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  • 1
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    Variation in postoperative outcomes of patients with intracranial tumors: insights from a prospective international cohort study during the COVID-19 pandemic
    Oxford University Press (OUP) ; 2023
    In:  Neuro-Oncology Vol. 25, No. 7 ( 2023-07-06), p. 1299-1309
    Details
    In: Neuro-Oncology, Oxford University Press (OUP), Vol. 25, No. 7 ( 2023-07-06), p. 1299-1309
    Abstract: This study assessed the international variation in surgical neuro-oncology practice and 30-day outcomes of patients who had surgery for an intracranial tumor during the COVID-19 pandemic. Methods We prospectively included adults aged ≥18 years who underwent surgery for a malignant or benign intracranial tumor across 55 international hospitals from 26 countries. Each participating hospital recorded cases for 3 consecutive months from the start of the pandemic. We categorized patients’ location by World Bank income groups (high [HIC], upper-middle [UMIC] , and low- and lower-middle [LLMIC]). Main outcomes were a change from routine management, SARS-CoV-2 infection, and 30-day mortality. We used a Bayesian multilevel logistic regression stratified by hospitals and adjusted for key confounders to estimate the association between income groups and mortality. Results Among 1016 patients, the number of patients in each income group was 765 (75.3%) in HIC, 142 (14.0%) in UMIC, and 109 (10.7%) in LLMIC. The management of 200 (19.8%) patients changed from usual care, most commonly delayed surgery. Within 30 days after surgery, 14 (1.4%) patients had a COVID-19 diagnosis and 39 (3.8%) patients died. In the multivariable model, LLMIC was associated with increased mortality (odds ratio 2.83, 95% credible interval 1.37–5.74) compared to HIC. Conclusions The first wave of the pandemic had a significant impact on surgical decision-making. While the incidence of SARS-CoV-2 infection within 30 days after surgery was low, there was a disparity in mortality between countries and this warrants further examination to identify any modifiable factors.
    Type of Medium: Online Resource
    ISSN: 1522-8517 , 1523-5866
    URL: Article
    DOI: 10.1093/neuonc/noad019
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2023
    detail.hit.zdb_id: 2094060-9
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  • 2
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    O22 Risk of death following pulmonary complications of surgery with and without SARS-CoV-2 infection: a comparative analysis of pre-pandemic and pandemic cohort studies
    Oxford University Press (OUP) ; 2021
    In:  British Journal of Surgery Vol. 108, No. Supplement_5 ( 2021-07-30)
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 108, No. Supplement_5 ( 2021-07-30)
    Abstract: No comparison has been made between the risk of death following pulmonary complications in patients with and without SARS-CoV-2 infection. This study aimed to determine the incidence and impact of pulmonary complications before and during the SARS-CoV-2 pandemic. Method A patient-level comparative analysis of two international prospective cohort studies; conducted pre-pandemic (22 January to 19 October 2019) and during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines were included in analysis. The primary outcome measure was the mortality within 30 days of surgery. Result This study included 7402 patients from 50 countries; 3031 (40.9%) were operated pre-pandemic and 4371 (59.1%) during the pandemic. 5.1% (n = 224/4371) of patients during the pandemic developed a postoperative SARS-CoV-2 infection. Despite selection of lower risk cases during the pandemic, the rates of pulmonary complications pre were similar (6.3% vs 6.9%, P = 0.280). However, the risk of death after surgery was higher during the pandemic (2.0% vs 0.7%, P  & lt; 0.001). The population attributable fraction of deaths due to pulmonary complications was 37.7% (95% CI: 15.2–64.7%) pre-pandemic and 66.0% (95% CI: 48.6–79.3%) during the pandemic. The increased mortality was largely attributable to SARS-CoV-2 infection; 68.9% (n = 31/45) of deaths patients with pulmonary complications occurred following SARS-CoV-2 infection. Conclusion Pulmonary complications are the primary driver of death after elective surgery during the pandemic. Care providers must urgently reconfigure surgical services to protect patients from perioperative SARS-CoV-2 infection. Take-home Message Pulmonary complications are the primary driver of death after elective surgery during the pandemic. Care providers must urgently reconfigure surgical services to protect patients from perioperative SARS-CoV-2 infection.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znab282.027
