23 research outputs found
Endothelial nitric oxide synthase gene T-786C and 27-bp repeat gene polymorphisms in retinopathy of prematurity
No full textDifferences in cardiac output of patients undergoing trans-catheter aortic valve implantation according to their underlying rhythm
No full text\ua9The Author(s) 2026.BACKGROUND The recent Cardiac Output in Patients with Small Annuli Undergoing Transcatheter Aortic Valve Implantation with Self-Expanding vs Balloon Expandable Valve (COPS-TAVI) study provided some insights into the differences in cardiac output in patients with small aortic annuli undergoing transcatheter aortic valve implantation (TAVI) according to the implanted platform: Balloon-expandable (BEV) vs self-expanding valves (SEV). AIM To investigate the understudied role of atrial fibrillation (AF) on cardiac output in patients undergoing TAVI. METHODS The COPS-TAVI study enrolled consecutive patients with severe aortic stenosis and small annuli who underwent successful TAVI. Cardiac output was measured using echocardiography within 4 weeks following TAVI. Data were analyzed according to the presence of AF and stratified by SEV or BEV. RESULTS A total of 138 patients were included in the analysis, of whom 22% had AF. Cardiac output was significantly lower in patients with AF compared to those without it (4.6 L/minute vs 5.3 L/minute, P = 0.02). Consistent with the main study findings, the difference in cardiac output was evident among patients without AF who underwent SEV vs BEV (P < 0.05). On the other hand, there was no difference in cardiac output in patients with AF, irrespective of the implanted platform (P > 0.05). There was no difference in clinical outcomes between the two groups. CONCLUSION Cardiac output, as measured by echocardiography, was larger in patients with small annuli who underwent TAVI procedure with SEV compared to BEV in patients without AF. This observation should be considered during procedural planning
Soybean oil-based HFD induces gut dysbiosis that leads to steatosis, hepatic inflammation and insulin resistance in mice
No full textHigh-fat diets (HFDs) shape the gut microbiome and promote obesity, inflammation, and liver steatosis. Fish and soybean are part of a healthy diet; however, the impact of these fats, in the absence of sucrose, on gut microbial dysbiosis and its association with liver steatosis remains unclear. Here, we investigated the effect of sucrose-free soybean oil-and fish oil-based high fat diets (HFDs) (SF-Soy-HFD and SF-Fish-HFD, respectively) on gut dysbiosis, obesity, steatosis, hepatic inflammation, and insulin resistance. C57BL/6 mice were fed these HFDs for 24 weeks. Both diets had comparable effects on liver and total body weights. But 16S-rRNA sequencing of the gut content revealed induction of gut dysbiosis at different taxonomic levels. The microbial communities were clearly separated, showing differential dysbiosis between the two HFDs. Compared with the SF-Fish-HFD control group, the SF-Soy-HFD group had an increased abundance of Bacteroidetes, Firmicutes, and Deferribacteres, but a lower abundance of Verrucomicrobia. The Clostridia/Bacteroidia (C/B) ratio was higher in the SF-Soy-HFD group (3.11) than in the SF-Fish-HFD group (2.5). Conversely, the Verrucomicrobiacae/S24_7 (also known as Muribaculaceae family) ratio was lower in the SF-Soy-HFD group (0.02) than that in the SF-Fish-HFD group (0.75). The SF-Soy-HFD group had a positive association with S24_7, Clostridiales, Allobaculum, Coriobacteriaceae, Adlercreutzia, Christensenellaceae, Lactococcus, and Oscillospira, but was related to a lower abundance of Akkermansia, which maintains gut barrier integrity. The gut microbiota in the SF-Soy-HFD group had predicted associations with host genes related to fatty liver and inflammatory pathways. Mice fed the SF-Soy-HFD developed liver steatosis and showed increased transcript levels of genes associated with de novo lipogenesis (Acaca, Fasn, Scd1, Elovl6) and cholesterol synthesis (Hmgcr) pathways compared to those in the SF-Fish-HFD-group. No differences were observed in the expression of fat uptake genes (Cd36 and Fabp1). The expression of the fat efflux gene (Mttp) was reduced in the SF-Soy-HFD group. Moreover, hepatic inflammation markers (Tnfa and Il1b) were notably expressed in SF-Soy-HFD-fed mice. In conclusion, SF-Soy-HFD feeding induced gut dysbiosis in mice, leading to steatosis, hepatic inflammation, and impaired glucose homeostasis.Peer reviewe
Optimising Clinical Epidemiology in Disease Outbreaks: Analysis of ISARIC-WHO COVID-19 Case Report Form Utilisation
No full textStandardised forms for capturing clinical data promote consistency in data collection and analysis across research sites, enabling faster, higher-quality evidence generation. ISARIC and the World Health Organization have developed case report forms (CRFs) for the clinical characterisation of several infectious disease outbreaks. To improve the design and quality of future forms, we analysed the inclusion and completion rates of the 243 fields on the ISARIC-WHO COVID-19 CRF. Data from 42 diverse collaborations, covering 1886 hospitals and 950,064 patients, were analysed. A mean of 129.6 fields (53%) were included in the adapted CRFs implemented across the sites. Consistent patterns of field inclusion and completion aligned with globally recognised research priorities in outbreaks of novel infectious diseases. Outcome status was the most highly included (95.2%) and completed (89.8%) field, followed by admission demographics (79.1% and 91.6%), comorbidities (77.9% and 79.0%), signs and symptoms (68.9% and 78.4%), and vitals (70.3% and 69.1%). Mean field completion was higher in severe patients (70.2%) than in all patients (61.6%). The results reveal how clinical characterisation CRFs can be streamlined to reduce data collection time, including the modularisation of CRFs, to offer a choice of data volume collection and the separation of critical care interventions. This data-driven approach to designing CRFs enhances the efficiency of data collection to inform patient care and public health response
Twelve-month observational study of children with cancer in 41 countries during the COVID-19 pandemic
No full textIntroduction Childhood cancer is a leading cause of death. It is unclear whether the COVID-19 pandemic has impacted childhood cancer mortality. In this study, we aimed to establish all-cause mortality rates for childhood cancers during the COVID-19 pandemic and determine the factors associated with mortality. Methods Prospective cohort study in 109 institutions in 41 countries. Inclusion criteria: children <18 years who were newly diagnosed with or undergoing active treatment for acute lymphoblastic leukaemia, non-Hodgkin's lymphoma, Hodgkin lymphoma, retinoblastoma, Wilms tumour, glioma, osteosarcoma, Ewing sarcoma, rhabdomyosarcoma, medulloblastoma and neuroblastoma. Of 2327 cases, 2118 patients were included in the study. The primary outcome measure was all-cause mortality at 30 days, 90 days and 12 months. Results All-cause mortality was 3.4% (n=71/2084) at 30-day follow-up, 5.7% (n=113/1969) at 90-day follow-up and 13.0% (n=206/1581) at 12-month follow-up. The median time from diagnosis to multidisciplinary team (MDT) plan was longest in low-income countries (7 days, IQR 3-11). Multivariable analysis revealed several factors associated with 12-month mortality, including low-income (OR 6.99 (95% CI 2.49 to 19.68); p<0.001), lower middle income (OR 3.32 (95% CI 1.96 to 5.61); p<0.001) and upper middle income (OR 3.49 (95% CI 2.02 to 6.03); p<0.001) country status and chemotherapy (OR 0.55 (95% CI 0.36 to 0.86); p=0.008) and immunotherapy (OR 0.27 (95% CI 0.08 to 0.91); p=0.035) within 30 days from MDT plan. Multivariable analysis revealed laboratory-confirmed SARS-CoV-2 infection (OR 5.33 (95% CI 1.19 to 23.84); p=0.029) was associated with 30-day mortality. Conclusions Children with cancer are more likely to die within 30 days if infected with SARS-CoV-2. However, timely treatment reduced odds of death. This report provides crucial information to balance the benefits of providing anticancer therapy against the risks of SARS-CoV-2 infection in children with cancer
Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
No full textnone5203siBackground: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction.
Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20-60), and full lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926.
Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays.
Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.openGlasbey, James; Ademuyiwa, Adesoji; Adisa, Adewale; AlAmeer, Ehab; Arnaud, Alexis P; Ayasra, Faris; Azevedo, José; Minaya-Bravo, Ana; Costas-Chavarri, Ainhoa; Edwards, John; Elhadi, Muhammed; Fiore, Marco; Fotopoulou, Christina; Gallo, Gaetano; Ghosh, Dhruva; Griffiths, Ewen A; Harrison, Ewen; Hutchinson, Peter; Lawani, Ismail; Lawday, Samuel; Lederhuber, Hans; Leventoglu, Sezai; Li, Elizabeth; Gomes, Gustavo Mendonça Ataíde; Mann, Harvinder; Marson, Ella J; Martin, Janet; Mazingi, Dennis; McLean, Kenneth; Modolo, Maria; Moore, Rachel; Morton, Dion; Ntirenganya, Faustin; Pata, Francesco; Picciochi, Maria; Pockney, Peter; Ramos-De la Medina, Antonio; Roberts, Keith; Roslani, April Camilla; Kottayasamy Seenivasagam, Rajkumar; Shaw, Richard; Simões, Joana Filipa Ferreira; Smart, Neil; Stewart, Grant D; Sullivan, Richard; Sundar, Sudha; Tabiri, Stephen; Taylor, Elliott H; Vidya, Raghavan; Nepogodiev, Dmitri; Bhangu, Aneel; Glasbey, James C; McLean, Kenneth; Nepogodiev, Dmitri; Harrison, Ewen; Bhangu, Aneel A; Nepogodiev, Dmitri; Siaw-Acheampong, Kwabena; Benson, Ruth A; Bywater, Edward; Chaudhry, Daoud; Dawson, Brett E; Evans, Jonathan P; Glasbey, James C; Gujjuri, Rohan R; Heritage, Emily; Jones, Conor S; Kamarajah, Sivesh K; Khatri, Chetan; Khaw, Rachel A; Keatley, James M; Knight, Andrew; Lawday, Samuel; Li, Elizabeth; Mann, Harvinder S; Marson, Ella J; McLean, Kenneth A; Mckay, Siobhan C; Mills, Emily C; Pellino, Gianluca; Picciochi, Maria; Taylor, Elliott H; Tiwari, Abhinav; Simoes, Joana FF; Trout, Isobel M; Venn, Mary L; Wilkin, Richard JW; Bhangu, Aneel; Glasbey, James C; Smart, Neil J; Minaya-Bravo, Ana; Evans, Jonathan P; Gallo, Gaetano; Moug, Susan; Pata, Francesco; Pockney, Peter; Di Saverio, Salomone; Vallance, Abigail; Vimalchandran, Dale; Griffiths, Ewen A; Kamarajah, Sivesh K; Evans, Richard PT; Townend, Philip; Roberts, Keith; McKay, Siobhan; Isaac, John; Satoi, Sohei; Edwards, John; Coonar, Aman S; Marchbank, Adrian; Caruana, Edward J; Layton, Georgia R; Patel, Akshay; Brunelli, Alessandro; Ford, Samuel; Desai, Anant; Gronchi, Alessandro; Fiore, Marco; Almond, Max; Tirotta, Fabio; Dumitra, Sinziana; Kolias, Angelos; Price, Stephen J; Fountain, Daniel M; Jenkinson, Michael D; Hutchinson, Peter; Marcus, Hani J; Piper, Rory J; Lippa, Laura; Servadei, Franco; Esene, Ignatius; Freyschlag, Christian; Neville, Iuri; Rosseau, Gail; Schaller, Karl; Demetriades, Andreas K; Robertson, Faith; Alamri, Alex; Shaw, Richard; Schache, Andrew G; Winter, Stuart C; Ho, Michael; Nankivell, Paul; Rey Biel, Juan; Batstone, Martin; Ganly, Ian; Vidya, Raghavan; Wilkins, Alex; Singh, Jagdeep K; Thekinkattil, Dinesh; Sundar, Sudha; Fotopoulou, Christina; Leung, Elaine YL; Khan, Tabassum; Chiva, Luis; Sehouli, Jalid; Fagotti, Anna; Cohen, Paul; Gutelkin, Murat; Ghebre, Rahel; Konney, Thomas; Pareja, Rene; Bristow, Rob; Dowdy, Sean; Shylasree, TS; Kottayasamy Seenivasagam, Rajkumar; Ng, Joe; Fujiwara, Keiichi; Stewart, Grant D; Lamb, Benjamin; Narahari, Krishna; McNeill, Alan; Colquhoun, Alexandra; McGrath, John S; Bromage, Steve; Barod, Ravi; Kasivisvanathan, Veeru; Klatte, Tobias; Simoes, Joana FF; Abbott, Tom EF; Abukhalaf, Sadi; Adamina, Michel; Ademuyiwa, Adesoji O; Agarwal, Arnav; Akkulak, Murat; Alameer, Ehab; Alderson, Derek; Alakaloko, Felix; Albertsmeier, Markus; Alser, Osaid; Alshaar, Muhammad; Alshryda, Sattar; Arnaud, Alexis P; Augestad, Knut Magne; Ayasra, Faris; Azevedo, José; Bankhead-Kendall, Brittany K; Barlow, Emma; Beard, David; Benson, Ruth A; Blanco-Colino, Ruth; Brar, Amanpreet; Minaya-Bravo, Ana; Breen, Kerry A; Bretherton, Chris; Buarque, Igor Lima; Burke, Joshua; Caruana, Edward J; Chaar, Mohammad; Chakrabortee, Sohini; Christensen, Peter; Cox, Daniel; Cukier, Moises; Cunha, Miguel F; Davidson, Giana H; Desai, Anant; Di Saverio, Salomone; Drake, Thomas M; Edwards, John G; Elhadi, Muhammed; Emile, Sameh; Farik, Shebani; Fiore, Marco; Fitzgerald, J Edward; Ford, Samuel; Garmanova, Tatiana; Gallo, Gaetano; Ghosh, Dhruva; Gomes, Gustavo Mendonça Ataíde; Grecinos, Gustavo; Griffiths, Ewen A; Gruendl, Magdalena; Halkias, Constantine; Harrison, Ewen M; Hisham, Intisar; Hutchinson, Peter J; Hwang, Shelley; Isik, Arda; Jenkinson, Michael D; Jonker, Pascal; Kaafarani, Haytham MA; Keller, Debby; Kolias, Angelos; Kruijff, Schelto; Lawani, Ismail; Lederhuber, Hans; Leventoglu, Sezai; Litvin, Andrey; Loehrer, Andrew; Löffler, Markus W; Lorena, Maria Aguilera; Modolo, Maria Marta; Major, Piotr; Martin, Janet; Mashbari, Hassan N; Mazingi, Dennis; Metallidis, Symeon; Minaya-Bravo, Ana; Mohan, Helen M; Moore, Rachel; Moszkowicz, David; Moug, Susan; Ng-Kamstra, Joshua S; Maimbo, Mayaba; Negoi, Ionut; Niquen, Milagros; Ntirenganya, Faustin; Olivos, Maricarmen; Oussama, Kacimi; Outani, Oumaima; Parreno-Sacdalanm, Marie Dione; Pata, Francesco; Rivera, Carlos Jose Perez; Pinkney, Thomas D; van der Plas, Willemijn; Pockney, Peter; Qureshi, Ahmad; Radenkovic, Dejan; Ramos-De la Medina, Antonio; Richards, Toby; Roberts, Keith; Roslani, April C; Rutegård, Martin; Segura-Sampedro, Juan José; Santos, Irène; Satoi, Sohei; Sayyed, Raza; Schache, Andrew; Schnitzbauer, Andreas