O4 Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study

Abstract Background The impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on postoperative recovery is poorly understood. 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. The secondary outcome measure was pulmonary complications (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. 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 < 0·0001), age 70 years or older versus younger than 70 years (2·30 [1·65–3·22], p < 0·0001), American Society of Anesthesiologists grades 3–5 versus grades 1–2 (2·35 [1·57–3·53], p < 0·0001), 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 normal practice, particularly in men aged 70 years and older.

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Burden and outcome of neonatal surgical conditions in Nigeria: A countrywide multicenter cohort study

Journal of Neonatal Surgery ◽

10.47338/jns.v11.1029 ◽

2022 ◽

Vol 11 ◽

pp. 3

Author(s):

Hyginus Okechukwu Ekwunife ◽

Emmanuel Ameh ◽

Lukman Abdur-Rahman ◽

Adesoji Ademuyiwa ◽

Emem Akpanudo ◽

...

Keyword(s):

Cohort Study ◽

Surgical Site Infection ◽

Postoperative Complication ◽

Outcome Measure ◽

Postoperative Mortality ◽

Sub Saharan Africa ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Complication Rates ◽

Site Infection

Background: Despite a decreasing global neonatal mortality, the rate in sub-Saharan Africa is still high. The contribution and the burden of surgical illness to this high mortality rate have not been fully ascertained. This study is performed to determine the overall and disease-specific mortality and morbidity rates following neonatal surgeries; and the pre, intra, and post-operative factors affecting these outcomes. Methods: This was a prospective observational cohort study; a country-wide, multi-center observational study of neonatal surgeries in 17 tertiary hospitals in Nigeria. The participants were 304 neonates that had surgery within 28 days of life. The primary outcome measure was 30-day postoperative mortality and the secondary outcome measure was 30-day postoperative complication rates. Results: There were 200 (65.8%) boys and 104 (34.2%) girls, aged 1-28 days (mean of 12.1 ± 10.1 days) and 99(31.6%) were preterm. Sepsis was the most frequent major postoperative complication occurring in 97(32%) neonates. Others were surgical site infection (88, 29.2%) and malnutrition (76, 25.2%). Mortality occurred in 81 (26.6%) neonates. Case-specific mortalities were: gastroschisis (14, 58.3%), esophageal atresia (13, 56.5%) and intestinal atresia (25, 37.2%). Complications significantly correlated with 30-day mortality (p <0.05). The major risk predictors of mortality were apnea (OR=10.8), severe malnutrition (OR =6.9), sepsis (OR =7. I), deep surgical site infection (OR=3.5), and re-operation (OR=2.9). Conclusion: Neonatal surgical mortality is high at 26.2%. Significant mortality risk factors include prematurity, apnea, malnutrition, and sepsis.

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Determining universal processes related to best outcome in emergency abdominal surgery: a multicentre, international, prospective cohort study

BMJ Open ◽

10.1136/bmjopen-2014-006239 ◽

2014 ◽

Vol 4 (10) ◽

pp. e006239 ◽

Cited By ~ 7

Author(s):

Aneel Bhangu ◽

J Edward Fitzgerald ◽

Stuart Fergusson ◽

Chetan Khatri ◽

Hampus Holmer ◽

...

Keyword(s):

Cohort Study ◽

Abdominal Surgery ◽

Prospective Cohort Study ◽

Prospective Cohort ◽

Outcome Measure ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Perioperative Mortality ◽

Acute Surgery ◽

Emergency Abdominal Surgery

IntroductionEmergency abdominal surgery outcomes represent an internationally important marker of healthcare quality and capacity. In this study, a novel approach to investigating global surgical outcomes is proposed, involving collaborative methodology using ‘snapshot’ clinical data collection over a 2-week period. The primary aim is to identify internationally relevant, modifiable surgical practices (in terms of modifiable process, equipment and clinical management) associated with best care for emergency abdominal surgery.Methods and analysisThis is a multicentre, international, prospective cohort study. Any hospital in the world performing acute surgery can participate, and any patient undergoing emergency intraperitoneal surgery is eligible to enter the study. Centres will collect observational data on patients for a 14-day period during a 5-month window and required data points will be limited to ensure practicality for collaborators collecting data. The primary outcome measure is the 24 h perioperative mortality, with 30-day perioperative mortality as a secondary outcome measure. During registration, participants will undertake a survey of available resources and capacity based on the WHO Tool for Situational Analysis.Ethics and disseminationThe study will not affect clinical care and has therefore been classified as an audit by the South East Scotland Research Ethics Service in Edinburgh, Scotland. Baseline outcome measurement in relation to emergency abdominal surgery has not yet been undertaken at an international level and will provide a useful indicator of surgical capacity and the modifiable factors that influence this. This novel methodological approach will facilitate delivery of a multicentre study at a global level, in addition to building international audit and research capacity.Trial registration numberThe study has been registered with ClinicalTrials.gov (Identifier: NCT02179112).