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 3
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    SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study
    Wiley ; 2022
    In:  Anaesthesia Vol. 77, No. 1 ( 2022-01), p. 28-39
    Details
    In: Anaesthesia, Wiley, Vol. 77, No. 1 ( 2022-01), p. 28-39
    Abstract: SARS‐CoV‐2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri‐operative or prior SARS‐CoV‐2 were at further increased risk of venous thromboembolism. We conducted a planned sub‐study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS‐CoV‐2 diagnosis was defined as peri‐operative (7 days before to 30 days after surgery); recent (1–6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre‐operative anti‐coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS‐CoV‐2; 2.2% (50/2317) in patients with peri‐operative SARS‐CoV‐2; 1.6% (15/953) in patients with recent SARS‐CoV‐2; and 1.0% (11/1148) in patients with previous SARS‐CoV‐2. After adjustment for confounding factors, patients with peri‐operative (adjusted odds ratio 1.5 (95%CI 1.1–2.0)) and recent SARS‐CoV‐2 (1.9 (95%CI 1.2–3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS‐CoV‐2 (1.7 (95%CI 0.9–3.0)). Overall, venous thromboembolism was independently associated with 30‐day mortality (5.4 (95%CI 4.3–6.7)). In patients with SARS‐CoV‐2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri‐operative or recent SARS‐CoV‐2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS‐CoV‐2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.
    Type of Medium: Online Resource
    ISSN: 0003-2409 , 1365-2044
    URL: Issue
    URL: Article
    DOI: 10.1111/anae.v77.1
    DOI: 10.1111/anae.15563
    Language: English
    Publisher: Wiley
    Publication Date: 2022
    detail.hit.zdb_id: 2003379-5
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  • 4
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    V9 Risk of death following pulmonary complications after surgery with and without SARS-CoV-2 infection: a pooled analysis of individual patient data from pre-pandemic and pandemic international cohort studies
    Oxford University Press (OUP) ; 2021
    In:  BJS Open Vol. 5, No. Supplement_1 ( 2021-04-08)
    Details
    In: BJS Open, Oxford University Press (OUP), Vol. 5, No. Supplement_1 ( 2021-04-08)
    Abstract: Whilst the severe consequences of COVID-19 around the time of surgery are well described, no comparison has been made to pulmonary complications in the absence of infection. This study aimed to compare postoperative death in patients with and without SARS-CoV-2 infection. Methods A patient-level comparative analysis of two international prospective cohort studies; one conducted before (January to October 2019) and one during the SARS-CoV-2 pandemic (from local emergence of COVID-19 to April 2020). Patients undergoing elective resection of an intra-abdominal cancer with curative intent were included in a multilevel logistic regression. The primary outcome was 30-day postoperative mortality. Results Of 7402 patients included, 3031 underwent surgery before and 4371 during the pandemic. Overall, 6.5% (n = 484) patients suffered a pulmonary complication, 5.1% had a SARS-CoV-2 infection diagnosed, and 1.4% patients (n = 107) died. Compared to patients without pulmonary complications, those with SARS-CoV-2 pulmonary complications had a higher adjusted odds of death (OR: 54.14, 95%CI: 23.46 to 124.91, p  & lt; 0.001) than those with non-SARS-CoV-2 pulmonary complications (OR: 7.20, 95%CI: 3.85 to 13.45, p  & lt; 0.001). Conclusion Postoperative pulmonary complications were associated with increased 30-day mortality. SARS-CoV-2 associated pulmonary complications were associated with a far higher mortality than a non-SAR-CoV-2 pulmonary complication.
