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

Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic

This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic

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

Campo abierto

Resumen en inglésSe describen las actividades cooperativas entre el Colegio Santa María Assumpta de Badajoz y la Universidad de Extremadura relacionados con la educación ambiental, la bioética, la medicina popular, etc. actividades adaptadas al momento psicoevolutivo de los alumnos de Secundaria y englobadas en el área de Ciencias de la Naturaleza.ExtremaduraConsejería de Educación. Dirección General de Política Educativa; Calle Delgado Valencia, 6; 06800 Mérida (Badajoz); Tel. +34924006714; Fax +34924006716; [email protected]

Commentaria litteralia, moralia, mystica in Genesim, de opere sex dierum ...

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Por el Marques de Uillena y Moya, Duque de Escalona. Con el señor Fiscal de la Real Hazienda. Sobre la nulidad de un instrumento, que se supone ser transaccion de las alcavalas de la villa, y tierra de Moya

A 111/138(01

La subcontratación laboral en América Latina: miradas multidimensionales

La subcontratación laboral, la flexibilidad laboral externa, la terciarización laboral, la deslaboralización de las relaciones de trabajo y el trabajo no registrado, son distintas términos para nombrar la exteriorización de los riesgos que los empresarios descargan sobre los trabajadores y las trabajadoras, quienes, sin el apoyo de las garantías del derecho laboral, quedan sometidos a las presiones de los contratos del derecho civil. Este libro aborda esta problemática que afecta a todos los trabajadores del Continente

Tratados de artes figurativas [Recurso electrónico]

PC 486; 8 Mb de memoria RAM, recomendado 16 MB; MS-DOS 6.0 y Microsoft Windows 3.1 o superior; Espacio libre en disco local superior a 10 Mb; Monitor VGA, recomendado SVGA, resolución 800x600, 256 colores; Lector de CD-ROM local o en red.Tít. tomado de la etiquetaArce y Cacho, Celedonio Nicolás De: Conversaciones sobre la escultura: compendio historico, teorico y practico de ella... En Pamplona: Por Joseph Longas, 1786. -- Arfe y Villafañe, Juan: Qvilatador de la plata, oro, y piedras. Impresso en Valladolid: por Alonso y Diego Fernandez de Cordoua, 1572. -- Arfe y Villafañe, Juan: De varia commensvracion para la escvltvra, y Architectura. En Sevilla: En la imprenta de Andrea Pescioni y Iuan de Leon, 1585. -- Arteaga, Esteban De: Investigaciones filosoficas sobre la belleza ideal, considerada como objeto de todas las artes de imitación. En Madrid: Por don Antonio de Sancha, 1789. -- [Butrón, Juan De]: Epístola dirigida al rey solicitando protección para la Academia. [S. l.]: [s. n.], [s. d.]. -- Butrón, Juan De: Discvrsos apologeticos en qve se defiende la ingenvidad del arte de la pintvra... En Madrid: Por Luis Sánchez, 1626. -- Cabrera, Claudio Antonio De: Ivizio de artes y sciencias. En Madrid: por Iulian de Paredes, 1655. -- Carducho, Vincencio: Dialogo de la pintvra sv defensa, origen, essencia, definicion, modos y diferencias. [En Madrid]: Impresso con licencia por Francisco Martínez, 1633. -- Caveda, José: Memorias para la Historia de la Real Academia de San Fernando... [2 vol.]. Madrid: [s. n.] (Imprenta de Manuel Tello), 1867. -- Ceán Bermúdez, Juan Agustín: Diccionario historico de los mas ilustres profesores de Bellas Artes en España [6 vol.]. Madrid: Real Academia de San Fernando, 1800. -- Ceán Bermúdez, Juan Agustín: Ocios de Don Juan Agustín Cean-Bermudez sobre Bellas Artes: (hasta ahora ineditos). Madrid: [s. n.] (Imprenta de Berenguillo), 1870. -- Copia de los pareceres, y censvras de los reverendissimos padres maestros... En Madrid: Por la vivda de Alonso Martin, 1632. -- Elogios al Palacio Real del Bven Retiro. En Madrid: En la Imprenta del Reyno, 1635. -- Esquivel, Antonio María: Tratado de anatomía pictórica... Madrid: [s. n.] (Imprentra de Don Francisco Andrés y Compañía), 1848. -- Estatutos de la Real Academia de San Fernando. En Madrid: En Casa de D. Gabriel Ramírez, 1757. -- Galofre, José: El artista en Italia y demas paises de Europa... Madrid: Monier (Imprenta de L. García), 1851. -- García De La Huerta, Pedro: Comentarios de la pintura encáustica del pincel. En Madrid: En la Imprenta Real, 1795. -- Giner, Hermenegildo: Teoría del arte e historia de las artes bellas en la antigüedad. Baeza: Imp. y lib. de la Comisión general de libros, 1873. -- Giner, Hermenegildo: Filosofía y arte. Madrid: [s. n.] (Imprenta de M. Minuesa de los Ríos), 1878. -- Guevara, Felipe De: Comentarios de la pintura. Madrid: Por don Gerónimo Ortega, hijos de Ibarra y compañia, 1788. -- Gutiérrez De Los Ríos, Gaspar: Noticia general para la estimación de artes... En Madrid: Por Pedro Madrigal, 1600. -- Haes, Carlos De: De la pintura de paisaje antigua y moderna... [S. l.]: [s. n.], [s. d.]. (**) -- Interian De Ayala, Juan: El pintor christiano, y erudito, ó tratado de los errores... [2 vol.]. Madrid: Por D. Joachín Ibarra, 1782. -- Madrazo, Pedro De: Catálogo de los cuadros del Real Museo de Pintura y Escultura de S.M.Madrid: [s. n.] (Oficina deAguado, Impresor de Cámara), 1843. -- Manjarres y De Bofarull, José De: Teoría é Historia de las Bellas Artes... Barcelona: Librería de Joaquín Verdaguer, 1859. -- Martínez, Francisco: Introduccion al conocimiento de las Bellas Artes o Diccionario manual de Pintura, Escultura, Arquitectura, Grabado, etc. Madrid: Por la Viuda de Escribano, 1788. -- Martínez, Juseppe: Discursos practicables del nobilísimo arte de la pintura... Madrid: Real Academia de San Fernando, 1866. -- Mendoza, Francisco De: Manual del pintor de historia... Madrid: [s. n.] (Imprenta de T. Fontanet), 1870. -- Mengs, Antonio Rafael: Obras de D. Antonio Rafael Mengs, primer pintor de camara del rey. En Madrid: Por don Joseph Nicolas de Azara, 1780. -- Moreno De Tejada, Juan: Excelencias del pincel y del buril... Madrid: En la Imprenta de Sancha, 1804. -- Pacheco, Francisco: Arte de la pintvra, sv antigvedad y grandezas. En Sevilla: Por Simón Faxardo, impressor de libros, a la Cerrajeria, 1649. -- Palomino De Castro y Velasco, Antonio: El museo pictorico y escala optica [3 vol.]. EnMadrid: Por LucasAntonio de Bedmar, Impresor del Reyno, 1715. -- Pi y Margall, Francisco: Historia de la Pintura en España... Madrid: [s. n.] (Imprenta à cargo de Manini hermanos), 1851. -- Rejón De Silva, Diego Antonio: La Pintura: Poema didactico en tres cantos. En Segovia: Por Don Antonio Espinosa de los Monteros, 1786. -- Tebano, Parraiso: Arcadia pictórica en sueño, alegoría ó poema prosaico sobre la teórica y práctica de la pintura. Madrid: Por Don Antonio de Sancha, 1789