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

Impact of mitral regurgitation on the outcome of patients treated with CRT-D: data from the InSync ICD Italian Registry.

Background: We assessed the influence of clinically significant mitral regurgitation (MR) on clinical-echocardiographic response and outcome in heart failure (HF) patients treated with a biventricular defibrillator (cardiac resynchronization therapy defibrillator [CRT-D]). Methods and Results: A total of 659 HF patients underwent successful implantation of CRT-D and were enrolled in a multicenter prospective registry (median follow-up of 15 months). Following baseline echocardiographic evaluation, patients were stratified into two groups according to the severity of MR: 232 patients with more than mild MR (Group MR+: grade 2, 3, and 4 MR) versus 427 patients with mild (grade 1) or no functional MR (Group MR−). On 6- and 12-month echocardiographic evaluation, MR was seen to have improved in the vast majority of MR+ patients, while it remained unchanged in most MR− patients. On 12-month follow-up evaluation, a comparable response to CRT was observed in the two groups, in terms of the extent of left ventricular reverse remodeling and combined clinical and echocardiographic response. During long-term follow-up, event-free survival did not differ between MR+ and MR− patients, even when subpopulations of patients with ischemic heart disease and with dilated cardiomyopathy were analyzed separately. On multivariate analysis, the only independent predictor of death from any cause was the lack of β-blocker use. Conclusions: This observational analysis supports the use of CRT-D in HF patients with clinically significant MR; MR had no major influence on patient outcom

Searches for heavy neutral lepton production and lepton flavour violation in kaon decays at the NA62 experiment

Search for heavy neutral lepton (HNL) production and lepton flavor and number violation (LFV/LNV) in charged kaon decays using the data collected by Kaon experiment NA62 at CERN are reported. Upper limits are established on the elements of the extended neutrino mixing matrix for heavy neutral lepton mass in the range 130-450 MeV, improving on the results from previous HNL production search. The progress and prospects in different LNV/LFV analysis on data sets from 2015-2018 are reviewed

Search for production of an invisible dark photon from π0 decays at NA62

A search for an invisible dark photon A' has been performed, exploiting the efficient photon-veto capability and high resolution tracking of the NA62 detector at CERN. The signal stems from the chain K+ → π+π0 followed by π0 → A'γ. No significant statistical excess has been identified. Upper limits on the dark photon coupling to the ordinary photon as a function of the dark photon mass have been set, improving on the previous limits over the mass range 60–110 MeV/c

Search for LNV/LFV K+ decays at the NA62 experiment at CERN

New results are presented for the first time of searches for lepton number violating (LNV) decays K+ → π−e+e+ and K+ → π−μ+μ+ from the NA62 experiment at CERN using a subset of 2017 data. No LNV signals are observed and upper limits are set on the branching ratios, B(K+ → π−e+e+) < 2.2 × 10−10 and B(K+ → π−μ+μ+) < 4.2 × 10−11, at 90% confidence level

Search for production of an invisible dark photon from π0 decays at NA62

A search for an invisible dark photon A' has been performed, exploiting the efficient photon-veto capability and high resolution tracking of the NA62 detector at CERN. The signal stems from the chain K+ → π+π0 followed by π0 → A'γ. No significant statistical excess has been identified. Upper limits on the dark photon coupling to the ordinary photon as a function of the dark photon mass have been set, improving on the previous limits over the mass range 60–110 MeV/c