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

Pandemic Policing: Public Attitudes Towards Compliance and Organisational Resilience, 2020-2021

The UK's COVID-19 response has provided the police with new powers which potentially impinge upon civil liberties, altering the nature of policing activities. National policing bodies have encouraged a compliance not coercion approach based upon the 4 E's of Engage, Explain, Encourage and Enforce. In an innovative collaboration between the University of Portsmouth and Hampshire Constabulary, this research considers the impact of pandemic policing on the police and the public. It seeks to analyse the experiences of police officers and police leaders in exceptional circumstances and to explore the physical and psychological challenges of pandemic policing. This knowledge will provide evidence of i) organisational resilience, risk identification and effective decision-making, ii) strategies for the maintenance of future service delivery and iii) the impact of pandemic policing on police wellbeing. The research will also consider how the worldviews of individuals influence their perceptions of COVID-19 restrictions, their willingness to comply and key drivers of compliance/non-compliance which will shape the medium-long term police response. This knowledge will provide evidence of iv) effective policing in a crisis, v) public satisfaction/confidence in the police, vi) whether and for how long the public are willing to suspend their civil liberties and vii) factors that underlie any social/spatial variability. The link between perceptions of police legitimacy and willingness to comply means this understanding is crucial. Research findings will be scaled up into evidenced-based policing policies/practices nationally and its impact assessed and practices modified over the period of the crisis and beyond.The UK's COVID-19 response has provided the police with new powers which potentially impinge upon civil liberties, altering the nature of policing activities. National policing bodies have encouraged a compliance not coercion approach based upon the 4 E's of Engage, Explain, Encourage and Enforce. In an innovative collaboration between the University of Portsmouth and Hampshire Constabulary, this research considers the impact of pandemic policing on the police and the public. It seeks to analyse the experiences of police officers and police leaders in exceptional circumstances and to explore the physical and psychological challenges of pandemic policing. This knowledge will provide evidence of i) organisational resilience, risk identification and effective decision-making, ii) strategies for the maintenance of future service delivery and iii) the impact of pandemic policing on police wellbeing. The research will also consider how the worldviews of individuals influence their perceptions of COVID-19 restrictions, their willingness to comply and key drivers of compliance/non-compliance which will shape the medium-long term police response. This knowledge will provide evidence of iv) effective policing in a crisis, v) public satisfaction/confidence in the police, vi) whether and for how long the public are willing to suspend their civil liberties and vii) factors that underlie any social/spatial variability. The link between perceptions of police legitimacy and willingness to comply means this understanding is crucial. Research findings will be scaled up into evidenced-based policing policies/practices nationally and its impact assessed and practices modified over the period of the crisis and beyond.</p

Regional and Local Economics (2007/2008): examination paper

Regional and Local Economics (2007/2008): examination paper from Portsmouth Business School, University of Portsmouth.