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Trajectories of sickness absence after road traffic injury: a Swedish register-based cohort study

BMJ Open ◽

10.1136/bmjopen-2019-031132 ◽

2019 ◽

Vol 9 (7) ◽

pp. e031132 ◽

Cited By ~ 1

Author(s):

Ritva Rissanen ◽

Yajun Liang ◽

Jette Moeller ◽

Alicia Nevriana ◽

Hans-Yngve Berg ◽

...

Keyword(s):

Cohort Study ◽

Return To Work ◽

Sickness Absence ◽

Injury Severity ◽

Outcome Measure ◽

Road Traffic ◽

Road Traffic Injury ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Traffic Injury

ObjectivesDespite much focus on the health impact of road traffic injury (RTI) on life, there is a lack of knowledge of the dynamic process of return to work following RTI and its related factors. The aim of this study was to identify longitudinal patterns of sickness absence (SA) following RTI, to examine the patterns’ interplay with health-related quality of life (HRQoL) and to determine if there are differences, regarding the patterns and interplay, according to injury severity.DesignA register-based prospective cohort study.SettingAdministrative data on RTI in Sweden from the Swedish Traffic Accident Data Acquisition System (STRADA) and Swedish Social Insurance data.ParticipantsIndividuals suffering an RTI (total n=4761) were identified in STRADA between 1 January 2007 and 31 December 2009. A total of 903 of these met the inclusion criteria for the current study and were included.Primary and secondary outcome measuresThe primary outcome measure was SA following RTI. The secondary outcome measure was HRQoL.ResultsThree distinct patterns of SA were identified; ‘Stable’, ‘Quick decrease’ and ‘Gradual decrease’. The patterns differed in the number of initial SA days and the rate of reduction of SA days. After 3 years, all three patterns had almost the same level of SA. Higher injury severity and a higher number of SA days had a negative interplay with HRQoL. Participants who initially had a higher number of SA days were more likely to report a low HRQoL, indicating that people with a slower return to work are more vulnerable.ConclusionThe study highlights the heterogeneity of return to work after an RTI. People with a more severe injury and slower pace of return to work seem to be more vulnerable with regards to HRQoL loss following RTI.

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Insurance Status and Survival of Patients with Salivary Gland Cancer

Otolaryngology ◽

10.1177/0194599818791798 ◽

2018 ◽

Vol 159 (6) ◽

pp. 998-1005 ◽

Cited By ~ 4

Author(s):

Anirudh Saraswathula ◽

Uchechukwu C. Megwalu

Keyword(s):

Salivary Gland ◽

Outcome Measure ◽

Primary Outcome Measure ◽

Secondary Outcome ◽

Salivary Gland Cancer ◽

Insurance Status ◽

Secondary Outcome Measure ◽

Major Salivary Gland ◽

Insured Patients ◽

The Impact

Objectives To evaluate the impact of insurance status on survival among patients with major salivary gland cancer. Study Design Retrospective cohort study. Setting SEER program. Subjects and Methods We included patients aged <65 years diagnosed with major salivary gland cancers from 2007 to 2013. Those aged ≥65 years were excluded due to issues ascertaining insurance status. The independent variable was insurance status (insured, uninsured, or Medicaid); the primary outcome measure was overall survival (OS); and the secondary outcome measure was disease-specific survival (DSS). Results Compared with insured patients, uninsured and Medicaid patients were more likely to present with stage III-IV disease (uninsured: odds ratio [OR], 1.57; 95% CI, 1.09-2.27; Medicaid: OR, 1.67; 95% CI, 1.27-2.20) and with distant metastasis (uninsured: OR, 2.10; 95% CI, 1.18-3.57; Medicaid: OR, 1.96; 95% CI, 1.25-3.01) after adjusting for demographic and tumor variables. Uninsured and Medicaid patients also had worse OS (uninsured: hazard ratio [HR], 1.62; 95% CI, 1.14-2.29; Medicaid: HR, 1.74; 95% CI, 1.33-2.38) and DSS (uninsured: HR, 1.57; 95% CI, 1.08-2.29; Medicaid: HR, 1.68; 95% CI, 1.25-2.25) after adjusting for demographic and tumor variables. After further adjusting for treatment variables, only Medicaid status was significantly associated with worse OS (HR, 1.71; 95% CI, 1.30-2.26) and DSS (HR, 1.65; 95% CI, 1.23-2.23). Conclusions Insurance status is associated with stage at presentation and survival among patients with salivary gland cancer.

