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

大気中粒子の健康影響に関する疫学研究における新しい視点 : 曝露におけるタイムラグ、期間および強度

京都大学0048新制・課程博士博士(工学)甲第22060号工博第4641号新制||工||1724(附属図書館)京都大学大学院工学研究科都市環境工学専攻(主査)教授 高野 裕久, 教授 米田 稔, 准教授 上田 佳代学位規則第4条第1項該当Doctor of Philosophy (Engineering)Kyoto UniversityDGA

Investigation of association between smoke haze and under-five mortality in Malaysia, accounting for time lag, duration and intensity

[Background] Studies on the association between smoke haze (hereafter ‘haze’) and adverse health effects have increased in recent years due to extreme weather conditions and the increased occurrence of vegetation fires. The possible adverse health effects on under-five children (U5Y) is especially worrying due to their vulnerable condition. Despite continuous repetition of serious haze occurrence in Southeast Asia, epidemiological studies in this region remained scarce. Furthermore, no study had examined the association accounting for three important aspects (time lag, duration and intensity) concurrently. [Objective] This study aimed to examine the association between haze and U5Y mortality in Malaysia, considering time lag, duration and intensity of exposure. [Methods] We performed a time-stratified case-crossover study using a generalized additive model to examine the U5Y mortality related to haze in 12 districts in Malaysia, spanning from 2014 to 2016. A ‘haze day’ was characterized by intensity [based on concentrations of particulate matter (PM)] and duration (continuity of haze occurrence, up to 3 days). [Results] We observed the highest but non-significant odds ratios (ORs) of U5Y mortality at lag 4 of Intensity-3. Lag patterns revealed the possibility of higher acuteness at prolonged and intensified haze. Stratifying the districts by the 95th-percentile of PM distribution, the ‘low’ category demonstrated marginal positive association at Intensity-2 Duration-3 [OR: 1.210 (95% confidence interval: 1.000, 1.464)]. [Conclusions] We found a null association between haze and U5Y mortality. The different lag patterns of the association observed over different duration and intensity suggest consideration of these aspects in future studies

Acute Effects of Ambient PM2.5 on All-Cause and Cause-Specific Emergency Ambulance Dispatches in Japan

Short-term health effects of ambient PM₂.₅ have been established with numerous studies, but evidence in Asian countries is limited. This study aimed to investigate the short-term effects of PM₂.₅ on acute health outcomes, particularly all-cause, cardiovascular, respiratory, cerebrovascular and neuropsychological outcomes. We utilized daily emergency ambulance dispatches (EAD) data from eight Japanese cities (2007–2011). Statistical analyses included two stages: (1) City-level generalized linear model with Poisson distribution; (2) Random-effects meta-analysis in pooling city-specific effect estimates. Lag patterns were explored using (1) unconstrained-distributed lags (lag 0 to lag 7) and (2) average lags (lag: 0–1, 0–3, 0–5, 0–7). In all-cause EAD, significant increases were observed in both shorter lag (lag 0: 1.24% (95% CI: 0.92, 1.56)) and average lag 0–1 (0.64% (95% CI: 0.23, 1.06)). Increases of 1.88% and 1.48% in respiratory and neuropsychological EAD outcomes, respectively, were observed at lag 0 per 10 µg/m3 increase in PM₂.₅. While respiratory outcomes demonstrated significant average effects, no significant effect was observed for cardiovascular outcomes. Meanwhile, an inverse association was observed in cerebrovascular outcomes. In this study, we observed that effects of PM₂.₅ on all-cause, respiratory and neuropsychological EAD were acute, with average effects not exceeding 3 days prior to EAD onset

Future fire-PM2.5 mortality varies depending on climate and socioeconomic changes

Fire emits hazardous air pollutants, the most dominant of which is fine particulate matter of diameter ⩽2.5 μ m (PM _2.5 ). PM _2.5 is a great concern due to its adverse effects on public health. Previous studies have examined the health burden from fire-related PM _2.5 for the historical period; however, future global mortality associated with fire-PM _2.5 , particularly under the coexisting impacts of climate and socioeconomic changes, is yet to be projected. Here, we estimated the mortality associated to fire-PM _2.5 (fire-PM _2.5 mortality) for the present period (2010s) and then projected the mortality for the 2050s and 2090s under 10 scenarios created by combining two Representative Concentration Pathways (RCP2.6 or 6.0) with five Shared Socioeconomic Pathways (SSP1–5). We used the Li-Park fire model in combination with a chemical transport model and health risk assessment to calculate fire-PM _2.5 mortality. For the present period, the estimated fire-PM _2.5 mortality was 135 180 (105 403–163 738), which is 1.7 deaths per 100 000 population globally. When countries were grouped by income, the fire-PM _2.5 mortality rate was the highest in the high-income country group and lowest in the lowest-income country group. For the 2050s and 2090s, the fire-PM _2.5 mortality rate was projected to decrease under most scenarios because of decreases in fire emissions and baseline mortality rate. However, a scenario of high population growth and low technical development (SSP3) together with severe global warming (RCP6.0) would lead to an increase in the fire-PM _2.5 mortality rate in the 2090s, particularly in the highest-income countries, due to increased fire under drier and warmer weather conditions. Stratification of countries by gross domestic product indicated the need for adaptation efforts in the highest-income countries to avoid future increases of mortality associated with fire-PM _2.5