A; Seyi-Olajide, Justina O; Sharma, Neil; Shaw, Catherine A; Shaw, Richard; Shu, Sebastian; Soreide, Kjetil; Spinelli, Antonino; Stewart, Grant D; Sund, Malin; Sundar, Sudha; Tabiri, Stephen; Townend, Philip; Tsoulfas, Georgios; van Ramshorst, Gabrielle H; Vidya, Raghavan; Vimalachandran, Dale; Warren, Oliver J; Wedderburn, Duane; Wright, Naomi; EuroSurg, null; Booth, Lesley; Runigamugabo, Emmy; Barker, Margaret; Barker, Neil; Cooke, Shirley; Doré, Suzanne; Horwood, Nigel; Tierney Weir, Carrie; Dajti, I; Allemand, C; Boccalatte, LA; Figari, M; Lamm, M; Larrañaga, J; Marchitelli, C; Noll, F; Odetto, D; Perrotta, M; Saadi, J; Zamora, L; Ballester, AM; Tapper, KE; Zeff, N; Valenzuela, JI; Alurralde, C; Anastasio, J; Apas Perez de Nucci, A; Caram, EL; Eskinazi, D; Mendoza, JP; Usandivaras, M; Badra, R; Esteban, A; García, JS; García, PM; Gerchunoff, JI; Lucchini, SM; NIgra, MA; Vargas, L; Hovhannisyan, T; Stepanyan, A; Vasey, CE; Watson, EGR; Ip, C; Kealey, J; Lim, CSH; Sengupta, S; Ward, S; Wong, E; Gould, T; Gourlay, R; Griffiths, B; Gananadha, S; McLaren, M; Cecire, J; Joshi, N; Salindera, S; Sutherland, A; Ahn, JH; Charlton, G; Chen, S; Gauri, N; Hayhurst, R; Jang, S; Jia, F; Mulligan, C; Yang, W; Ye, G; Zhang, H; Ballal, M; Gibson, D; Hayne, D; McMillan, H; Moss, J; Pugliese, MJ; Richards, T; Seow, YTN; Thian, A; Viswambaram, P; Vo, UG; Bennetts, J; Bright, T; Brooke-Smith, M; Fong, R; Gricks, B; Huang, L; Lam, YH; Nathan, A; Ong, BS; Ooi, E; Szpytma, M; Watson, D; Bagraith, K; Caird, S; Chan, E; Dawson, C; Ho, D; Hui, N; Izwan, S; Jeyarajan, E; Jordan, S; Liang, R; Lim, A; Nolan, GJ; Oar, A; Parker, D; Puhalla, H; Quennell, A; Rutherford, L; Sommerville, C; Townend, P; Von Papen, M; Wullschleger, M; Dawson, AC; Drane, A; Blatt, A; Cope, D; Egoroff, N; Fenton, M; Gani, J; Lott, N; Pockney, P; Shugg, N; Elliott, M; Phung, D; Phan, D; Townend, D; Bong, C; Gundara, J; Frankel, A; Bowman, S; Guerra, GR; Gerns, N; McGeorge, S; Riddell, A; Roberts, M; Rukin, N; Bolt, J; Buddingh, K; Dudi-Venkata, NN; Jog, S; Kroon, HM; Sammour, T; Smith, R; Stranz, C; Batstone, M; Lah, K; McGahan, W; Mitchell, D; Morton, A; Pearce, A; Roberts, M; Sheahan, G; Swinson, B; Waldron, A; Walker, P; Alam, N; Banting, S; Chong, L; Choong, P; Clatworthy, S; Foley, D; Fox, A; Hii, MW; Knowles, B; Mack, J; Read, M; Rowcroft, A; Ward, S; Wright, G; Dawson, AC; Drane, A; Lun, EWY; Lanner, M; Burtscher, J; Trivik-Barrientos, F; Königsrainer, I; Bauer, M; Freyschlag, C; Kafka, M; Messner, F; Öfner, D; Tsibulak, I; Holawe, S; Zimmermann, M; Emmanuel, K; Grechenig, M; Gruber, R; Harald, M; Öhlberger, L; Presl, J; Wimmer, A; Namazov, I; Samadov, E; Barker, D; Boyce, R; Corbin, S; Doyle, A; Eastmond, A; Gill, R; Haynes, A; Millar, S; O'Shea, M; Padmore, G; Paquette, N; Phillips, E; St. John, S; Walkes, K; Abeloos, J; De Backer, T; De Ceulaer, J; Dick, C; Diez-Fraile, A; Lamoral, P; Spaas, C; Ceelen, W; Pattyn, P; Van de putte, D; Van Nieuwenhove, Y; Van Ramshorst, G; Willaert, W; Bazzett-Matabele, L; Chiyapo, SP; Ramogola-Masire, D; Ramontshonyana, G; Seiphetlheng, A; Vuylsteke, P; Abdallah, EA; Aguiar Júnior, S; Baiocchi, G; Carvalho, GB; Coimbra, FJF; Kowalski, LP; Makdissi, F; Marques, N; Marques, T; Soares Dos Santos, S; Tirapelli Gonçalves, B; Vartanian, JG; Dos Reis, R; Camara, P; De Lima, RK; Della Giustina, E; Hoffmann, PV; Gatti, A; Nardi, C; Oliva, R; Nacif, L; Carvalho Ferro, C; Gomes Mendonça Ataíde, G; Lima Buarque, I; Lira dos Santos Leite, A; Pol-Fachin, L; Santos Bezerra, T; Maylson Ramos da Silva, A; Windson de Araújo Silvestre, D; Vieira Barros, A; Campbell, L; De Cicco, R; Cecconello, I; Gregorio, P; Pontual Lima, L; Ribeiro Junior, U; Takeda, FR; Terra, RM; Faccini Teixeira, M; Kowalski, LP; Kulcsar, MAV; Matos, LL; Nunes, KS; Laporte, G; Salem, M; Barakat Awada, J; Ijichi, TR; Kim, NJ; Marreiro, A; Muller, B; Nunes, R; Bodanese, B; Eidt, ER; Isoton, JC; Lemos Vieira da Cunha, M; Regina de Sampaio, L; Vendrame, C; Zeni, M; Zortéa, JA; Zortéa, MR; Sokolov, M; Kidane, B; Srinathan, S; Munro, A; Helyer, L; McKeen, D; Boutros, M; Caminsky, NG; Ghitulescu, G; Jamjoum, G; Moon, J; Pelletier, J; Vanounou, T; Wong, S; Cheng, D; MacNeil, SD; Martin, J; Boutros, M; Dumitra, S; Kouyoumdjian, A; Schmid, S; Spicer, J; Agarwal, A; Brar, A; Dada, J; Dare, A; Hameed, U; Osman, F; Johnston, B; Russell, C; Groot, G; Persad, A; Pham, H; Wood, M; Brar, A; Ko, M; Rajendran, L; Boutros, M; Demyttenaere, S; Garfinkle, R; Brown, C; Karimuddin, A; Lee, N; Liu, J; Madani Kia, T; Phang, PT; Raval, M; Tom, K; Abou-Khalil, J; Martel, A; Nessim, C; Stevenson, J; Al Riyami, S; Bali, K; Bigam, D; Dajani, K; Dell, A; Modolo, MM; Ramirez Nieto, P; Sepulveda, R; Molero, A; Bolbaran, A; Ruiz, I; Heredia, F; Bellolio, F; Besser, N; Grasset, E; Guaman, JO; Inzunza, M; Irarrázaval, MJ; Jarry, C; Quintana Martinic, M; Riquoir Altamirano, C; Romero Manqui, CA; Ruiz Esquide, M; Vargas Añazco, C; Almeciga, A; Fletcher, A; Merchan, A; Merchan, A; Quijano, T; Sanabria, D; Arias-Amézquita, F; Cétares, C; Cortes Murgueitio, N; Gomez-Mayorga, JL; Herrera-Almario, G; Rodriguez, J; Sanabria, D; Iglesias, P; Puentes, LO; Calvache, JA; Orozco-Chamorro, CM; Rojas, DA; Sánchez-Gómez, A; Abadia, M; Acosta, J; Almeciga, A; Angel Aristizabal, J; Bonilla, A; Caicedo, L; Calderon Quiroz, PH; Cervera Bonilla, S; Diaz, S; Facundo, H; Garcia Mora, M; Guevara, O; Guzman, L; Herrera Mora, DR; Jimenez Ramirez, LJ; Lehmann, C; Manrique, E; Mariño, I; Medina, M; Pinilla Morales, RE; Puerto, A; Puerto Horta, J; Quintero, M; Rey Ferro, M; Rodriguez, J; Saénz, A; Santana, D; Serrano, W; 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Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
