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

Youwin

Youwin es un proyecto que busca ayudar a los microempresarios en aspectos de marketing digital. Para ello, se le ofrece un servicio integrado que abarca la creación de un logo o portada, en caso no lo tuviera, así como la planificación y ejecución de un sorteo en redes sociales. Adicional a ello, durante el proceso se dan recomendaciones que puedan ayudar a sostener esta estrategia de promoción, así como algunos detalles tributarios a tomar en cuenta que permitan crecer el negocio del microempresario. Difundirse en redes sociales en esta época de confinamiento social es clave para los pequeños negocios, pues ya no podrán ofrecer sus servicios presencialmente como lo solían hacer ni con la frecuencia de antes cuando la cuarentena termine. Con recientes estudios estadísticos y entrevistas propias realizadas se determinó que alrededor del 50% de microempresas no tienen redes o son incipientes en estas. En este contexto nace Youwin, que busca a largo plazo posicionarse como un aliado del microempresario y ser reconocidos como una ventana para ofrecer sus servicios o productos.Youwin is a project that seeks to help microentrepreneurs in aspects of digital marketing. For this, an integrated service is offered that covers the creation of a logo or cover, in case it does not have it, as well as the planning and execution of a draw on social networks. In addition to this, during the process recommendations are given that may help sustain this promotion strategy, as well as some tax details to take into account that allow the microentrepreneur´s business to grow. Spreading on social networks in this time of social confinement is key for small businesses, since they will no longer be able to offer their services in person as they used to do or as often as before when the quarantine ends. With recent statistical studies and own interviews, it was determined that around 50% of microenterprises do not have networks or are incipient in these. In this context, Youwin was born, which seeks in the long term to position itself as an ally of the microentrepreneur and to be recognized as a window to offer its services or BLABproducts.Trabajo de investigació