tested at 0.1, 0.33, 3.3 \ub5M and 0.09, 0.31, 3.1 \ub5M respectively and the effects of a combination of the two mycotoxins, at 0.1 \ub5M (DON) and at 0.09 \ub5M (\u3b1-ZEA), were also evaluated. Progesterone production was dramatically reduced only after exposure to DON at the highest concentration (3.3 \ub5M) while estradiol production decreased after exposure to all DON and \u3b1-ZEA dosages, showing the biggest change after exposure to DON at 3.3 \ub5M. The concomitant treatment with 0.1 \ub5M DON and 0.09 \ub5M \u3b1-ZEA respectively showed a synergic inhibitory effect on estradiol production. In conclusion, DON can affect steroidogenesis in bovine SMGC more than \u3b1-ZEA , mainly after it has been introduced at high dosages or in combination