No full textnone5203openGlasbey, James; Ademuyiwa, Adesoji; Adisa, Adewale; AlAmeer, Ehab; Arnaud, Alexis P; Ayasra, Faris; Azevedo, José; Minaya-Bravo, Ana; Costas-Chavarri, Ainhoa; Edwards, John; Elhadi, Muhammed; Fiore, Marco; Fotopoulou, Christina; Gallo, Gaetano; Ghosh, Dhruva; Griffiths, Ewen A; Harrison, Ewen; Hutchinson, Peter; Lawani, Ismail; Lawday, Samuel; Lederhuber, Hans; Leventoglu, Sezai; Li, Elizabeth; Gomes, Gustavo Mendonça Ataíde; Mann, Harvinder; Marson, Ella J; Martin, Janet; Mazingi, Dennis; McLean, Kenneth; Modolo, Maria; Moore, Rachel; Morton, Dion; Ntirenganya, Faustin; Pata, Francesco; Picciochi, Maria; Pockney, Peter; Ramos-De la Medina, Antonio; Roberts, Keith; Roslani, April Camilla; Kottayasamy Seenivasagam, Rajkumar; Shaw, Richard; Simões, Joana Filipa Ferreira; Smart, Neil; Stewart, Grant D; Sullivan, Richard; Sundar, Sudha; Tabiri, Stephen; Taylor, Elliott H; Vidya, Raghavan; Nepogodiev, Dmitri; Bhangu, Aneel; Glasbey, James C; McLean, Kenneth; Nepogodiev, Dmitri; 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Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic
No full textAbstractAim: 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.Methods: 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.Appendix1 Writing group (*denotes joint first authors)Elizabeth Li*, James C. Glasbey*, Dmitri Nepogodiev*, Joana F. F. Simoes*, Omar M. Omar, Mary L. Venn, Jonathan P. Evans, Kaori Futaba, Charles H. Knowles, Ana Minaya-Bravo, Helen Mohan, Manish Chand, Peter Pockney, Salomone Di Saverio, Neil Smart, Abigail Vallance, Dale Vimalachandran, Richard J. W. Wilkin, Aneel Bhangu (Overall guarantor).2 Statistical analysisOmar M. Omar (Lead statistician), Elizabeth Li, James C. Glasbey, Aneel Bhangu.3 CovidSurg Operations CommitteeKwabena Siaw-Acheampong, Ruth A. Benson, Edward Bywater, Daoud Chaudhry, Brett E. Dawson, Jonathan P. Evans, James C. Glasbey, Rohan R. Gujjuri, Emily Heritage, Conor S. Jones, Sivesh K. Kamarajah, Chetan Khatri, Rachel A. Khaw, James M. Keatley, Andrew Knight, Samuel Lawday, Elizabeth Li, Harvinder S. Mann, Ella J. Marson, Kenneth A. McLean, Siobhan C. Mckay, Emily C. Mills, Dmitri Nepogodiev, Gianluca Pellino, Maria Picciochi, Elliott H. Taylor, Abhinav Tiwari, Joana F. F. Simoes, Isobel M. Trout, Mary L. Venn, Richard J. W. Wilkin, Aneel Bhangu.4 International Cancer Leads (*denotes specialty principal Investigator)James C. Glasbey (Chair); Colorectal: Neil J. Smart*, Ana Minaya-Bravo*, Jonathan P. Evans, Gaetano Gallo, Susan Moug, Francesco Pata, Peter Pockney, Salomone Di Saverio, Abigail Vallance, Dale Vimalchandran.5 Dissemination CommitteeJoana F. F. Simoes (Chair); Tom E. F. Abbott, Sadi Abukhalaf, Michel Adamina, Adesoji O. Ademuyiwa, Arnav Agarwal, Murat Akkulak, Ehab Alameer, Derek Alderson, Felix Alakaloko, Markus Albertsmeiers, Osaid Alser, Muhammad Alshaar, Sattar Alshryda, Alexis P. Arnaud, Knut Magne Augestad, Faris Ayasra, José Azevedo, Brittany K. Bankhead-Kendall, Emma Barlow, David Beard, Ruth A. Benson, Ruth Blanco-Colino, Amanpreet Brar, Ana Minaya-Bravo, Kerry A. Breen, Chris Bretherton, Igor Lima Buarque, Joshua Burke, Edward J. Caruana, Mohammad Chaar, Sohini Chakrabortee, Peter Christensen, Daniel Cox, Moises Cukier, Miguel F. Cunha, Giana H. Davidson, Anant Desai, Salomone Di Saverio, Thomas M. Drake, John G. Edwards, Muhammed Elhadi, Sameh Emile, Shebani Farik, Marco Fiore, J. Edward Fitzgerald, Samuel Ford, Tatiana Garmanova, Gaetano Gallo, Dhruv Ghosh, Gustavo Mendonça Ataíde Gomes, Gustavo Grecinos, Ewen A. Griffiths, Madalegna Gründl, Constantine Halkias, Ewen M. Harrison, Intisar Hisham, Peter J. Hutchinson, Shelley Hwang, Arda Isik, Michael D. Jenkinson, Pascal Jonker, Haytham M. A. Kaafarani, Debby Keller, Angelos Kolias, Schelto Kruijff, Ismail Lawani, Hans Lederhuber, Sezai Leventoglu, Andrey Litvin, Andrew Loehrer, Markus W. Löffler, Maria Aguilera Lorena, Maria Marta Madolo, Piotr Major, Janet Martin, Hassan N. Mashbari, Dennis Mazingi, Symeon Metallidis, Ana Minaya-Bravo, Helen M. Mohan, Rachel Moore, David Moszkowicz, Susan Moug, Joshua S. Ng-Kamstra, Mayaba Maimbo, Ionut Negoi, Milagros Niquen, Faustin Ntirenganya, Maricarmen Olivos, Kacimi Oussama, Oumaima Outani, Marie Dione Parreno-Sacdalanm, Francesco Pata, Carlos Jose Perez Rivera, Thomas D. Pinkney, Willemijn van der Plas, Peter Pockney, Ahmad Qureshi, Dejan Radenkovic, Antonio Ramos-De la Medina, Keith Roberts, April C. Roslani, Martin Rutegård, Irène Santos, Sohei Satoi, Raza Sayyed, Andrew Schache, Andreas A Schnitzbauer, Justina O. Seyi-Olajide, Neil Sharma, Richard Shaw, Sebastian Shu, Kjetil Soreide, Antonino Spinelli, Grant D Stewart, Malin Sund, Sudha Sundar, Stephen Tabiri, Philip Townend, Georgios Tsoulfas, Gabrielle H. van Ramshorst, Raghavan Vidya, Dale Vimalachandran, Oliver J. Warren, Duane Wedderburn, Naomi Wright, EuroSurg, European Society of Coloproctology (ESCP), Global Initiative for Children’s Surgery (GICS), GlobalSurg, GlobalPaedSurg, ItSURG, PTSurg, SpainSurg, Italian Society of Colorectal Surgery (SICCR), Association of Surgeons in Training (ASiT), Irish Surgical Research Collaborative (ISRC), Transatlantic Australasian Retroperitoneal Sarcoma Working Group (TARPSWG), Italian Society of Surgical Oncology (SICO).6 Collaboratoring authors (*denotes site principal investigators)Argentina: Alurralde C., Caram E. L., Eskinazi D* (Sanatorio 9 De Julio Sa); Badra R., García J.S., Lucchini S.M.