29 research outputs found
Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic
No full textAim: This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic. Method: This was an international cohort study of patients undergoing elective resection of colon or rectal cancer without preoperative suspicion of SARS-CoV-2. Centres entered data from their first recorded case of COVID-19 until 19 April 2020. The primary outcome was 30-day mortality. Secondary outcomes included anastomotic leak, postoperative SARS-CoV-2 and a comparison with prepandemic European Society of Coloproctology cohort data. Results: From 2073 patients in 40 countries, 1.3% (27/2073) had a defunctioning stoma and 3.0% (63/2073) had an end stoma instead of an anastomosis only. Thirty-day mortality was 1.8% (38/2073), the incidence of postoperative SARS-CoV-2 was 3.8% (78/2073) and the anastomotic leak rate was 4.9% (86/1738). Mortality was lowest in patients without a leak or SARS-CoV-2 (14/1601, 0.9%) and highest in patients with both a leak and SARS-CoV-2 (5/13, 38.5%). Mortality was independently associated with anastomotic leak (adjusted odds ratio 6.01, 95% confidence interval 2.58-14.06), postoperative SARS-CoV-2 (16.90, 7.86-36.38), male sex (2.46, 1.01-5.93), age >70 years (2.87, 1.32-6.20) and advanced cancer stage (3.43, 1.16-10.21). Compared with prepandemic data, there were fewer anastomotic leaks (4.9% versus 7.7%) and an overall shorter length of stay (6 versus 7 days) but higher mortality (1.7% versus 1.1%). Conclusion: Surgeons need to further mitigate against both SARS-CoV-2 and anastomotic leak when offering surgery during current and future COVID-19 waves based on patient, operative and organizational risks
Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic
No full textBackground: Surgical services are preparing to scale up in areas affected by COVID-19. This study aimed to evaluate the association between preoperative SARS-CoV-2 testing and postoperative pulmonary complications in patients undergoing elective cancer surgery. Methods: This international cohort study included adult patients undergoing elective surgery for cancer in areas affected by SARS-CoV-2 up to 19 April 2020. Patients suspected of SARS-CoV-2 infection before operation were excluded. The primary outcome measure was postoperative pulmonary complications at 30 days after surgery. Preoperative testing strategies were adjusted for confounding using mixed-effects models. Results: Of 8784 patients (432 hospitals, 53 countries), 2303 patients (26.2 per cent) underwent preoperative testing: 1458 (16.6 per cent) had a swab test, 521 (5.9 per cent) CT only, and 324 (3.7 per cent) swab and CT. Pulmonary complications occurred in 3.9 per cent, whereas SARS-CoV-2 infection was confirmed in 2.6 per cent. After risk adjustment, having at least one negative preoperative nasopharyngeal swab test (adjusted odds ratio 0.68, 95 per cent confidence interval 0.68 to 0.98; P = 0.040) was associated with a lower rate of pulmonary complications. Swab testing was beneficial before major surgery and in areas with a high 14-day SARS-CoV-2 case notification rate, but not before minor surgery or in low-risk areas. To prevent one pulmonary complication, the number needed to swab test before major or minor surgery was 18 and 48 respectively in high-risk areas, and 73 and 387 in low-risk areas. Conclusion: Preoperative nasopharyngeal swab testing was beneficial before major surgery and in high SARS-CoV-2 risk areas. There was no proven benefit of swab testing before minor surgery in low-risk areas
Early outcomes and complications following cardiac surgery in patients testing positive for coronavirus disease 2019: An international cohort study
No full textMachine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: the COVIDSurg mortality score
No full textTo support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients
Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study
