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2. The Operating Room management for emergency Surgical Activity (ORSA) study: a WSES international survey

Author

De Simone, Belinda, Agnoletti, Vanni, Abu-Zidan, Fikri M., Biffl, Walter L., Moore, Ernest E., Chouillard, Elie, Coccolini, Federico, Sartelli, Massimo, Podda, Mauro, Di Saverio, Salomone, Kaafarani, Haytham, Balogh, Zsolt J., Bala, Miklosh, Leppäniemi, Ari K., Kirkpatrick, Andrew W., Pikoulis, Emmanouil, Rasa, Kemal, Rosato, Chiara, Sawyer, Robert, Ansaloni, Luca, de’Angelis, Nicola, Damaskos, Dimitris, Stahel, Philip F., Kluger, Yoram, Coimbra, Raul, and Catena, Fausto

Published
2024
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5. Are we ready for "green surgery" to promote environmental sustainability in the operating room? Results from the WSES STAR investigation

Author

Dal Mas, Francesca, Cobianchi, Lorenzo, Piccolo, Daniele, Balch, Jeremy, Biancuzzi, Helena, Biffl, Walter L., Campostrini, Stefano, Cicuttin, Enrico, Coccolini, Federico, Damaskos, Dimitris, Filiberto, Amanda C., Filisetti, Claudia, Fraga, Gustavo, Frassini, Simone, Fugazzola, Paola, Hardcastle, Timothy, Kaafarani, Haytham M., Kluger, Yoran, Massaro, Maurizio, Martellucci, Jacopo, Moore, Ernest, Ruta, Federico, Sartelli, Massimo, Stahel, Philip F., Velmahos, George, Weber, Dieter G., Catena, Fausto, Loftus, Tyler J., and Ansaloni, Luca

Published
2024
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6. Bibliometric analysis of academic journal recommendations and requirements for surgical and anesthesiologic adverse events reporting.

Author

Sholklapper, Tamir, Ballon, Jorge, Sayegh, Aref, La Riva, Anibal, Perez, Laura, Huang, Sherry, Eppler, Michael, Nelson, Gregg, Marchegiani, Giovanni, Hinchliffe, Robert, Gordini, Luca, Furrer, Marc, Brenner, Michael, Dell-Kuster, Salome, Biyani, Chandra, Francis, Nader, Kaafarani, Haytham, Siepe, Matthias, Winter, Des, Bandello, Francesco, Siemens, Robert, Walz, Jochen, Briganti, Alberto, Gratzke, Christian, Abreu, Andre, Desai, Mihir, Sotelo, Rene, Agha, Riaz, Lillemoe, Keith, Wexner, Steven, Collins, Gary, Gill, Inderbir, Cacciamani, Giovanni, and Sosa, Julie Ann

Subjects
Humans, Anesthesiology, Bibliometrics, Journal Impact Factor, Europe, Middle East
Abstract

BACKGROUND: Standards for reporting surgical adverse events (AEs) vary widely within the scientific literature. Failure to adequately capture AEs hinders efforts to measure the safety of healthcare delivery and improve the quality of care. The aim of the present study is to assess the prevalence and typology of perioperative AE reporting guidelines among surgery and anesthesiology journals. MATERIALS AND METHODS: In November 2021, three independent reviewers queried journal lists from the SCImago Journal & Country Rank (SJR) portal (www.scimagojr.com), a bibliometric indicator database for surgery and anesthesiology academic journals. Journal characteristics were summarized using SCImago, a bibliometric indicator database extracted from Scopus journal data. Quartile 1 (Q1) was considered the top quartile and Q4 bottom quartile based on the journal impact factor. Journal author guidelines were collected to determine whether AE reporting recommendations were included and, if so, the preferred reporting procedures. RESULTS: Of 1409 journals queried, 655 (46.5%) recommended surgical AE reporting. Journals most likely to recommend AE reporting were: by category surgery (59.1%), urology (53.3%), and anesthesia (52.3%); in top SJR quartiles (i.e. more influential); by region, based in Western Europe (49.8%), North America (49.3%), and the Middle East (48.3%). CONCLUSIONS: Surgery and anesthesiology journals do not consistently require or provide recommendations on perioperative AE reporting. Journal guidelines regarding AE reporting should be standardized and are needed to improve the quality of surgical AE reporting with the ultimate goal of improving patient morbidity and mortality.

Published
2023

8. The impact of post-operative enteral nutrition on duodenal injury outcomes: A post hoc analysis of an EAST multicenter trial

Author

Choron, Rachel L., Rallo, Michael, Piplani, Charoo, Youssef, Sara, Teichman, Amanda L., Bargoud, Christopher G., Sciarretta, Jason D., Smith, Randi N., Hanos, Dustin S., Afif, Iman N., Beard, Jessica H., Dhillon, Navpreet K., Zhang, Ashling, Ghneim, Mira, Devasahayam, Rebekah J., Gunter, Oliver L., Smith, Alison A., Sun, Brandi L., Cao, Chloe, Reynolds, Jessica K., Hilt, Lauren A., Holena, Daniel, Chang, Grace, Jonikas, Meghan, Echeverria, Karla, Fung, Nathaniel, Anderson, Aaron, Dumas, Ryan P., Fitzgerald, Caitlin A., Levin, Jeremy, Trankiem, Christine, Yoon, JaeHee Jane, Blank, Jacqueline, Hazelton, Joshua, McLaughlin, Christopher J., Al-Aref, Rami, Kirsch, Jordan M., Howard, Daniel S., Scantling, Dane R., Dellonte, Kate, Vella, Michael, Hopkins, Brent, Shell, Chloe, Udekwu, Pascal O., Wong, Evan G., Joseph, Bellal A., Lieberman, Howard, Ramsey, Walter, Stewart, Collin, Alvarez, Claudia, Berne, John D., Nahmias, Jeffry, Puente, Ivan, Patton, J. Pat, Rakitin, Ilya, Perea, Lindsey L., Pulido, Odessa R., Ahmed, Hashim, Keating, Jane, Kodadek, Lisa, Wade, Jason, Henry, Reynold, Schreiber, Martin, Benjamin, Andrew, Khan, Abid, Mann, Laura K., Mentzer, Caleb, Mousafeiris, Vasileios, Mulita, Francesk, Reid-Gruner, Shari, Sais, Erica, Foote, Christopher, Palacio-Lascano, Carlos, Argandykov, Dias, Kaafarani, Haytham, Bover Manderski, Michelle, Narayan, Mayur, and Seamon, Mark J.

