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

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

Cognición social en la violencia de pareja: una perspectiva neurocriminológica

Evaluation and interpretation of real or imagined stimuli done by humans is one of the predictors that will determine the behavioral repertoire, be it adaptive or maladaptive, with legal effect to be executed in the partner relationship. Therefore, this study assessed the performance on social cognition tasks in a group of men with a history of intimate partner violence. Participants were given emotion recognition and empathy tests. Results indicate that male abusers have difficulties with social cognition, possibly due to an intentional bias in recognizing the behaviors of others, which results in the attribution of a negative intentionality to their behavior. These results provide an empirical basis for legal psychology in the bimodal understanding of partner violence and thus guides intervention toward the needs of the individual.La evaluación e interpretación que realizan los seres humanos de estímulos reales o imaginados, constituye uno de los factores predictores que determinará el repertorio conductual, ya sea adaptativo o desadaptativo, con alcance jurídico a ejecutar en la relación de pareja. Por lo anterior, el estudio evaluó el desempeño en tareas de cognición social en un grupo de hombres que poseen antecedentes por violencia de pareja. A los participantes se les aplicó pruebas de reconocimiento emocional y empatía. Los resultados indicaron que el grupo de hombres maltratadores presenta dificultades en su cognición social, debido posiblemente a un sesgo intencional en el reconocimiento de las conductas de su congénere, por lo cual, atribuyen una intencionalidad negativa al comportamiento del otro. Estos resultados permiten aportar una base empírica desde la psicología jurídica en la comprensión bimodal de la violencia de pareja, y de esta forma centrar la intervención en las necesidades del individuo

Experiencias Significativas en Procesos de Construcción de Paz en Tres Municipios del Magdalena Medio Afectados por la Violencia

Peace with a Territorial Focus in the country aims to promote the experience of a stable and lasting peace, under the protection of the State. However, the same communities must intervene directly in this construction process. The research, which was carried out in Barrancabermeja, Puerto Boyacá, and San Pablo, wanted to know the proposals and conceptions of these territories regarding peace and the implementation of the agreements, and identifies the concrete actions of the communities for the reconciliation, by considering the factors, which fuelled the conflict and the development plans. Here are some significant experiences.La Paz con Enfoque Territorial, pretende impulsar en el país la vivencia de una paz estable y duradera, bajo la protección del Estado. Sin embargo, las mismas comunidades las que deben intervenir directamente en ese proceso de construcción. La investigación realizada en Barrancabermeja, Puerto Boyacá y San Pablo quiso conocer las propuestas y concepciones de estos territorios con respecto a la paz y la implementación de los acuerdos, e identifica las acciones concretas de las comunidades para la reconciliación, considerando los factores que alimentaron el conflicto y los planes de desarrollo. Éstas son algunas experiencias significativas

Bienestar psicológico de los sobrevivientes del conflicto armado: una arista de la salud mental

The armed conflict in Colombia has caused more than 8,746,541 survivors and psychosocial effects and incidence on mental health in those affected. The advances obtained in the improvement of the psychological well-being of the survivors by the State are not clear; however, the literature shows that the socio-political conditions surrounding the survivors are unfavorable. Therefore, the study evaluated the psychological well-being of the population victim of the armed conflict in seven municipalities of Colombia, benefited by some measure of attention, assistance and reparation of law 1448 of 2011. Therefore, a cross-sectional descriptive study was used and Ryff's psychological well-being scale translated into Spanish; The following results were obtained: the dimensions with the best evaluation were "purposes in life" and "personal growth"; dimensions with lower ratings are "positive relationships" and "autonomy". it is concluded that psychological well-being is better perceived in terms of setting goals for oneself and showing improvement, but that autonomy is affected, as well as positive relationships (distrust, building new relationships when one is displaced) due to related issues with the armed conflict. The findings will improve the attention actions.El conflicto armado en Colombia ha causado más de 8.746.541 sobrevivientes y efectos psicosociales e incidencia sobre la salud mental en los afectados. Los avances obtenidos en el mejoramiento del bienestar psicológico de los sobrevivientes por parte del Estado no son claros; sin embargo, la literatura evidencia que las condiciones socio-políticas que rodean a los sobrevivientes son poco favorables. Por lo expuesto, el estudio evaluó el bienestar psicológico de la población víctima del conflicto armado de siete municipios de Colombia, beneficiada por alguna medida de atención, asistencia y reparación de la ley 1448 de 2011. Por lo anterior, se utilizó un estudio descriptivo transversal y la escala de Bienestar psicológico de Ryff traducida al español; se obtuvieron los siguientes resultados: las dimensiones con mejor valoración fueron “propósitos en la vida” y “crecimiento personal”; dimensiones con calificaciones más bajas son “relaciones positivas” y “autonomía”. se concluye que el bienestar psicológico es percibido mejor en función de plantearse metas para sí mismo y mostrar una mejora, pero que la autonomía se ve afectada, así como las relaciones positivas (desconfianza, construcción de relaciones nuevas cuando se es desplazado) por asuntos relacionados con el conflicto armado. Los hallazgos permitirán mejorar las acciones de atención