No full textPurpose: As cancer surgery restarts after the first COVID-19 wave, health care providers urgently require data to determine where elective surgery is best performed. This study aimed to determine whether COVID-19-free surgical pathways were associated with lower postoperative pulmonary complication rates compared with hospitals with no defined pathway. Patients and methods: This international, multicenter cohort study included patients who underwent 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 April 19, 2020. At the time of surgery, hospitals were defined as having a COVID-19-free surgical pathway (complete segregation of the operating theater, critical care, and inpatient ward areas) or no defined pathway (incomplete or no segregation, areas shared with patients with COVID-19). The primary outcome was 30-day postoperative pulmonary complications (pneumonia, acute respiratory distress syndrome, unexpected ventilation). Results: Of 9,171 patients from 447 hospitals in 55 countries, 2,481 were operated on in COVID-19-free surgical pathways. Patients who underwent surgery within COVID-19-free surgical pathways were younger with fewer comorbidities than those in hospitals with no defined pathway but with similar proportions of major surgery. After adjustment, pulmonary complication rates were lower with COVID-19-free surgical pathways (2.2% v 4.9%; adjusted odds ratio [aOR], 0.62; 95% CI, 0.44 to 0.86). This was consistent in sensitivity analyses for low-risk patients (American Society of Anesthesiologists grade 1/2), propensity score-matched models, and patients with negative SARS-CoV-2 preoperative tests. The postoperative SARS-CoV-2 infection rate was also lower in COVID-19-free surgical pathways (2.1% v 3.6%; aOR, 0.53; 95% CI, 0.36 to 0.76). Conclusion: 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
Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: the COVIDSurg mortality score
No full textnone4869siDajti, I; Valenzuela, J I; Boccalatte, L A; Gemelli, N A; Smith, D E; Dudi-Venkata, N N; Kroon, H M; Sammour, T; Roberts, M; Mitchell, D; Lah, K; Pearce, A; Morton, A; Dawson, A C; Drane, A; Sharpin, C; Nataraja, R M; Pacilli, M; Cox, D R A; Muralidharan, V; Riddiough, G E; Clarke, E M; Jamel, W; Qin, K R; Pockney, P; Cope, D; Egoroff, N; Lott, N; Putnis, S; De Robles, S; Ang, Z; Mitteregger, M; Uranitsch, S; Stiegler, M; Seitinger, G; Aigner, F; Lumenta, D B; Nischwitz, P S; Richtig, E; Pau, M; Srekl-Filzmaier, P; Eibinger, N; Michelitsch, B; Fediuk, M; Papinutti, A; Seidel, G; Kahn, J; Cohnert, T U; Messner, D; Öfner, F; Presl, J; Varga, M; Weitzendorfer, M; Emmanuel, K; Binder, A D; Zimmermann, M; Holawe, S; Nkenke, E; Grimm, C; Kranawetter, M; Rahman Mitul, A; Islam, N; Karim, S; Komen, N; Putnis, S; De Robles, S; Ang, E; De Praetere, H; Tollens, T; Schols, G; Smets, C; Haenen, L; Quintens, J; Van Belle, K; Van Ramshorst, G H; Pattyn, P; Desender, L; Martens, T; 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Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic
No full textnone5549Background: This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods: This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January-October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results: This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion: Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. 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Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: the COVIDSurg mortality score
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Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic
No full textnone5549siBackground: This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic.Methods: This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January-October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection.Results: This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P=0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P<0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P<0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P<0.001).Conclusion: Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. 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Machine learning risk prediction of mortality for patients undergoing surgery with perioperative SARS-CoV-2: the COVIDSurg mortality score