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Impact of maternal age on delivery outcomes following spontaneous labour at term

Journal of Perinatal Medicine ◽

10.1515/jpm-2015-0128 ◽

2016 ◽

Vol 44 (7) ◽

Cited By ~ 7

Author(s):

Edwin Eseoghene Omih ◽

Stephen Lindow

Keyword(s):

Caesarean Section ◽

Vaginal Delivery ◽

Maternal Age ◽

Outcome Measure ◽

Statistical Significance ◽

Perineal Trauma ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Assisted Vaginal Delivery ◽

The Impact

AbstractAim:Pregnancy in women of advancing maternal age is linked to incrementally worsening perinatal outcome. The aim of this study is to assess the impact of maternal age on delivery outcome in women that spontaneously labour at term.Methods:This was a retrospective study of women that spontaneously labour at term. Women with singletons in spontaneous onset labour beyond 37 weeks of gestation were divided into five maternal age groups: <19 years, 20–24 years, 25–29 years, 30–34 years and >35 years by their age at delivery. The main outcome variables are augmentation of labour, caesarean section, assisted vaginal delivery, and perineal trauma, while admission of the newborn into the neonatal unit within 24 h following delivery was the secondary outcome measure.Results:A total of 30,022 met the inclusion criteria with primiparae and multiparae accounting for 46 and 54%, respectively. Increasing age in primiparae was associated with; augmentation of labour OR 2.05 (95% CI 1.73–2.43), second degree perineal tear 1.35 (1.12–1.61), assisted vaginal delivery 1.92 (1.53–2.41) and caesarean section 4.23 (3.19–5.12). While that for multiparae; augmentation of labour OR 1.93 (1.05–3.52), perineal trauma 2.50 (1.85–3.34), assisted vaginal delivery 4.95 (91.82–13.35) and caesarean section 1.64 (1.13–2.38). The secondary outcome measure did not reach statistical significance.Conclusion:Increasing maternal age is an independent risk factor for operative delivery, and perineal trauma. However, maternal age has no significant effect on admission of infants into the NICU during the first 24 h following delivery.

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Safety of Large Volume Liposuction in Aesthetic Surgery: A Systematic Review and Meta-Analysis

Aesthetic Surgery Journal ◽

10.1093/asj/sjaa338 ◽

2020 ◽

Author(s):

Muholan Kanapathy ◽

Marc Pacifico ◽

Ahmed M Yassin ◽

Edward Bollen ◽

Afshin Mosahebi

Keyword(s):

Systematic Review ◽

Large Volume ◽

Outcome Measure ◽

Surgical Complication ◽

Major Complication ◽

Current Data ◽

Current Evidence ◽

Secondary Outcome ◽

Secondary Outcome Measure ◽

Complication Rates

Abstract Background Current literature clearly outlines the complication rates of liposuction in general, however data specific to large-volume liposuction (LVL) remains unclear. Objectives This systematic review aims to synthesize the current evidence on the safety of LVL. Methods A comprehensive search in the MEDLINE, EMBASE and CENTRAL databases was conducted for primary clinical studies reporting on safety or complications related to aesthetic LVL from 1946 to March 2020. The primary outcome measure was the incidence of surgical complication while the secondary outcome measure was changes in metabolic profile. Meta-analyses were conducted to pool the estimated surgical complication incidence and metabolic changes. Results Twenty-three articles involving 3583 patients were included. The average aspirate volume was 7,734.90ml (95%CI=5727.34ml to 9742.45ml). The pooled overall incidence of major surgical complications was 3.35% (95%CI=1.07% to 6.84%). The most common major complication was blood loss requiring transfusion (2.89% (95%CI=0.84% to 6.12%)) followed by pulmonary embolism (0.18% (95%CI=0.06% to 0.33%)), hematoma (0.16% (95%CI=0.05% to 0.32%)), necrotizing fasciitis (0.13% (95%CI=0.04% to 0.29%)), and deep vein thrombosis (0.12% (95%CI=0.03% to 0.27%)). No fat embolism or death was reported in the included studies. The pooled overall incidence of minor surgical complication was 11.62% (95%CI=6.36% to 18.21%), with seroma being the commonest minor complication (5.51% (95%CI=2.69% to 9.27%)). Reductions in lipid profile, glucose profile, body weight and hematocrit level were observed after LVL. Conclusions This study meta-analyzed and highlighted the complication rates specifically related to LVL, however the current data is limited by the lack of Level 1 evidence.