* (Sanatorio Allende).Australia: Cecire J., Salindera S.*, Sutherland A. (Coffs Harbour Health Campus); Ahn J.H., Chen S., Gauri N., Jang S., Jia F., Mulligan C., Yang W., Ye G., Zhang H. (Concord Repatriation General Hospital); Moss J.*, Richards T., Thian A., Vo U. G. (Fiona Stanley Hospital); Bagraith K., Chan E., Ho D., Jeyarajan E., Jordan S., Nolan G. J., Von Papen M., Wullschleger M. (Gold Coast University Hospital); Egoroff N., Gani J., Lott N., Pockney P.* (John Hunter Hospital); Phan D., Townend D.* (Lismore Base Hospital); Bong C., Gundara J.* (Logan Hospital); Bowman S.*, Guerra G. R. (Queen Elizabeth II Jubilee Hospital); Dudi-Venkata N. N., Kroon H. M.*, Sammour T. (Royal Adelaide Hospital); Mitchell D.*, Swinson B. (Royal Brisbane and Women’s Hospital).Austria: Messner F., Öfner D.* (Medical University of Innsbruck); Emmanuel K., Grechenig M., Gruber R., Harald M., Öhlberger L., Presl J.*, Wimmer A. (Paracelsus Medical University Salzburg).Barbados: Barker D., Boyce R., Doyle A., Eastmond A., Gill R., O’Shea M., Padmore G.*, Paquette N., Phillips E., St John S., Walkes K. (Queen Elizabeth Hospital).Belgium: Flamey N., Pattyn P.* (Az Delta); Oosterlinck W.*, Van den Eynde J., Van den Eynde R. (Uz Leuven).Bulgaria: Sokolov M.* (University Hospital Alexandrovska).Canada: Boutros M.*, Caminsky N. G., Ghitulescu G. (Jewish General Hospital); Boutros M.*, Demyttenaere S.*, Garfinkle R. (St Mary’s Hospital); Nessim C.*, Stevenson J. (The Ottawa Hospital).Croatia: Bačić G., Karlović D., Kršul D., Zelić M.* (University Hospital Center Rijeka); Bakmaz B., Ćoza I., Dijan E., Katusic Z., Mihanovic J.*, Rakvin I. (Zadar General Hospital).Cyprus: Frantzeskou K., Gouvas N.*, Kokkinos G., Papatheodorou P., Pozotou I., Stavrinidou O., Yiallourou A.* (Nicosia General Hospital).Czechia: Martinek L., Skrovina M.*, Szubota I. (Hospital and Oncological Centre Novy Jicin).Denmark: Ebbehøj A. L., Krarup P., Schlesinger N., Smith H.* (Bispebjerg Hospital).Egypt: Al Sayed M., Ashoush F.*, Elazzazy E., Essam E., Eweda M., Hassan E., Metwalli M., Mourad M., Qatora M. S., Sabry A.*, Samih A., Samir Abdelaal A., Shehata S.*, Shenit K. (Alexandria Main University Hospital); Attia D., Kamal N., Osman N.* (Alexandria Medical Research Institute); Alaa S., Hamza H. M., M. elghazaly S., Mohammed M. M.*, Nageh M. A., Saad M. M.*, Yousof E. A. (Assiut University Hospital); Eldaly A. S.* (El-Menshawy Hospital); Amira G., Sallam I.*, Sherief M., Sherif A. (Misr Cancer Center); Ghaly G.*, Hamdy R., Morsi A., Salem H.*, Sherif G. (National Cancer Institute); Abdeldayem H., Abdelkader Salama I.*, Balabel M., Fayed Y., Sherif A. E.* (National Liver Institute, Menoufia University).Finland: Kauppila J. H.*, Sarjanoja E. (Länsi-Pohja Central Hospital); Helminen O., Huhta H., Kauppila J. H.* (Oulu University Hospital).France: Beyrne C., Jouffret L.*, Marie-Macron L. (Centre Hospitalier Avignon); Lakkis Z.*, Manfredelli S. (CHU Besançon); Chebaro A.*, El Amrani M., Lecolle K., Piessen G.*, Pruvot F. R., Zerbib P. (CHU Lille); Ballouhey Q.*, Barrat B., Taibi A. (Chu Limoges); Bergeat D., Merdrignac A. (CHU Rennes – General Surgery); Le Roy B., Perotto L. O., Scalabre A.* (Chu Saint Etienne); Aimé A., Ezanno A.*, Malgras B. (Hia Begin); Bouche P. A.*, Tzedakis S.* (Hôpital Cochin – APHP); Cotte E., Glehen O., Kepenekian V., Passot G. (Hopital Lyon Sud); D’Urso A., Mutter D., Seeliger B.* (Strasbourg University Hospitals/IHU-Strasbourg); Bonnet S., Denet C., Fuks D., Laforest A., Pourcher G., Seguin-Givelet A.*, Tribillon E. (Institut Mutualiste Montsouris); Duchalais E.* (Nantes University Hospital).Germany: Bork U.*, Fritzmann J., Praetorius C., Weitz J., Welsch T. (Carl-Gustav-Carus University Hospital, TU Dresden); Beyer K., Kamphues C.*, Lauscher J. C., Loch F. N., Schineis C. (Charité University Medicine, Campus Benjamin Franklin); Becker R.*, Jonescheit J. (Heilig-Geist Hospital Bensheim); Pergolini I., Reim D.* (Klinikum Rechts der Isar TUM School of Medicine); Boeker C., Hakami I.*, Mall J.* (KRH Nordstadt-Siloah Hospitals); Albertsmeier M.*, Kappenberger A., Schiergens T., Werner J. (LMU Klinikum Campus Innenstadt); Nowak K.*, Reinhard T.* (Romed Klinikum Rosenheim); Kleeff J., Michalski C., Ronellenfitsch U.* (University Hospital Halle (Saale)); Bertolani E., Königsrainer A.*, Löffler M. W., Quante M.*, Steidle C., Überrück L., Yurttas C. (University Hospital Tuebingen); Izbicki J., Nitschke C., Perez D., Uzunoglu F. G.* (University Medical Center Hamburg–Eppendorf).Greece: Antonakis P., Contis I., Dellaportas D., Gklavas A., Konstadoulakis M., Memos N.*, Papaconstantinou I.*, Polydorou A., Theodosopoulos T., Vezakis A. (Aretaieion Hospital); Antonopoulou M. I., Manatakis D. K.*, Tasis N. (Athens Naval and Veterans Hospital); Arkadopoulos N., Danias N., Economopoulou P., Frountzas M., Kokoropoulos P., Larentzakis A., Michalopoulos N.