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

Clinical practice guideline. Fitness to drive in cognitive impairment and dementia

El deterioro de las funciones cognitivas puede afectar a las habilidades de conducción vehicular representando un riesgo de salud pública al incrementar los accidentes de tránsito. El deterioro cognitivo leve y las demencias se caracterizan por presentar alteraciones cognitivas que afectan, en mayor o menor grado, a las actividades instrumentales de la vida diaria e influyen en la conducción segura. El Grupo de Trabajo de Neurología de la Conducta y Neurociencias Cognitivas de la Sociedad Neurológica Argentina ha elaborado esta Guía de práctica clínica para facilitar a los profesionales médicos la evaluación de pacientes en quienes se sospecha deterioro cognitivo o demencia y para detectar y prevenir eventuales conductas de riesgo.Cognitive impairment may compromise driving skills and represent a public health risk by increasing traffic accidents. Mild Cognitive Impairment and Dementia are characterized by cognitive impairment affecting to a greater or lesser degree the instrumental activities of daily living and fitness to drive. The Argentine Neurologic Society Working Group on Behavioural Neurology and Cognitive Neurosciences has prepared this clinical practice guideline to help physicians evaluate patients suspected to present cognitive impairment or dementia and detect and prevent risky behaviors.Fil: Allegri, Ricardo Francisco. Sociedad Neurológica Argentina. Buenos Aires; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Arizaga, Raúl Luciano. Sociedad Neurológica Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Bavec, Claudia Veronica. Sociedad Neurológica Argentina; ArgentinaFil: Barreto, María Dolores. Sociedad Neurológica Argentina; ArgentinaFil: Brusco, Luis Ignacio. Sociedad Neurológica Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Colli, Liliana Patricia. Sociedad Neurológica Argentina; ArgentinaFil: Demey, Ignacio. Sociedad Neurológica Argentina; ArgentinaFil: Fernandez, Maria Cecilia. Sociedad Neurológica Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Frontera, Silvana A.. Sociedad Neurológica Argentina; ArgentinaFil: Garau, Maria Laura. Sociedad Neurológica Argentina; ArgentinaFil: Gimenez, Julio Jorge. Sociedad Neurológica Argentina; ArgentinaFil: Golimstok, Angel. Sociedad Neurológica Argentina; ArgentinaFil: Kremer, Janus. Sociedad Neurológica Argentina; ArgentinaFil: Labos, Luisa Edit. Sociedad Neurológica Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Leis, Adriana Mónica. Sociedad Neurológica Argentina; ArgentinaFil: Lopez Llano, María Luz. Sociedad Neurológica Argentina; ArgentinaFil: Mangone, Carlos Alberto. Sociedad Neurológica Argentina; ArgentinaFil: Ollari, Juan Alberto. Sociedad Neurológica Argentina; ArgentinaFil: Rojas, Zenón Galeno. Sociedad Neurológica Argentina; Argentina. Consejo Nacional de Investigaciones Científicas y Técnicas; ArgentinaFil: Russo, María Julieta. Sociedad Neurológica Argentina; ArgentinaFil: Serrano, Mariela Cecilia. Sociedad Neurológica Argentina; ArgentinaFil: Somale, Maria Veronica. Sociedad Neurológica Argentina; ArgentinaFil: D. Souza, Leandro. Sociedad Neurológica Argentina; ArgentinaFil: Ure, Jorge Alberto. Sociedad Neurológica Argentina; ArgentinaFil: Zuin, Daniel Raul. Sociedad Neurológica Argentina; Argentin