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Mortality and pulmonary complications in patients undergoing upper extremity surgery at the peak of the SARS-CoV-2 pandemic in the UK: a national cohort study

BMJ Quality & Safety ◽

10.1136/bmjqs-2020-012156 ◽

2020 ◽

pp. bmjqs-2020-012156 ◽

Cited By ~ 1

Author(s):

Benjamin John Floyd Dean

Keyword(s):

Cohort Study ◽

Upper Limb ◽

Complication Rate ◽

Postoperative Mortality ◽

Pulmonary Complications ◽

Complication Rates ◽

Day Case ◽

Related Complication ◽

Upper Limb Surgery ◽

The Uk

IntroductionThis study reports the 30-day mortality, SARS-CoV-2 complication rate and SARS-CoV-2-related hospital processes at the peak of the first wave of the pandemic in the UK.MethodsThis national, multicentre, cohort study at 74 centres in the UK included all patients undergoing any surgery below the elbow at the peak of the UK pandemic. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. The secondary outcomes were SARS-CoV-2 complication rates and overall complication rates. A clinician survey relating to SARS-CoV-2 safety processes was carried out for each participating centre.ResultsThis analysis includes 1093 patients who underwent upper limb surgery from the 1 to 14 April 2020 inclusively. The overall 30-day mortality was 0.09% (1 pre-existing SARS-CoV-2 pneumonia) and the mortality of day case surgery was zero. Most centres (96%) screened patients for symptoms prior to admission, only 22% routinely tested for SARS-CoV-2 prior to admission. The SARS-CoV-2 complication rate was 0.18% (2 pneumonias) and the overall complication rate was 6.6% (72 patients). Both SARS-CoV-2-related complications occurred in patients who had been hospitalised for a prolonged period before their surgery and a total of 19 patients (1.7%) were SARS-CoV-2 positive.ConclusionsThe SARS-CoV-2-related complication rate for upper limb surgery even at the peak of the UK pandemic was low at 0.18% and the mortality was zero for patients admitted on the day of surgery. Urgent surgery should not be delayed pending the results of SARS-CoV-2 testing. Routine SARS-CoV-2 testing for day case upper limb surgery not requiring general anaesthesia may be excessive and have unintended negative impacts.

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1015 Elective Cancer Surgery In COVID-19 Free Surgical Pathways During The SARS-Cov-2 Pandemic: An International, Multi-Centre, Comparative Cohort Study

British Journal of Surgery ◽

10.1093/bjs/znab135.040 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

Keyword(s):

Cohort Study ◽

Pulmonary Complication ◽

Elective Surgery ◽

Pulmonary Complications ◽

Cancer Surgery ◽

Sensitivity Analyses ◽

Solid Cancer ◽

Postoperative Pulmonary Complication ◽

Complication Rates ◽

Inpatient Ward

Abstract Introduction This study aimed to determine whether COVID-19 free surgical pathways were associated with lower postoperative pulmonary complication rates compared to hospitals with no defined pathway. Method This international multi-centre cohort study included patients undergoing elective surgery for 10 solid cancer types, without preoperative suspicion of SARS-CoV-2. Participating hospitals included patients from local emergence of SARS-CoV-2 until 19 April 2020. At the time of surgery, hospitals were defined as having a COVID-19 free surgical pathway (complete segregation of the operating theatre, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with COVID-19 patients). The primary outcome was 30-day postoperative pulmonary complications. Results Of 9171 patients from 447 hospitals in 55 countries, 2481 were operated in COVID-19 free surgical pathways. After adjustment, pulmonary complication rates were lower with COVID-19 free surgical pathways (2.2% versus 4.9%, OR: 0.62 [0.44-0.86]). This was consistent in sensitivity analyses and a propensity-score matched model. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19 free surgical pathways (2.1% versus 3.6%; OR 0.53 [0.36-0.76]). Conclusions Within available resources, dedicated COVID-19 free surgical pathways should be established to provide safe elective cancer surgery during current and before future SARS-CoV-2 outbreaks.