    Type of Medium: Online Resource
    ISSN: 2474-9842
    URL: Article
    DOI: 10.1093/bjsopen/zrab034.008
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
    detail.hit.zdb_id: 2902033-5
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  • 5
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    458 Urological Cancers During COVID-19: Analyses of Short-Term Outcomes from the COVIDSurg-Cancer Study
    Oxford University Press (OUP) ; 2022
    In:  British Journal of Surgery Vol. 109, No. Supplement_6 ( 2022-08-19)
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 109, No. Supplement_6 ( 2022-08-19)
    Abstract: To assess 30-day postoperative outcomes for patients undergoing urological cancer surgery during the COVID-19 pandemic. Method All bladder, kidney, UTUC and prostate cancer patients from the COVIDSurg-Cancer Study who underwent elective potentially curative cancer surgery during the COVID-19 pandemic until July 2020 were included. Univariable and multivariable regression was performed to assess the association of patient factors with mortality, respiratory complications, and operative complications. Results A total of 1,902 patients from 36 countries were included. A total of 42/1902 (0.2%) patients were diagnosed with COVID-19 during their inpatient stay. 21 (0.1%) mortalities were observed; of those, 8 (38.1%) were diagnosed with COVID-19. Mortalities were found to be more likely in patients with concurrent COVID-19 infection (OR 31.7, 95% CI 12.4–81.42, p & lt;0.001), aged over 80, ASA grade 3+ and ECOG grade 1+. 40 (0.2%) respiratory complications (acute respiratory distress syndrome or pneumonia) were observed within 30 days of surgery. Respiratory complications were more likely in patients aged with concurrent COVID-19 infection (OR 40.6, 95%CI 11.41–144.45, p & lt;0.001), over 70, from an area with high community risk or with a revised cardiac risk index of 1+. There were 84 (4.4%) major complications (Clavien-Dindo score ≥3). Patients with a concurrent COVID-19 infection (OR 7.45, 95% CI 2.73–20.3, p & lt;0.001) or aged 80 or above were more likely to experience major complications. Conclusions Our data can inform health services to safely select patients for surgery during the pandemic. Patients with concurrent COVID-19 infection have a higher risk of mortality and respiratory complications and should not undergo surgery if possible.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znac268.052
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2022
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  • 6
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    Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study
    Wiley ; 2021
    In:  Anaesthesia Vol. 76, No. 6 ( 2021-06), p. 748-758
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    In: Anaesthesia, Wiley, Vol. 76, No. 6 ( 2021-06), p. 748-758
    Abstract: 주술기 SARS‐CoV‐2 감염은 수술 후 사망률을 증가시킨 다. 본 연구의 목적은 SARS‐CoV‐2에 감염된 환자에서 수술 전 계획된 지연(planned delay)의 최적 기간을 결정하는 것이 었다. 이 국제적 다기관 전향적 코호트 연구에는 2020년 10월 중에 정규 또는 응급 수술을 받은 환자가 포함되었다. 수술 전 SARS‐CoV‐2에 감염된 수술 대상 환자를 이전에 SARS‐ CoV‐2에 감염되지 않은 환자와 비교하였다. 일차 평가변수는 수술 후 30일 이내의 사망률이었다. 로지스틱 회귀분석 모델 을 사용하여 SARS‐CoV‐2 감염에서 수술까지의 경과 시간 에 따라 층화된 보정 30일 이내 사망률(adjusted 30‐day mortality rates)을 계산하였다. 14만 231명의 환자(116개국) 중 3127명(2.2%)이 수술 전에 SARS‐CoV‐2 감염 진단을 받았다. SARS‐CoV‐2에 감염되지 않은 환자의 보정 30일 이내 사망 률은 1.5%였다(95% 신뢰구간[CI] 1.4‐1.5). 수술 전 SARS‐CoV‐2 감염 진단을 받은 환자의 경우, 진단 후 0‐2주, 3‐4주 및 5‐6주 이내에 수술을 받은 환자에서 사망률이 증가하였다 (교차비[odds ratio] [95% CI]는 각각 4.1 [3.3‐4.8] , 3.9 [2.6‐5.1] 및 3.6 [2.0‐5.2] ). SARS‐CoV‐2 진단 후 7주 이상이 지난 뒤 실시된 수술은 기저치와 유사한 사망 위험도를 나타내었다 (교차비[95% CI] 1.5 [0.9‐2.1] ). SARS‐CoV‐2에 감염된 뒤 7주 이상 수술이 연기된 경우, 증상이 지속된 환자는 증상이 관해되었거나 무증상인 환자보다 사망률이 더 높았다(각각 6.0% [95%CI 3.2‐8.7] 대비 2.4% [95%CI 1.4‐3.4] 대비 1.3% [95%CI 0.6‐2.0]). 가능하다면 SARS‐CoV‐2에 감염된 이후 최소 7주 동안 수술을 연기해야 한다. 진단 후 7주 이상 증상 이 지속되는 환자는 추가적인 수술 연기가 도움이 될 수 있다.
