Impact of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients: A nationwide study in Spain

Objective To assess the effect of the first wave of the SARS-CoV-2 pandemic on the outcome of neurosurgical patients in Spain. Settings The initial flood of COVID-19 patients overwhelmed an unprepared healthcare system. Different measures were taken to deal with this overburden. The effect of these measures on neurosurgical patients, as well as the effect of COVID-19 itself, has not been thoroughly studied. Participants This was a multicentre, nationwide, observational retrospective study of patients who underwent any neurosurgical operation from March to July 2020. Interventions An exploratory factorial analysis was performed to select the most relevant variables of the sample. Primary and secondary outcome measures Univariate and multivariate analyses were performed to identify independent predictors of mortality and postoperative SARS-CoV-2 infection. Results Sixteen hospitals registered 1677 operated patients. The overall mortality was 6.4%, and 2.9% (44 patients) suffered a perioperative SARS-CoV-2 infection. Of those infections, 24 were diagnosed postoperatively. Age (OR 1.05), perioperative SARS-CoV-2 infection (OR 4.7), community COVID-19 incidence (cases/10 5 people/week) (OR 1.006), postoperative neurological worsening (OR 5.9), postoperative need for airway support (OR 5.38), ASA grade =3 (OR 2.5) and preoperative GCS 3-8 (OR 2.82) were independently associated with mortality. For SARS-CoV-2 postoperative infection, screening swab test <72 hours preoperatively (OR 0.76), community COVID-19 incidence (cases/10 5 people/week) (OR 1.011), preoperative cognitive impairment (OR 2.784), postoperative sepsis (OR 3.807) and an absence of postoperative complications (OR 0.188) were independently associated. Conclusions Perioperative SARS-CoV-2 infection in neurosurgical patients was associated with an increase in mortality by almost fivefold. Community COVID-19 incidence (cases/10 5 people/week) was a statistically independent predictor of mortality. Trial registration number CEIM 20/217

Campo Experimental Potrok Aike : resultado de 15 años de labor técnica

Libro de edición impresa publicado en 2005 y con edición electrónica en el año 2016.Al crearse, en el año 1985, la Estación Experimental Santa Cruz en el marco del convenio entre el INTA y la provincia de Santa Cruz surgió la necesidad de contar con un campo donde se pudieran desarrollar trabajos de investigación en ganadería, fundamentalmente ovina, y en pastizales naturales con el necesario control de diferentes variables productivas y ambientales. El gobierno provincial cedió un predio ubicado al sur de la provincia de Santa Cruz, en una zona representativa de la Estepa magallánica seca, en el extremo austral de la Patagonia. Esta publicación recopiló y organizó los datos e información dispersa resultante de más de 15 años de trabajo, y transformó esa materia prima en información accesible para técnicos y productores. Conformada por el aporte de distintos autores ofrece la información de base para describir el ambiente del Campo Experimental Potrok Aike, más las conclusiones de ensayos y experiencias llevadas a cabo en el lugar, que son perfectamente extrapolables a todo el sur provincial.EEA Santa CruzFil: Alegre, María Beatriz. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Alegre, María Beatriz. Consejo Agrario Provincial- Provincia de Santa Cruz; Argentina.Fil: Alegre, María Beatriz. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; ArgentinaFil: Anglesio, Francisco. Secretaría de Medio Ambiente. Provincia de Santa Cruz. Santa Cruz; Argentina.Fil: Baetti, Carlos. Consejo Agrario Provincial- Provincia de Santa Cruz; Argentina.Fil: Baetti, Carlos. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Bahamonde, Héctor Alejandro. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Bahamonde, Héctor Alejandro. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; ArgentinaFil: Barría, Julio. Consejo Agrario Provincial- Provincia de Santa Cruz; Argentina.Fil: Battini, Alberto. Consejo Agrario Provincial- Provincia de Santa Cruz; Argentina.Fil: Baumann, Osvaldo. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Borrelli, Pablo. Consultor privado. Buenos Aires; Argentina.Fil: Camejo, Ana María. Consultor privado. Trelew; Argentina.Fil: Castillo, Miguel. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Cibils, Andrés. New México State University. Department of Animal and Range Sciences; Estados UnidosFil: Ciurca, Lorena. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Clifton, Guillermo Raimundo. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; Argentina.Fil: Clifton, Guillermo Raimundo. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Culun, Victor Pascual. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; ArgentinaFil: Escalada, Julián. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Ferrante, Daniela. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; ArgentinaFil: Ferrante, Daniela. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Gismondi, Daniel. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: González, Liliana. Consejo Agrario Provincial- Provincia de Santa Cruz; Argentina.Fil: Grima, Daniel. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Humano, Gervasio. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; ArgentinaFil: Iacomini, Mónica. Secretaría de la Producción. Provincia de Santa Cruz. Santa Cruz; Argentina.Fil: Iglesias, Roberto. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Chubut; Argentina.Fil: Kofalt, Bustamante Rosa. Consejo Agrario Provincial- Provincia de Santa Cruz; Argentina.Fil: Kofalt, Bustamante Rosa. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Kofalt, Bustamante Rosa. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; Argentina.Fil: Lamoureux, Mabel Noemi. Consejo Agrario Provincial- Provincia de Santa Cruz; Argentina.Fil: Lamoureux, Mabel Noemi. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; ArgentinaFil: Larrosa, José. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; ArgentinaFil: Manero, Amanda. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Manero, Amanda. Consejo Agrario Provincial- Provincia de Santa Cruz; Argentina.Fil: Marcolín, Arrigo. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Bariloche; Argentina.Fil: Mascó, Mercedes. Consejo Agrario Provincial- Provincia de Santa Cruz; Argentina.Fil: Mascó, Mercedes. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; Argentina.Fil: Mascó, Mercedes. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Migliora, Horacio. Consejo Agrario Provincial- Provincia de Santa Cruz; Argentina.Fil: Milicevic, Francisco. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; ArgentinaFil: Montes, Leopoldo. Instituto Nacional de Tecnología Agropecuaria (INTA). Centro Regional Patagonia Sur; Argentina.Fil: Oliva, Gabriel Esteban. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Oliva, Gabriel Esteban. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; Argentina.Fil: Osses, Julio Angel. Consejo Agrario Provincial- Provincia de Santa Cruz; Argentina.Fil: Paredes, Paula. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; Argentina.Fil: Peinetti, Raúl. Universidad Nacional de La Pampa. Facultad de Agronomía; Argentina.Fil: Rial, Pablo Eduardo. Ministerio de Economía y Obras Públicas. Provincia de Santa Cruz; Argentina.Fil: Rial, Pablo Eduardo. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Santa Cruz; Argentina.Fil: Romero, Rubén. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Rosales, Valeria. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Salazar, Daniel. LU85 TV Canal 9. Auxiliar en Control de Erosión de Suelos. Provincia de Santa Cruz; Argentina.Fil: Tapia, Hector Horacio. Instituto Nacional de Tecnología Agropecuaria (INTA). Estación Experimental Agropecuaria Chubut; Argentina.Fil: Torra, Francisco. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina.Fil: Zerpa, Débora. Universidad Nacional de la Patagonia Austral. Unidad Académica Río Gallegos; Argentina

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