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

Needle chlorosis in Sitka spruce following a three-year exposure to low concentrations of ozone: changes in mineral content, pigmentation and ascorbic acid.

Two-year-old seedlings of Sitka spruce were exposed to 70 nl 1−1 ozone or to filtered air over three successive summers in outdoor large-scale fumigation chambers (Solardomes). Seven months after the last period of exposure to the pollutant and just prior to budburst, upper-surface chlorisis affecting only the older needles of ozone-exposed trees was observed. In many respects, the symptoms appeared to be similar to those characteristic of type 1 spruce damage occurring in parts of mainland Europe. Chlorophyll pigments were reduced in the ozone-exposed older foliage, but no change in the ratio of chlorophylls to carotene was observed. The content of ascorbic acid was clearly related to the amount of foliar damage observed on the trees exposed to ozone and the largest increases were seen in those trees which were most visibly damaged. Although none of the foliage examined was deficient in any of the nutrient cations which were measured, the concentration of Mg in the older needles was significantly reduced by exposure to ozone, irrespective of damage symptoms. Exposure to ozone also resulted in increases in the ratios of K: Mg and Ca: Mg. In the older needles, leaching of Mg2− and K− by 0.5 mM H2SO4, pH 3.0, was enhanced by prior exposure to ozone, but the amounts removed were small (< 6%). It is suggested that long-term exposure to ozone has a cumulative effect on plant tissue and that the observed chlorosis was the result of accelerated senescence