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606 Mortality and Pulmonary Complications in Patients Undergoing Upper Extremity Surgery at The Peak of the SARS-Cov-2 Pandemic in the UK: A National Cohort Study Presented on Behalf of The Corona Hands Collaborative

British Journal of Surgery ◽

10.1093/bjs/znab135.031 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

B Dean ◽

J Duncan

Keyword(s):

Cohort Study ◽

Upper Limb ◽

Complication Rate ◽

Postoperative Mortality ◽

Primary Outcome Measure ◽

Pulmonary Complications ◽

Related Complication ◽

Urgent Surgery ◽

Upper Limb Surgery ◽

The Uk

Abstract Introduction This study reports the 30-day mortality, SARS-CoV-2 complication rate and SARS-CoV-2 related hospital processes at the peak of the first wave of the pandemic in the UK. Method This national, multicentre, cohort study at 74 centres in the UK included all patients undergoing any surgery below the elbow at the peak of the UK pandemic. The primary outcome measure was 30-day postoperative mortality and was assessed in all enrolled patients. Results This analysis includes 1093 patients who underwent upper limb surgery from the 1st to the 14th of April 2020. The overall 30-day mortality was 0.09% and the mortality of day case surgery was zero. The SARS-CoV-2 complication rate was 0.18% (2 pneumonias) and the overall complication rate 6.6% (72 patients). Both SARS-CoV-2 related complications occurred in patients who had been hospitalised for a prolonged period before their surgery and a total of 19 patients (1.7%) were SARS-CoV-2 positive. Conclusions The SARS-CoV-2 related complication rate for upper limb surgery even at the peak of the UK pandemic was low at 0.18% and the mortality was zero for patients admitted on the day of surgery. Urgent surgery should not be delayed pending the results of SARS-CoV-2 testing.

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Seizure outcome in temporal glioblastoma surgery: lobectomy as a supratotal resection regime outclasses conventional gross-total resection

Journal of Neuro-Oncology ◽

10.1007/s11060-021-03705-x ◽

2021 ◽

Author(s):

Valeri Borger ◽

Motaz Hamed ◽

Inja Ilic ◽

Anna-Laura Potthoff ◽

Attila Racz ◽

...

Keyword(s):

Tumor Resection ◽

Temporal Lobectomy ◽

Secondary Outcome ◽

Seizure Outcome ◽

Seizure Freedom ◽

Secondary Outcome Measure ◽

Total Resection ◽

Class 1 ◽

Postoperative Seizure ◽

The Impact

Abstract Introduction The postoperative seizure freedom represents an important secondary outcome measure in glioblastoma surgery. Recently, supra-total glioblastoma resection in terms of anterior temporal lobectomy (ATL) has gained growing attention with regard to superior long-term disease control for temporal-located glioblastoma compared to conventional gross-total resections (GTR). However, the impact of ATL on seizure outcome in these patients is unknown. We therefore analyzed ATL and GTR as differing extents of resection in regard of postoperative seizure control in patients with temporal glioblastoma and preoperative symptomatic seizures. Methods Between 2012 and 2018, 33 patients with preoperative seizures underwent GTR or ATL for temporal glioblastoma at the authors’ institution. Seizure outcome was assessed postoperatively and 6 months after tumor resection according to the International League Against Epilepsy (ILAE) classification and stratified into favorable (ILAE class 1) versus unfavorable (ILAE class 2–6). Results Overall, 23 out of 33 patients (70%) with preoperative seizures achieved favorable seizure outcome following resection of temporal located glioblastoma. For the ATL group, postoperative seizure freedom was present in 13 out of 13 patients (100%). In comparison, respective rates for the GTR group were 10 out of 20 patients (50%) (p = 0.002; OR 27; 95% CI 1.4–515.9). Conclusions ATL in terms of a supra-total resection strategy was associated with superior favorable seizure outcome following temporal glioblastoma resection compared to GTR. Regarding above mentioned survival benefit following ATL compared to GTR, ATL as an aggressive supra-total resection regime might constitute the surgical modality of choice for temporal-located glioblastoma.

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