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

Andean bears and people in Apolabamba, Bolivia : culture, conflict and conservation

This thesis deals in qualitative and quantitative terms with the interaction between Andean bears and people in Apolobamba, Bolivia. This mountain range is an important stronghold for this species, which is little-studied and yet of considerable conservation concern. Apolobamba is also a stronghold for traditional beliefs and attitudes towards bears. In addition, this area afforded the opportunity to compare human-bear interaction between people living in and outside of a protected area. Key ecological findings include the first description of the activity patterns of the species - both bears having displayed diurnal activity with two peaks on either side of a midday trough. Movement patterns, also previously undescribed for this species, were characterised by highly overlapping moderately sized home ranges. Seasonal variation was documented in activity patterns and in habitat use according to changes in the availability of bear foods. In an omnivorous diet similar to what has been found in other studies, bromeliads were shown to be a staple food of markedly low nutritive value - highlighting the attraction of anthropogenic food sources such as maize and beef. Myths and rituals relating to bears were documented. The famous "Bear's Son" tale was far from being the only bear-related story in circulation, contrary to what had previously been supposed. Accompanying the wide range of depictions of bears in these stories, there was also documented a wide range of bear-related beliefs and attitudes. At one extreme, the beat was thought merely a pest animal, no good for anything, dangerous to people and its possible extinction considered good. At the other extreme, the bear was thought God-like, possessing seven human souls, with a high medicinal value to its body parts and its possible extinction considered tragic. Perceived depredation of crops and livestock was high, although this was not corroborated by investigations on the ground. Frustration about the restrictions of living inside the protected area focussed on the prohibition against killing problem animals. Despite the evident cultural salience of bears, most people in Apolobamba would be glad if there were no more in the future. However, tolerance was higher in certain valleys, amongst older people and those who did not keep livestock

Data from: Photos provide information on age, but not kinship, of Andean bear

Using photos of captive Andean bears of known age and pedigree, and photos of wild Andean bear cubs <6 months old, we evaluated the degree to which visual information may be used to estimate bears’ ages and assess their kinship. We demonstrate that the ages of Andean bear cubs ≤6 months old may be estimated from their size relative to their mothers with an average error of <0.01 ± 13.2 days (SD; n = 14), and that ages of adults ≥10 years old may be estimated from the proportion of their nose that is pink with an average error of <0.01 ± 3.5 years (n = 41). We also show that similarity among the bears’ natural markings, as perceived by humans, is not associated with pedigree kinship among the bears (R2 < 0.001, N = 1,043, p = 0.499). Thus, researchers may use photos of wild Andean bears to estimate the ages of young cubs and older adults, but not to infer their kinship. Given that camera trap photos are one of the most readily available sources of information on large cryptic mammals, we suggest that similar methods be tested for use in other poorly understood species

Photos provide information on age, but not kinship, of Andean bear

Using photos of captive Andean bears of known age and pedigree, and photos of wild Andean bear cubs <6 months old, we evaluated the degree to which visual information may be used to estimate bears’ ages and assess their kinship. We demonstrate that the ages of Andean bear cubs ≤6 months old may be estimated from their size relative to their mothers with an average error of <0.01 ± 13.2 days (SD; n = 14), and that ages of adults ≥10 years old may be estimated from the proportion of their nose that is pink with an average error of <0.01 ± 3.5 years (n = 41). We also show that similarity among the bears’ natural markings, as perceived by humans, is not associated with pedigree kinship among the bears (R2 < 0.001, N = 1,043, p = 0.499). Thus, researchers may use photos of wild Andean bears to estimate the ages of young cubs and older adults, but not to infer their kinship. Given that camera trap photos are one of the most readily available sources of information on large cryptic mammals, we suggest that similar methods be tested for use in other poorly understood species

Visual estimates of the sizes of Andean bear cubs relative to their mothers

This csv file contains data from photos of Andean bear cubs in captivity and in the wild (Cerro Venado, Lambayeque, Peru)

Perceived similarity of the facial markings of captive Andean bears

This csv file contains data from an online survey in which participants were asked to rate the perceived similarity of the facial markings of the two captive bears shown in sequential pairs of photos

Visual estimates of the sizes of Andean bear cubs relative to their mothers

This csv file contains data from photos of Andean bear cubs in captivity and in the wild (Cerro Venado, Lambayeque, Peru)