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

Incidentally Learned Emotional Valence Affects Spatial Working Memory

Little is known on how emotion information is processed in the working memory system, especially in the visuo-spatial domain. The aim of the present research was to investigate the effect of incidentally learned emotional stimuli on short-term memory for object-location. In the two experiments presented we sought to ascertain the role of valence in spatial working memory by keeping the level of pictures’ arousal constant, and by modulating the level of pictures’ valence. Participants (N=18 in Experiment A; N=21 in Experiment B) were submitted to a modified version of the object relocation task: eight black rectangles appeared (1s) simultaneously on the screen of a computer; this was immediately followed by the sequential presentation of 8 pictures selected from the International Affective Picture System (1s for each picture; ISI: 250 ms) superimposed onto each rectangle. Rectangle position was tagged with pictures with comparable arousal levels, negative and neutral in Experiment A, and positive and neutral in Experiment B. In both cases valence is a within-subject factor. Immediately after presentation, participants had to relocate the black rectangles in the original position as accurately as possible. The statistical analyses (paired t- tests) carried out on displacement errors revealed a significant effect of valence: lower displacement errors for negative-related objects compared to neutral ones (t(17) = −2.89; p < 0.05) in Experiment A, and lower displacement errors for objects associated to positive pictures than those associated to neutral ones (t(20) = 2.28; p < 0.05) in Experiment B. Overall, findings show that when arousal is kept constant (at a low level) the position of negative-related objects (Experiment A) or positive- related object (Experiment B) are better relocated than neutral ones in an immediate visuo-spatial working memory test, thus indicating that valence significantly affects visuo-spatial performance