*, Parasyris S., Selmani J., Sidiropoulos T., Vassiliu P. (Attikon University General Hospital); Bouchagier K.*, Klimopoulos S., Paspaliari D., Stylianidis G. (Evaggelismos General Hospital); Baxevanidou K., Bouliaris K., Chatzikomnitsa P., Efthimiou M., Giaglaras A., Kalfountzos C.*, Koukoulis G., Ntziovara A. M., Petropoulos K., Soulikia K., Tsiamalou I., Zervas K., Zourntou S. (General Hospital of Larissa ‘Koutlimpaneio and Triantafylleio’); Baloyiannis I., Diamantis A., Perivoliotis K., Tzovaras G.* (General University Hospital of Larissa); Christidis P., Ioannidis O.*, Loutzidou L. (George Papanikolaou General Hospital of Thessaloniki); Karaitianos I.*, Tsirlis T. (Henry Dunant Hospital Center); Charalabopoulos A., Liakakos T., Baili E., Schizas D.*, Spartalis E., Syllaios A., Zografos C. (Laiko University Hospital); Athanasakis E., Chrysos E., Tsiaoussis I., Xenaki S.*, Xynos E.* (University Hospital of Heraklion Crete and Interclinic Hospital of Crete).Hong Kong: Futaba K.*, Ho M. F., Hon S. F., Mak T. W. C., Ng S. S. M. (Prince of Wales Hospital); Foo C. C.* (Queen Mary Hospital).Hungary: Banky B.*, Suszták N. (Szent Borbála Kórház).India: Bhat G. A., Chowdri N. A., Mehraj A.*, Parray F., Shah Z. A., Wani R. (Sher-I-Kashmir Institute of Medical Sciences); Ahmed Z., Bali R., Bhat M. A., Laharwal A., Mahmood M., Mir I., Mohammad Z., Muzamil J., Rashid A.* (SMHS Hospital, Government Medical College).Ireland: Aremu M.*, Canas-Martinez A., Cullivan O., Murphy C., Owens P., Pickett L. (Connolly Hospital Blanchardstown); Corrigan M.*, Daly A., Fleming C.*, Jordan P., Killeen S., Lynch N., O’Brien S., Syed W. A. S., Vernon L. (Cork University Hospital); Fahey B. A., Larkin J. O.*, McCormick P., Mehigan B. J., Mohan H., Shokuhi P., Smith. J (St James’s Hospital); Bashir Y., Bass G. A., Connelly T. M., Creavin B., Earley H., Elliott J. A.*, Gillis A. E., Kavanagh D. O., Neary P. C., O’Riordan J. M., Reynolds I. S., Rice D., Ridgway P. F., Umair M., Whelan M. (Tallaght University Hospital); Corless K., Finnegan L., Fowler A., Hogan A., Lowery A.*, McKevitt K.*, Ryan É. (University Hospital Galway); Coffey J. C., Cunningham R. M., Devine M., Nally D.*, Peirce C. (University Hospital Limerick); Hardy N. P., Neary P. M., O’Malley S.*, Ryan M. (University Hospital Waterford/University College Cork).Italy: Macina S.* (ASST Mantua); Mariani N. M.*, Opocher E., Pisani Ceretti A. (ASST Santi Paolo E. Carlo); Bianco F.* (ASST Papa Giovanni XXIII – Bergamo); Marino M. V.*, Mirabella A., Vaccarella G. (Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello); Agostini C., Alemanno G., Bartolini I., Bergamini C., Bruscino A., De Vincenti R., Di Bella A., Fortuna L., Maltinti G., Muiesan P.*, Prosperi P.*, Ringressi M. N., Risaliti M., Taddei A.*, Tucci R. (Azienda Ospedaliera Universitaria Careggi); Campagnaro T.*, Guglielmi A., Pedrazzani C., Rattizzato S., Ruzzenente A., Turri G. (Azienda Ospedaliera Universitaria Integrata di Verona); Bellora P., D’Aloisio G., Ferrari M., Francone E., Gentilli S.*, Nikaj H. (Azienda Ospedaliero Universitaria Maggiore della Carità); Bianchini M., Chiarugi M., Coccolini F., Di Franco G., Furbetta N., Gianardi D., Guadagni S., Morelli L.*, Palmeri M., Tartaglia D.* (Azienda Ospedaliero Universitaria Pisana); Anania G.*, Carcoforo P.*, Chiozza M., De Troia A., Koleva Radica M., Portinari M., Sibilla M. G., Urbani A. (Azienda Ospedaliero Universitaria San’anna); Fabbri N., Feo C. V.*, Gennari S., Parini S., Righini E. (Azienda Unità Sanitaria Locale di Ferrara, Università di Ferrara); Annessi V., Castro Ruiz C., Montella M. T., Zizzo M.* (Azienda Unità Sanitaria Locale – IRCCS di Reggio Emilia); Grossi U., Novello S., Romano M., Rossi S., Zanus G.* (Ca’ Foncello Treviso – DISCOG – Università di Padova); Esposito G., Frongia F., Pisanu A., Podda M.* (Cagliari University Hospital); Belluco C., Lauretta A.*, Montori G., Moras L., Olivieri M.; Feo C. F., Perra T.*, Porcu A.*, Scanu A. M. (Cliniche San Pietro, Aou Sassari); Aversano A., Carbone F., Delrio P.*, Di Lauro K., Fares Bucci A., Rega D.*, Spiezio G. (Colorectal Surgical Oncology Unit – Istituto Nazionale Tumori Fondazione, Pascale IRCCS); Calabrò M.*, Farnesi F., Lunghi E. G., Muratore A.*, Pipitone Federico N. S. (Edoardo Agnelli); De Palma G. D., Luglio G.*, Pagano G., Tropeano F. P. (Federico II University Hospital); Baldari L.*, Boni L.*, Cassinotti E.* (Fondazione IRCCS Ca’ Granda – Ospedale Maggiore Policlinico di Milano); Cosimelli M., Fiore M.*, Guaglio M.*, Sorrentino L. (Fondazione IRCCS Istituto Nazionale dei Tumori, Milano); Agnes A., Alfieri S., Belia F., Biondi A., Cozza V., D’Ugo D., De Simone V., Litta F., Lorenzon L., Marra A. A., Marzi F., Parello A., Persiani R., Ratto C., Rosa F., Scrima O., Sganga G. (Fondazione Policlinico Universitario Agostino Gemelli IRCCS); Belli A.*, Izzo F., Patrone R. (HPB Surgical Oncology Unit – Istituto Nazionale Tumori Fondazione, Pascale IRCCS); Carrano F. M., Carvello M. M., Di Candido F., Maroli A., Spinelli A.* (Humanitas Clinical and Research Center IRCCS, Rozzano (Mi) and Humanitas University, Department of Biomedical Sciences, Pieve Emanuele (Mi)); Aprile A., Batistotti P., Massobrio A., Pertile D., Scabini S.*, Soriero D. (IRCCS Ospedale Policlinico San Martino); De Manzoni Garberini A.* (Ospedale Civile Spirito Santo); Federico P., Maida P., Marra E., Marte G., Petrillo A., Tammaro P., Tufo A.