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

Statut des lectrices et pratique de lecture dans le projet pédagogique de madame de Genlis

La voix que Madame de Genlis prête aux femmes est souvent celle de la lectrice, lectrice solitaire dans son intimité ou voix lisant en public, personnage typique du dix-huitième siècle, époque où la place des femmes est cantonnée dans une visibilité plus apparente que substantielle. Leur fonction n’est cependant pas simplement iconique ; au contraire, elle est le signe d’un goût en formation et qui va inspirer un des canons de l’imaginaire : Montrer un personnage en train de lire un roman éta..

Le premier Huysmans et les critiques de son temps (1874-1883)

De son vivant Huysmans a fait l objet de critiques contradictoires et de vives polémiques. En proposant un ensemble de plus de 300 articles, qui illustrent les premières réactions de la critique devant son œuvre, du Drageoir à épices (1874) à À vau-l eau (1882), cette thèse tente de dégager les principaux thèmes auxquels s attachent les commentateurs et les sujets qui les opposent.La première notoriété de Huysmans est le fruit de son engagement dans la bataille naturaliste. Son étude sur L Assommoir, publiée dans L Actualité de Bruxelles en 1877, et sa contribution aux Soirées de Médan, en 1880, montrent son adhésion à la nouvelle école. Et la critique ne manque pas de situer ses premiers écrits dans le sillage de Goncourt et de Zola.Si quelques critiques reconnaissent le talent de Huysmans, d autres le discréditent. Son style, qui séduit les uns, choque les autres. De nombreux chroniqueurs condamnent l immoralité de Marthe, déplorent la présence de motifs scatologiques dans Les Sœurs Vatard, En ménage et Sac au dos, déprécient En ménage et À vau-l eau pour l absence d intrigue et la vision pessimiste qui s en dégage.Rares sont les commentaires sensibles aux aspects novateurs de son œuvre, à la promesse d un affranchissement par rapport à l esthétique naturaliste, et au fait que Huysmans réussit à se distinguer en réalisant sa double ambition : se faire connaître et conserver son autonomie.During his lifetime, Huysmans was the object of varied and sometimes controversial criticism. By proposing more than 300 articles that illustrate the critics first reactions to Huysmans s work, from Drageoir à épices (1874) to À vau-l eau (1882), this thesis aims to identify the main themes presented by critics and those who oppose them.Huysmans first came to prominence thanks to his commitment to the naturalist cause. His study of L Assommoir, published in L Actualité of Brussels in 1877, and his contribution to the Soirées de Médan, in 1880, are evidence of his belonging to the new school, and critics would soon enough place Huysmans s first texts in the footsteps of Goncourt and Zola.If a number of critics appreciate Huysmans s talent, many others discredit him. His style, seductive for some, can be shocking for others. Many chroniclers condemn the immorality of Marthe, deplore the presence of scatological motifs in Les Sœurs Vatard, En ménage and Sac au dos, and even depreciate En ménage and À vau-l eau for their lack of intrigue and their pessimistic points of view.Few are the comments which recognize the innovative aspects of his work, the promise of emancipation from the naturalist aesthetic and the fact that Huysmans distinguishes himself by reaching his double ambition: being both well-known and keeping his autonomy.PARIS4-Bib. électronique (751059905) / SudocSudocFranceF