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

Summary statistics of UK Biobank blood pressure genome-wide association studies (GWAS) using 337,422 unrelated white European individuals

Three blood pressure traits were analysed: systolic blood pressure (SBP), diastolic blood pressure (DBP) and pulse pressure (PP; the difference between SBP and DBP). Mean SBP and DBP values from automated values were calculated. After calculating blood pressure values, SBP and DBP were adjusted for medication use by adding 15 and 10 mm Hg to their values, respectively, for individuals reported to be taking blood pressure–lowering medication.For the UK Biobank genome-wide association studies (GWAS), we performed linear mixed model (LMM) association testing under an additive genetic model of the three continuous, medication-adjusted blood pressure traits (SBP, DBP, PP) for all measured and imputed genetic variants (Data Field-22828) with minor allele frequency (MAF) >=1% and imputation score>=0.3 in dosage format using the BOLT-LMM (v2.4.1) software. Covariates were age, age2, sex, BMI, genotyping array and 10PCs. Genomic inflation was not applied to the GWAS summary statistics.Sample QC was described below:We included up to 337,422 individuals from UK Biobank for the purpose of this project. We followed UK Biobank sample-based quality control criteria (Nature 2018;562:203-209); excluded were samples/individuals based on the following criteria: (i) outliers in heterozygosity and missingness, (ii) self-reported gender not consistent with genetic data inferred gender (ii) sample call rate (computed using probesets internal to Affymetrix

Additional file 22 of Implicating genes, pleiotropy, and sexual dimorphism at blood lipid loci through multi-ancestry meta-analysis

Additional file 22: Table S14. Test for difference in effects for index variants from sex-stratified meta-analysis