* (Ospedale del Mare); Berselli M.*, Borroni G.*, Cocozza E., Conti L., Desio M., Rizzi A. (ASST Sette Laghi-Varese); Baldi C.*, Corbellini C., Sampietro G. M. (Ospedale di Rho – ASST Rhodense); Baldini E.*, Capelli P., Conti L., Isolani S. M., Ribolla M. (Ospedale Guglielmo da Saliceto Piacenza); Bondurri A., Colombo F.*, Ferrario L., Guerci C., Maffioli A. (Ospedale Luigi Sacco Milano); Armao T., Ballabio M.*, Bisagni P., Gagliano A., Longhi M., Madonini M., Pizzini P. (Ospedale Maggiore di Lodi); Mochet S.*, Usai A. (Ospedale Regionale Umberto Parini); Bianco F.*, Incollingo P. (Ospedale S. Leonardo – Asl Napoli 3 Sud, Castellammare di Stabia); Mancini S., Marino Cosentino L.*, Sagnotta A.* (Ospedale San Filippo Neri); Nespoli L. C., Tamini N.* (Ospedale San Gerardo); Anastasi A., Bartalucci B., Bellacci A., Canonico G.*, Capezzuoli L., Di Martino C., Ipponi P., Linari C., Montelatici M., Nelli T., Spagni G., Tirloni L., Vitali A. (Ospedale San Giovanni di Dio); Abate E., Casati M.*, Casiraghi T., Laface L., Schiavo M. (Ospedale Vittorio Emanuele III – Carate Brianza); Arminio A., Cotoia A., Lizzi V.*, Vovola F. (Ospedali Riuniti Azienda Ospedaliera Universitaria Foggia); Vergari R.* (Ospedali Riuniti di Ancona); D’Ugo S.*, Depalma N., Spampinato M. G. (Vito Fazzi, Leece); Brachini G., Chiappini A., Cicerchia P. M., Cirillo B., De Toma G., Fiori E., Fonsi G. B., Iannone I., La Torre F., Lapolla P.*, Meneghini S., Mingoli A., Sapienza P., Zambon M. (Policlinico Umberto I Sapienza University of Rome); Capolupo G. T.*, Mazzotta E. (Policlinico Universitario Campus Bio Medico of Rome); Gattolin A., Migliore M., Rimonda R., Sasia D.*, Travaglio E. (Regina Montis Regalis Hospital, Mondovì); Cervellera M., Gori A., Sartarelli L., Tonini V.* (S. Orsola-Malpighi Hospital); Chessa A.*, Fiorini A., Norcini C. (San Giovanni di Dio); Colletti G., Confalonieri M., Costanzi A.*, Frattaruolo C., Mari G., Monteleone M. (San Leopoldo Mandic); De Nardi P.*, Parise P., Vignali A. (San Raffaele Scientific Institute, Milan); Belvedere A., Bernante P., Jovine E., Neri J., Parlanti D., Pezzuto A. P., Poggioli G., Rottoli M.*, Tanzanu M., Violante T. (IRCCS Azienda Ospedaliero – Universitaria di Bologna; Alma Mater Studiorum University of Bologna); Borghi F., Cianflocca D., Di Maria Grimaldi S., Donati D., Gelarda E., Giraudo G., Giuffrida M. C., Marano A.*, Palagi S., Pellegrino L., Peluso C., Testa V.* (Santa Croce E. Carle Hospital, Cuneo); Agresta F.*, Prando D.*, Zese M.* (Santa Maria degli Angeli Hospital ULSS 5 – Adria); Armatura G.*, Frena A., Scotton G.* (St Moritz Hospital); Gallo G.*, Sammarco G., Vescio G. (University ‘Magna Graecia’ of Catanzaro); Di Marzo F.* (Valtiberina); Fontana T.* (‘Vittorio Emanuele’ – Gela).Japan: Kanemitsu Y.*, Moritani K. (National Cancer Center Hospital).Jordan: Al Abdallah M.*, Ayasra F., Ayasra Y., Qasem A. (Al-Basheer Hospital); Fahmawee T., Hmedat A., Obeidat K.* (King Abdullah University Hospital); Abou Chaar M. K., Al-Masri M.*, Al-Najjar H., Alawneh F. (King Hussein Cancer Center).Libya: Alkadeeki G.*, Al Maadany F. S. (Al-Jalaa Hospital); Aldokali N., Senossi O., Subhi M. T. (Alkhadra Hospital); Burgan D.*, Kamoka E., Kilani A. I. (National Cancer Institute, Sabratha); Ellojli I.*, Kredan A. (Tripoli University Hospital).Lithuania: Bradulskis S., Dainius E., Kubiliute E., Kutkevičius J., Parseliunas A., Subocius A., Venskutonis D.* (Lithuanian University of Health Sciences Kaunas Clinical Hospital).Madagascar: Rasoaherinomenjanahary F.*, Razafindrahita J. B., Samison L. H. (Joseph Ravoahangy Andrianavalona Hospital).Malaysia: Hamdan K. H., Ibrahim M. R., Tan J. A., Thanapal M. R.* (Hospital Kuala Lumpur); Amin Sahid N., Hayati F.*, Jayasilan J., Sriram R. K.*, Subramaniam S. (Queen Elizabeth Hospital and Universiti Malaysia Sabah, Kota Kinabalu, Sabah); Che Jusoh M. A., Hussain A. H., Mohamed Sidek A. S., Mohd Yunus M. F., Soh J. Y., Wong M., Zakaria A. D.*, Zakaria Z. (School of Medical Sciences and Hospital, Universiti Sains Malaysia); Fathi N. Q., Xavier R. G., Roslani A. C.* (University Malaya Medical Centre).Mexico: Buerba G. A., Mercado M. Á.*, Posadas-Trujillo O. E., Salgado-Nesme N., Sarre C. (Instituto Nacional de Ciencias Médicas y Nutrición ‘Salvador Zubirán’).Morocco: Amrani L., El Ahmadi B., El Bouazizi Y., Majbar A. M., Benkabbou A., Mohsine R., Souadka A.* (Institut National d’Oncologie, Université Mohammed V Rabat).Netherlands: Hompes R.*, Meima-van Praag E. M., Pronk A. J. M., Sharabiany S. (Amsterdam UMC, University of Amsterdam); Grotenhuis B.*, Hartveld L. (Antoni Van Leeuwenhoek Ziekenhuis); Posma-Bouman L.* (Slingeland Ziekenhuis); Derksen T., Franken J., Oosterling S.* (Spaarne Gasthuis); Konsten J.*, Van Heinsbergen M. (Viecuri Medisch Centrum).Nigeria: Olaogun J.* (Ekiti State University Teaching Hospital); Abdur-Rahman L.*, Adeyeye A.*, Bello J., Olasehinde O., Popoola A. (University of Ilorin Teaching Hospital).Pakistan: Jamal A., Kerawala A. A.* (Cancer Foundation Hospital); Memon A. S.*, Nafees Ahmed R., Rai .L*
Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study
No full textnone5203siSummary
Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19
outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of
elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction.
Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in
61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were
followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19
Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the
period they awaited surgery, and classified into light restrictions (index <20), moderate lockdowns (20–60), and full
lockdowns (>60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not
undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between
lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government
response index groups. This study was registered at ClinicalTrials.gov, NCT04384926.
Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up
of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were
associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted
hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11827; HR 0·51,
0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate
lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained
independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without
neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in
moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability
rates observed with longer delays.
Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in
regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although
short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations
might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience
of elective surgery systems requires strengthening, which might include protected elective surgical pathways and longterm investment in surge capacity for acute care during public health emergencies to protect elective staff and services.
Funding National Institute for Health Research Global Health Research Unit, 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, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and
Ireland, and Yorkshire Cancer Research.openGlasbey, James; Ademuyiwa, Adesoji; Adisa, Adewale; AlAmeer, Ehab; Arnaud, Alexis P; Ayasra, Faris; Azevedo, José; Minaya-Bravo, Ana; Costas-Chavarri, Ainhoa; Edwards, John; Elhadi, Muhammed; Fiore, Marco; Fotopoulou, Christina; Gallo, Gaetano; Ghosh, Dhruva; Griffiths, Ewen A; Harrison, Ewen; Hutchinson, Peter; Lawani, Ismail; Lawday, Samuel; Lederhuber, Hans; Leventoglu, Sezai; Li, Elizabeth; Gomes, Gustavo Mendonça Ataíde; Mann, Harvinder; Marson, Ella J; Martin, Janet; Mazingi, Dennis; McLean, Kenneth; Modolo, Maria; Moore, Rachel; Morton, Dion; Ntirenganya, Faustin; Pata, Francesco; Picciochi, Maria; Pockney, Peter; Ramos-De la Medina, Antonio; Roberts, Keith; Roslani, April Camilla; Kottayasamy Seenivasagam, Rajkumar; Shaw, Richard; Simões, Joana Filipa Ferreira; Smart, Neil; Stewart, Grant D; Sullivan, Richard; Sundar, Sudha; Tabiri, Stephen; Taylor, Elliott H; Vidya, Raghavan; Nepogodiev, Dmitri; Bhangu, Aneel; Glasbey, James C; McLean, Kenneth; 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Teoh, AYB; Teoh, JY; Foo, CC; Banky, B; Suszták, N; Misra, S; Pareek, P; Vishnoi, JR; Ambre, S; Balasubiramaniyan, V; Chappity, P; Chaudhary, I; Colney, L; Das, MK; Imaduddin, M; Jain, A; Jena, SK; Kar, M; Mandal, S; Mishra, A; Mishra, SS; Mishra, TS; Mitra, JK; Mittal, Y; Muduly, DK; Nayak, P; Parida, PK; Pradhan, P; Rajan, DK; Rebba, E; Samal, DK; Singh, A; Sultania, M; Agarwal, SP; Agrawal, A; Arora, RK; Chaturvedi, J; Garg, PK; Gaurav, A; Gupta, A; Kottayasamy Seenivasagam, R; Maharaj, DD; Majumdar, KS; Mishra, N; Mittal, A; Narain, TA; Nirjhar, R; Poonia, DR; Sadhasivam, S; Singh, MP; Tiwari, AR; Akula, AK; Bandegudda, SK; Bindlish, RP; Chaitanya, A; Chandrasekhara Rao, LM; Dalakoti, P; Dasu, S; Giridhar, A; Gorijavolu, NB; Iyer, RR; Jayakarthik, Y; Jonathan, GT; Kalla, MB; Kheni, Y; Kumar, CS; Murtuza, SA; Naidu, CCK; Nalukurthi, RK; Nemade, HO; Nusrath, S; Patnaik, SC; Raju, KVVN; Ramalingam, PR; Rao, KV; Rayani, BK; Reddy Kallam, SM; R
30-day postoperative mortality and the effects of hospital preparedness during the COVID-19 pandemic: a pooled analysis of prospective international cohort studiesResearch in context
No full textSummary: Background: Surgical services were poorly prepared for the COVID-19 pandemic, leading to widescale disruption to elective activity. This study aimed to identify actionable priorities to strengthen pandemic preparedness of surgical and hospital systems. Methods: This study pooled data from three international, prospective cohort studies including patients who had a positive SARS-CoV-2 test result in the seven days before or within 30 days after surgery. Patients were included across four pandemic time periods: Period 1 (January–May 2020), Period 2 (June–July 2020), Period 3 (October 2020), and Period 4 (December–March 2022). The primary outcome measure was 30-day postoperative mortality. Hierarchical logistic regression models were developed to explore association between pandemic periods (primary analysis) and hospital-level preparedness (secondary analysis) on 30-day postoperative mortality. Hospital preparedness was classified in to poorly-, moderately-, and highly-prepared tertiles based on Surgical Preparedness Index (SPI) score. Findings: A total of 31,751 patients were included from 1589 hospitals and 102 countries. From Period 1 through to Period 4 there was a decrease in the proportion of patients aged ≥70 years and with ASA grades 3–5.30-day postoperative mortality fell from Period 1 (18.4% [1378/7502]), Period 2 (9.9% [219/2234], adjusted odds ratio (aOR) 0.65, 95% confidence interval (CI) 0.53–0.78), Period 3 (10.5% [246/2427], aOR 0.60, 95% CI 0.50–0.71), through to Period 4 (5.8% [1132/19,588], aOR 0.33, 95% CI 0.30–0.37). During Period 4, SARS-CoV-2 vaccinated patients had lower mortality compared to unvaccinated patients (4.9% [603/12,361] versus 7.4% [529/7178], aOR 0.49, 95% CI 0.42–0.57). Compared to poorly-prepared hospitals (11.2% [1019/9071]), moderately-prepared (9.4% [857/9071], aOR 0.84, 95% CI 0.75–0.94) and highly-prepared hospitals (5.8% [530/9071], aOR 0.70, 95% CI 0.62–0.80) had lower mortality. Interpretation: Postoperative mortality decreased over the course of the COVID-19 pandemic and was lower in better prepared hospitals. Hospitals are critical national infrastructure and strengthening their preparedness by developing formal pandemic plans, establishing patient and procedure prioritisation protocols, and ring-fencing surgical beds would ensure safer surgical care during future pandemics. Funding: National Institute for Health and Care Research, United Kingdom
