10 research outputs found

    Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

    Get PDF
    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

    La sociedad de la urbanizaciĂłn total. CartografĂ­a y legislaciĂłn parametrizable

    Full text link
    La sucesiĂłn normativa (como la legislaciĂłn del suelo madrileña actual y en revisiĂłn) y los intentos por atraer inversiones de capital atestiguan la decisiĂłn de la expansiĂłn urbanizadora como instrumento de reestructuraciĂłn del sistema de producciĂłn-acumulaciĂłn regional. Desde la crisis inmobiliaria española, se han llevado a cabo numerosos intentos para atajar el problema desde la legislaciĂłn y normativa, como la Ley 5/2012, de 20 de diciembre, de Viviendas Rurales Sostenibles. “La Sociedad de la UrbanizaciĂłn Total: CartografĂ­a y LegislaciĂłn parametrizable” toma prestada la Ley ViRuS como caso de estudio para exponer las oportunidades que la cartografĂ­a de leyes brinda en la catalogaciĂłn de espacios, adaptaciĂłn y aportaciĂłn en los avances tecnolĂłgicos y anticipaciĂłn por medio de la parametrizaciĂłn. Siguiendo los parĂĄmetros que la legislaciĂłn marca, se realizan una serie de mapas por medio de la herramienta GIS. A partir de una base de datos (dBASE) de elaboraciĂłn propia, se genera una lĂ­nea de cĂłdigo en lenguaje Python: una compleja funciĂłn matemĂĄtica que genera simulaciones de la Ley de conformidad con las variables (shapefiles). The normative succession (such as the current and revised Madrid Soil Law) and the attempts to attract capital investment testify to the decision of urban expansion as an instrument for the restructuring of the regional production-accumulation system. Since the Spanish real estate crisis, numerous attempts have been made to tackle the problem through legislation and regulations, such as Law 5/2012, of December 20, on Sustainable Rural Housing. “The Society of Total Urbanization: Cartography and Parameterizable Legislation” borrows the ViRuS (Sustainable Rural Housing) Law as a case study to expose the opportunities that the cartography of laws offers in the cataloging of spaces, adaptation and contribution to technological advances and anticipation through the parameterization. Following the parameters established by the legislation, a series of maps are made using the GIS tool. From a self-made database (dBASE), a line of code is generated in Python language: a complex mathematical function that generates simulations of the Law in accordance with the variables (shapefiles)

    Santorcaz. Propuestas bioclimĂĄticas en el espacio pĂșblico

    Full text link
    Santorcaz. Propuestas bioclimĂĄticas en el espacio pĂșblico. PublicaciĂłn digital de los trabajos elaborados por los estudiantes del curso 2020/21 de la asignatura La Ciudad y el Medio de la Escuela TĂ©cnica Superior de Arquitectura de Madrid de la Universidad PolitĂ©cnica de Madrid. Muestra una serie de propuestas elaboradas en la asignatura para mejorar bioclimĂĄticamente diferentes espacios pĂșblicos municipales en el marco del acuerdo realizado entre el Departamento de UrbanĂ­stica y OrdenaciĂłn del Territorio y el Excmo. Ayuntamiento de Santorcaz (Madrid)

    Bustarviejo. Propuestas bioclimĂĄticas en el espacio pĂșblico.

    Full text link
    Bustarviejo. Propuestas bioclimĂĄticas en el espacio pĂșblico. PublicaciĂłn digital de los trabajos elaborados por los estudiantes del curso 2017/18 de la asignatura La Ciudad y el Medio de la Escuela TĂ©cnica Superior de Arquitectura de Madrid de la Universidad PolitĂ©cnica de Madrid. Muestra una serie de propuestas elaboradas en la asignatura para mejorar bioclimĂĄticamente diferentes espacios pĂșblicos municipales en el marco del acuerdo realizado entre el Departamento de UrbanĂ­stica y OrdenaciĂłn del Territorio y el Excmo. Ayuntamiento de Bustarviejo (Madrid)

    Pezuela de las Torres. Propuestas bioclimĂĄticas en el espacio pĂșblico

    Full text link
    PublicaciĂłn de los trabajos elaborados por los estudiantes del curso 2019/20 de la asignatura 1602 - La Ciudad y el Medio de la Escuela TĂ©cnica Superior de Arquitectura de Madrid de la Universidad PolitĂ©cnica de Madrid. Muestra una serie de propuestas elaboradas en la asignatura para mejorar bioclimĂĄticamente diferentes espacios pĂșblicos municipales en el marco del acuerdo de colaboraciĂłn acadĂ©mica realizado entre el Departamento de UrbanĂ­stica y OrdenaciĂłn del Territorio y el Excmo. Ayuntamiento de Pezuela de Las Torres (Madrid)

    Geología de Huelva : lugares de interés geológico

    Get PDF

    Anchuelo. Propuestas bioclimĂĄticas en el espacio pĂșblico

    Full text link
    Anchuelo. Propuestas bioclimĂĄticas en el espacio pĂșblico. PublicaciĂłn digital de los trabajos elaborados por los estudiantes del curso 2021/22 de la asignatura La Ciudad y el Medio de la Escuela TĂ©cnica Superior de Arquitectura de Madrid de la Universidad PolitĂ©cnica de Madrid. Muestra una serie de propuestas elaboradas en la asignatura para mejorar bioclimĂĄticamente diferentes espacios pĂșblicos municipales en el marco del acuerdo realizado entre el Departamento de UrbanĂ­stica y OrdenaciĂłn del Territorio y el Excmo. Ayuntamiento de Anchuelo (Madrid)

    The impact of surgical delay on resectability of colorectal cancer: An international prospective cohort study

    Get PDF
    AimThe SARS-CoV-2 pandemic has provided a unique opportunity to explore the impact of surgical delays on cancer resectability. This study aimed to compare resectability for colorectal cancer patients undergoing delayed versus non-delayed surgery.MethodsThis was an international prospective cohort study of consecutive colorectal cancer patients with a decision for curative surgery (January-April 2020). Surgical delay was defined as an operation taking place more than 4 weeks after treatment decision, in a patient who did not receive neoadjuvant therapy. A subgroup analysis explored the effects of delay in elective patients only. The impact of longer delays was explored in a sensitivity analysis. The primary outcome was complete resection, defined as curative resection with an R0 margin.ResultsOverall, 5453 patients from 304 hospitals in 47 countries were included, of whom 6.6% (358/5453) did not receive their planned operation. Of the 4304 operated patients without neoadjuvant therapy, 40.5% (1744/4304) were delayed beyond 4 weeks. Delayed patients were more likely to be older, men, more comorbid, have higher body mass index and have rectal cancer and early stage disease. Delayed patients had higher unadjusted rates of complete resection (93.7% vs. 91.9%, P = 0.032) and lower rates of emergency surgery (4.5% vs. 22.5%, P ConclusionOne in 15 colorectal cancer patients did not receive their planned operation during the first wave of COVID-19. Surgical delay did not appear to compromise resectability, raising the hypothesis that any reduction in long-term survival attributable to delays is likely to be due to micro-metastatic disease
    corecore