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

Don Juan de Torres y Portugal Conde del Villar y su tia hermanos y primos contra Don Fernando de Torres y Portugal menor hijo natural de Don Manuel de Torres vezinos de la ciudad de Jaen [Pleito]

Fecha aprox. de imp. deducida del resto de doc. con los que está encuadernadoEnc. Perg

Memorial del pleyto que trata el Colegio de la Compañia de Iesus de la ciudad de Iaê, como heredero de Alonso de Valençuela, vezino y Ventiquatro que fue de ella, con D. Iuan de Torres y Portugal, Conde del Villar D. Pardo, Marques de Cañete

En port. grab. xil. monograma IHSInic. grab.Enc. HolandesaSign.: A-I2, K3, L-S

Adicion al Memorial del pleyto que trata el Colegio de la Compañia de Iesus de la ciudad de Iaen, con don Iuan de Torres y Portugal, Conde del Villar Don Pardo

Pie de imp. tomado del Memorial al que se alude y con el que coinciden todas las característicasNo recogido en LopHueVid. A-044-119 (13) y A-044-119 (18)Enc. HolandesaSign.: A-D

Por Don Juan Alphonso de Sousa, y Portugal, vecino de la ciudad de Cordova, Marquès de Guadalcazar, en el pleyto con Don Luis Fernandez de Cordoba, Conde de Torres Cabrera ... sobre pretender dicho conde, que el Marqués trayga à el deposito de la testamentaria del defunto conde Don Juan Fernandez de Cordova, su padre, 12.000 ducados / [Ldo. Don Cristoval de Espinosa Ocampo].

Port. orlada y con grab. xil. de la InmaculadaInic. grab.Encuadernado en v. de variosEnc. HolandesaSign.: A-K

Memorial del pleyto que trata el Colegio de la Cõpañia de Iesus de la ciudad de Iaen, como heredero de Alonso de Valençuela, vezino y Ventiquatro que fue de ella, con D. Iuan de Torres y Portugal, Côde del Villar D. Pardo, Marques de Cañete / [Don Rodrigo Calderon]

En port. grab. xil. monograma IHSInic. grab.Está suscrito con autógrafo de Rodrigo CalderónNo recogido en LopHue.[Vid. A-044-119 (18)]Enc. HolandesaSign.: A-T

Impact of COVID-19 on Diagnostic Cardiac Procedural Volume in Oceania: The IAEA Non-Invasive Cardiology Protocol Survey on COVID-19 (INCAPS COVID)

Objectives: The INCAPS COVID Oceania study aimed to assess the impact caused by the COVID-19 pandemic on cardiac procedure volume provided in the Oceania region. Methods: A retrospective survey was performed comparing procedure volumes within March 2019 (pre-COVID-19) with April 2020 (during first wave of COVID-19 pandemic). Sixty-three (63) health care facilities within Oceania that perform cardiac diagnostic procedures were surveyed, including a mixture of metropolitan and regional, hospital and outpatient, public and private sites, and 846 facilities outside of Oceania. The percentage change in procedure volume was measured between March 2019 and April 2020, compared by test type and by facility. Results: In Oceania, the total cardiac diagnostic procedure volume was reduced by 52.2% from March 2019 to April 2020, compared to a reduction of 75.9% seen in the rest of the world (p<0.001). Within Oceania sites, this reduction varied significantly between procedure types, but not between types of health care facility. All procedure types (other than stress cardiac magnetic resonance [CMR] and positron emission tomography [PET]) saw significant reductions in volume over this time period (p<0.001). In Oceania, transthoracic echocardiography (TTE) decreased by 51.6%, transoesophageal echocardiography (TOE) by 74.0%, and stress tests by 65% overall, which was more pronounced for stress electrocardiograph (ECG) (81.8%) and stress echocardiography (76.7%) compared to stress single-photon emission computerised tomography (SPECT) (44.3%). Invasive coronary angiography decreased by 36.7% in Oceania. Conclusion: A significant reduction in cardiac diagnostic procedure volume was seen across all facility types in Oceania and was likely a function of recommendations from cardiac societies and directives from government to minimise spread of COVID-19 amongst patients and staff. Longer term evaluation is important to assess for negative patient outcomes which may relate to deferral of usual models of care within cardiology