    Type of Medium: Online Resource
    ISSN: 0003-2409 , 1365-2044
    URL: Issue
    URL: Article
    DOI: 10.1111/anae.v76.6
    DOI: 10.1111/anae.15458
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 7
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    Effects of pre‐operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study
    Wiley ; 2021
    In:  Anaesthesia Vol. 76, No. 11 ( 2021-11), p. 1454-1464
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    In: Anaesthesia, Wiley, Vol. 76, No. 11 ( 2021-11), p. 1454-1464
    Abstract: We aimed to determine the impact of pre‐operative isolation on postoperative pulmonary complications after elective surgery during the global SARS‐CoV‐2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre‐defined sub‐group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS‐CoV‐2 infection. Patients who isolated pre‐operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS‐CoV‐2 incidence and high‐income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05–1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre‐operative testing; use of COVID‐19‐free pathways; or community SARS‐CoV‐2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4–7 days or ≥ 8 days of 1.25 (1.04–1.48), p = 0.015 and 1.31 (1.11–1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.
    Type of Medium: Online Resource
    ISSN: 0003-2409 , 1365-2044
    URL: Issue
    URL: Article
    DOI: 10.1111/anae.v76.11
    DOI: 10.1111/anae.15560
    Language: English
    Publisher: Wiley
    Publication Date: 2021
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  • 8
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    Death following pulmonary complications of surgery before and during the SARS-CoV-2 pandemic
    Oxford University Press (OUP) ; 2021
    In:  British Journal of Surgery Vol. 108, No. 12 ( 2021-12-01), p. 1448-1464
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    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 108, No. 12 ( 2021-12-01), p. 1448-1464
    Abstract: 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  & lt; 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  & lt; 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  & lt; 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. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znab336
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 9
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    813 Risk of Death Following Pulmonary Complications After Surgery with And Without SARS-Cov-2 Infection: A Pooled Analysis of Individual Patient Data from Pre-Pandemic and Pandemic International Cohort Studies
    Oxford University Press (OUP) ; 2021
    In:  British Journal of Surgery Vol. 108, No. Supplement_2 ( 2021-05-04)
    Details
    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 108, No. Supplement_2 ( 2021-05-04)
    Abstract: Risk of death following pulmonary complications after surgery with and without SARS-CoV-2 infection: a pooled analysis of individual patient data from pre-pandemic and pandemic international cohort studies Introduction Diagnostic haematuria services have been reduced due to the COVID-19 pandemic, compromising patient care, and necessitating a more pragmatic pathway. Method The IDENTIFY study was an international, prospective, multicentre cohort study of over 11,000 patients referred to secondary care for investigation of haematuria. Using this data, we developed strategies using combinations of imaging and cytology as triage tests to maximise cancer detection within a pragmatic pathway. Results 8112 patients (74·4%) received an ultrasound or a CT urogram, with or without cytology. 5737 (70·7%) patients had visible haematuria (VH) and 2375 (29·3%) had non-visible haematuria (NVH). Diagnostic test performance was used to determine optimal age cut-offs for four proposed strategies. We recommended proceeding directly to transurethral resection of bladder tumour for patients of any age with positive triage tests for cancer. Patients with negative triage tests under 35-years-old with VH, or under 50-years-old with NVH can safely be discharged without undergoing flexible cystoscopy. The remaining patients may undergo flexible cystoscopy, with a greater priority for older patients to capture high risk bladder cancer. Conclusions We suggest diagnostic strategies in patients with haematuria, which focus on detection of bladder cancer, whilst reducing the burden to healthcare services in a resource-limited setting.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znab134.194
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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  • 10
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    SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
    Oxford University Press (OUP) ; 2021
    In:  British Journal of Surgery Vol. 108, No. 9 ( 2021-09-27), p. 1056-1063
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    In: British Journal of Surgery, Oxford University Press (OUP), Vol. 108, No. 9 ( 2021-09-27), p. 1056-1063
    Abstract: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. Methods The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18–49, 50–69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. Results NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. Conclusion As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
    Type of Medium: Online Resource
    ISSN: 0007-1323 , 1365-2168
    URL: Article
    DOI: 10.1093/bjs/znab101
    Language: English
    Publisher: Oxford University Press (OUP)
    Publication Date: 2021
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