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

Wasted Food: U.S. Consumers' Reported Awareness, Attitudes, and Behaviors

<div><p>The U.S. wastes 31 to 40% of its post-harvest food supply, with a substantial portion of this waste occurring at the consumer level. Globally, interventions to address wasted food have proliferated, but efforts are in their infancy in the U.S. To inform these efforts and provide baseline data to track change, we performed a survey of U.S. consumer awareness, attitudes and behaviors related to wasted food. The survey was administered online to members of a nationally representative panel (N=1010), and post-survey weights were applied. The survey found widespread (self-reported) awareness of wasted food as an issue, efforts to reduce it, and knowledge about how to do so, plus moderately frequent performance of waste-reducing behaviors. Three-quarters of respondents said they discard less food than the average American. The leading motivations for waste reduction were saving money and setting an example for children, with environmental concerns ranked last. The most common reasons given for discarding food were concern about foodborne illness and a desire to eat only the freshest food. In some cases there were modest differences based on age, parental status, and income, but no differences were found by race, education, rural/urban residence or other demographic factors. Respondents recommended ways retailers and restaurants could help reduce waste. This is the first nationally representative consumer survey focused on wasted food in the U.S. It provides insight into U.S. consumers’ perceptions related to wasted food, and comparisons to existing literature. The findings suggest approaches including recognizing that many consumers perceive themselves as being already-knowledgeable and engaged, framing messages to focus on budgets, and modifying existing messages about food freshness and aesthetics. This research also suggests opportunities to shift retail and restaurant practice, and identifies critical research gaps.</p></div

Respondent Demographics, Unweighted⁺.

<p>^<b>+</b>Due to rounding, some categories do not sum to 100 percent.</p><p>^a percentage is based on population age 18, not total population.</p><p>^b refers to percentage of households with members under age 18</p><p>^c refers to percentage of foreign-born individuals</p><p>Sources for US data: 1–2012 CPS ASEC; 2–2014 CPS ASEC; 3–2013 CPS ASEC.</p><p>[<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0127881#pone.0127881.ref024" target="_blank">24</a>–<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0127881#pone.0127881.ref026" target="_blank">26</a>]</p><p>Respondent Demographics, Unweighted<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0127881#t001fn001" target="_blank">⁺</a>.</p

Agreement with Statements Related to Discarding Food.

<p>Responses regarding eight possible reasons for discarding food. Percentages indicate the proportion of respondents who chose each response. * Restricted to respondents reporting in a separate question that they compost at least some of their food; percentages for all other motivations reflect the entire sample.</p

Survey results (selected) and chi-square tests ^a.

<p>* p<0.05</p><p>^a For each chi-square test, the percentages shown represent column proportions.</p><p>^b Household Income Quintiles: Q1: less than $29,000; Q2:$30,000 to $59,999; Q3:$60,000 to $84,999; Q4:$85,000 to $124,999; Q5:$125,000 or more.</p><p>Survey results (selected) and chi-square tests <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0127881#t002fn002" target="_blank">^a</a>.</p

Reported Importance of Motivations to Reduce Food Discards.

<p>Responses to four-point Likert-type questions about eight possible motivations for reducing the amount of food discarded. Percentages indicate the proportion of respondents who chose each response, adjusted to 100%.</p

Reported Frequency of Food Preparation Behaviors.

<p>Responses to three-point Likert-type questions about the frequency of performing nine behaviors related to food preparation. Percentages indicate the proportion of respondents who chose each response. Behaviors classified as “food waste reducing” are italicized; behaviors classified as “food waste promoting” are non-italicized.</p

Reported Frequency of Shopping Behaviors.

<p>Responses to five-point Likert-type questions about the frequency of performing nine behaviors related to food shopping. Percentages indicate the proportion of respondents who chose each response. Behaviors classified as “food waste reducing” are italicized; behaviors classified as “food waste promoting” are non-italicized.</p