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

Assessment of the physical characteristics and stormwater effluent quality of permeable pavement systems containing recycled materials

This paper evaluates the physical characteristics of two recycled materials and the pollutant removal efficiencies of four 0.2 m2 tanked permeable pavement rigs in the laboratory, that contained either natural aggregates or these recycled materials in the sub-base. The selected recycled materials were Crushed Concrete Aggregates (CCA) and Cement-bounded Expanded Polystyrene beads (C-EPS) whilst the natural aggregates were basalt and quartzite. Natural stormwater runoff was used as influent. Effluent was collected for analysis after 7–10 mins of discharge. Influent and effluent were analysed for pH, Chemical Oxygen Demand (COD), Dissolved Oxygen (DO), Electroconductivity (EC), turbidity, Total Suspended Solids (TSS), Total Dissolved Solids (TDS), Nitrate-Nitrogen (NO3-N), reactive phosphorous (PO43-) and sulphates (SO42-). Both CCA and C-EPS had suitable physical properties for use as sub-base materials in PPS. However, C-EPS is recommended for use in pavements with light to no traffic because of its relatively low compressive strength. In terms of pollutant removal efficiencies, significant differences (p 0.05) were found with respect to TSS, turbidity, COD and NO3-N. Effluent from rigs containing CCA and C-EPS saw significant increases in pH, EC and TDS measurements whilst improvements in DO, TSS, turbidity, COD, PO43- and SO42- were observed. All mean values except pH were, however, within the Maximum Permissible Levels (MPLs) of water pollutants discharged into the environment according to the Trinidad and Tobago Environmental Management Authority (EMA) or the United States Environmental Protection Agency (US EPA). In this regard, the CCA and C-EPS performed satisfactorily as sub-base materials in the permeable pavement rigs. It is noted, however, that further analysis is recommended through leaching tests on the recycled materials

Multi-Leptons with High Transverse Momentum at HERA

18 pages, 3 figures, revised version with small textual changesEvents with at least two high transverse momentum leptons (electrons or muons) are studied using the H1 and ZEUS detectors at HERA with an integrated luminosity of 0.94 fb^{-1}. The observed numbers of events are in general agreement with the Standard Model predictions. Seven di- and tri-lepton events are observed in e^+p collision data with a scalar sum of the lepton transverse momenta above 100 GeV while 1.94+-0.17 events are expected. Such events are not observed in e^-p collisions for which 1.19+-0.12 are predicted. Total visible and differential di-electron and di-muon photoproduction cross sections are extracted in a restricted phase space dominated by photon-photon collisions