No full textnone4650siNo abstract - rapid research communicationopenDajti, I; Valenzuela, J I; Boccalatte, L A; Gemelli, N A; Smith, D E; Dudi-Venkata, N N; Kroon, H M; Sammour, T; Roberts, M; Mitchell, D; Lah, K; Pearce, A; Morton, A; Dawson, A C; Drane, A; Sharpin, C; Nataraja, R M; Pacilli, M; Cox, D R A; Muralidharan, V; Riddiough, G E; Clarke, E M; Jamel, W; Qin, K R; Pockney, P; Cope, D; Egoroff, N; Lott, N; Putnis, S; De Robles, S; Ang, Z; Mitteregger, M; Uranitsch, S; Stiegler, M; Seitinger, G; Aigner, F; Lumenta, D B; Nischwitz, P S; Richtig, E; Pau, M; Srekl-Filzmaier, P; Eibinger, N; Michelitsch, B; Fediuk, M; Papinutti, A; Seidel, G; Kahn, J; Cohnert, T U; Messner, F; Öfner, D; Presl, J; Varga, M; Weitzendorfer, M; Emmanuel, K; Binder, A D; Zimmermann, M; Holawe, S; Nkenke, E; Grimm, C; Kranawetter, M; Rahman Mitul, A; Islam, N; Karim, S; Komen, N; Putnis, S; De Robles, S; Ang, E; De Praetere, H; Tollens, T; Schols, G; Smets, C; Haenen, L; Quintens, J; Van Belle, K; Van Ramshorst, G H; Pattyn, P; Desender, L; Martens, T; Van de Putte, D; Lerut, P; Grimonprez, A; Janssen, M; De Smul, G; Wallaert, P; Van den Eynde, J; Oosterlinck, W; Van den Eynde, R; Sermon, A; Boeckxstaens, A; Cordonnier, A; De Coster, J; Jaekers, J; Politis, C; Miserez, M; Duchateau, N; De Gheldere, C; Flamey, N; Pattyn, P; Christiano, A; Guidi, B; Minussi, A L; Castro, S; Okoba, W; Maldonado, F H R; Oliveira, P; Baldasso, T; Santos, L; Gomes, G M A; Buarque, I L; Pol-Fachin, L; Bezerra, T S; Barros, A V; da Silva, A M R; Leite, A L S; Silvestre, D W A; Ferro, C C; Araujo, M S; Lopes, L M; Damasceno, P D; Araujo, D H S; Laporte, G; Salem, M C; Guimaraes-Filho, M A C; Nacif, L; Flumignan, R L G; Nakano, L C U; Kuramoto, D A B; Aidar, A L S; Pereda, M R; Correia, R M; Santos, B C; Carvalho, A A; Amorim, J E; Guedes Neto, H J; Areias, L L; Sousa, A F; Flumignan, C D Q; Lustre, W G; Moreno, D H; Barros, N; Baptista-Silva, J C C; Matos, L L; Kowaski, L P; Kulcsar, M A V; Nunes, K S; Teixeira, M F; Nunes, R L; Ijichi, T R; Kim, N J; Marreiro, A; Muller, B; Barakat Awada, J; Baiocchi, G; Kowalski, L P; Vartanian, J G; Makdissi, F B; Aguiar, S; Marques, N; Carvalho, G B; Marques, T M D M; Abdallah, E A; Zurstrassen, C E; Gross, J L; Zequi, S C; Gonçalves, B T; Santos, S S; Duprat, J P; Coimbra, F J F; Cicco, R; Takeda, F; Cecconello, I; Ribeiro, U; Gatti, A; Oliva, R; Nardi, C; Slavchev, M; Atanasov, B; Belev, N; Dell, A; Bigam, D; Dajani, K; Al Riyami, S; Martin, J; Cheng, D; Yang, H; Fayad, A; Carrier, F M; Amzallag, E; Desroches, J; Ruel, M; Caminsky, N G; Boutros, M; Moon, J; Wong, E G; Vanounou, T; Pelletier, J; Wong, S; Girsowicz, E; Bayne, J; Obrand, D; Gill, H; Steinmetz, O; MacKenzie, K; Lukaszewski, M; Jamjoum, G; Richebé, P; Verdonck, O; Discepola, S; Godin, N; Idrissi, M; Lecluyse, V; Côté, G; Demyttenaere, S; Garfinkle, R; Boutros, M; Kouyoumdjian, A; Boutros, M; Dumitra, S; Moon, J; Wong, E G; Khwaja, K; Luo, L; Lukaszewski, M; Gill, H; Berry, G; Liberman, A S; Girsowicz, E; Bayne, J; Obrand, D; Steinmetz, O; MacKenzie, K; Schmid, S; Spicer, J; Al Farsi, M; Abou-Khalil, J; Couture, E; Mohammadi, S; Tremblay, H; Gagné, N; Bergeron, A; Turgeon, A F; Costerousse, O; Bellemare, D; Babin, C; Blier, C; Wood, M L; Persad, A; Groot, G; Pham, H; D'Aragon, F; Carbonneau, E; Bouchard, M; Masse, M; Pesant, F; Héroux, J; Karanicolas, P; Hallet, J; Nadler, A; Nathens, A; Ko, M; Brar, A; Mayson, K; Kidane, B; Srinathan, S; Escudero, M I; Reyes, J T; Modolo, M M; Ramirez Nieto, P; Sepulveda, R; Bolbarán, A; Molero, A; Ruiz, I; Reyes, G P; Salas, R; Suazo, C; Muñoz, R; Grasset, E; Inzunza, M; Besser, N; Irarrázaval, M J; Jarry, C; Bellolio, F; Romero Manqui, C A; Ruiz Esquide, M; Fuentes, T; Campos, J; Perez Rivera, C J; Cabrera, P A; Pinilla, R E; Guevara, O; Jimenez Ramirez, L J; Velasquez Cuasquen, B G; Herrera Mora, D R; Bonilla, A; Diaz, S; Manrique, E; Facundo, H; Velez Bernal, J L; ángel, J; García, M; Guzmán, L; Lehmann, C; Cervera, S; Trujillo Sanchez, L M; Guevara, R; Valbuena, D; Suarez, L; Jimenez, G; Velandia, A; Vargas, J; Espinosa, J; Rey, S; Mendoza Quevedo, J; Calvache, J A; Orozco-Chamorro, C M; Sánchez-Gómez, T A; Rojas-Tejada, D A; Mihanovic, J; Bakmaz, B; Rakvin, I; Sulen, N; Andabaka, T; Luksic, I; Mamic, M; Martinek, L; Skrovina, M; Žatecký, J; Peteja, M; Ø. 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