Published
2024
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21. Correction: Surgeons’ perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey

Author

Cobianchi, Lorenzo, Piccolo, Daniele, Dal Mas, Francesca, Agnoletti, Vanni, Ansaloni, Luca, Balch, Jeremy, Biffl, Walter, Butturini, Giovanni, Catena, Fausto, Coccolini, Federico, Denicolai, Stefano, De Simone, Belinda, Frigerio, Isabella, Fugazzola, Paola, Marseglia, Gianluigi, Marseglia, Giuseppe Roberto, Martellucci, Jacopo, Modenese, Mirko, Previtali, Pietro, Ruta, Federico, Venturi, Alessandro, Kaafarani, Haytham M., and Loftus, Tyler J.

Published
2023
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23. Surgeons’ perspectives on artificial intelligence to support clinical decision-making in trauma and emergency contexts: results from an international survey

Author

Cobianchi, Lorenzo, Piccolo, Daniele, Dal Mas, Francesca, Agnoletti, Vanni, Ansaloni, Luca, Balch, Jeremy, Biffl, Walter, Butturini, Giovanni, Catena, Fausto, Coccolini, Federico, Denicolai, Stefano, De Simone, Belinda, Frigerio, Isabella, Fugazzola, Paola, Marseglia, Gianluigi, Marseglia, Giuseppe Roberto, Martellucci, Jacopo, Modenese, Mirko, Previtali, Pietro, Ruta, Federico, Venturi, Alessandro, Kaafarani, Haytham M., and Loftus, Tyler J.

Published
2023
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24. Time for a paradigm shift in shared decision-making in trauma and emergency surgery? Results from an international survey

Author

Cobianchi, Lorenzo, Dal Mas, Francesca, Agnoletti, Vanni, Ansaloni, Luca, Biffl, Walter, Butturini, Giovanni, Campostrini, Stefano, Catena, Fausto, Denicolai, Stefano, Fugazzola, Paola, Martellucci, Jacopo, Massaro, Maurizio, Previtali, Pietro, Ruta, Federico, Venturi, Alessandro, Woltz, Sarah, Kaafarani, Haytham M., and Loftus, Tyler J.

Published
2023
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25. SARS‐CoV‐2 infection and venous thromboembolism after surgery: an international prospective cohort study

Author

Nepogodiev, Dmitri, Simoes, Joana FF, Li, Elizabeth, Picciochi, Maria, Glasbey, James C, Baiocchi, Glauco, Blanco‐Colino, Ruth, Chaudhry, Daoud, AlAmeer, Ehab, El‐Boghdadly, Kariem, Wuraola, Funmilola, Ghosh, Dhruva, Gujjuri, Rohan R, Harrison, Ewen M, Lule, Herman, Kaafarani, Haytham, Khosravi, Mohammad, Kronberger, Irmgard, Leventoğlu, Sezai, Mann, Harvinder, Mclean, Kenneth A, Mengesha, Mengistu Gebreyohanes, Modolo, Maria Marta, Ntirenganya, Faustin, Norman, Lisa, Outani, Oumaima, Pius, Riinu, Pockney, Peter, Qureshi, Ahmad Uzair, Roslani, April Camilla, Satoi, Sohei, Shaw, Catherine, Bhangu, Aneel, Omar, Omar M, Ahmed, Waheed‐Ul‐Rahman, Argus, Leah, Ball, Alasdair, Bywater, Edward P, Brar, Amanpreet, Dawson, Brett E, Duran, Irani, Elhadi, Muhammed, Jones, Conor S, Kamarajah, Sivesh K, Keatley, James M, Lawday, Samuel, Marson, Ella J, Ots, Riinu, Santos, Irène, Taylor, Elliott H, Trout, Isobel M, Varghese, Chris, Venn, Mary L, Xu, William, Dajti, Irida, Gjata, Arben, Kacimi, Salah Eddine Oussama, Boccalatte, Luis, Cox, Daniel, Townend, Philip, Aigner, Felix, Kronberger, Irmgard Elisabeth, Samadov, Elgun, Alderazi, Amer, Hossain, Kamral, Padmore, Greg, van Ramshorst, Gabrielle, Lawani, Ismaïl, Cerovac, Anis, Delibegovic, Samir, Gomes, Gustavo Mendonça Ataíde, Buarque, Igor Lima, Gohar, Muhammad, Slavchev, Mihail, Nwegbu, Chukwuemeka, Agarwal, Arnav, Martin, Janet, and Ng‐Kamstra, Joshua

Subjects
Lung, Patient Safety, Prevention, Clinical Research, Hematology, Pneumonia, Cardiovascular, Good Health and Well Being, Adolescent, Adult, Age Distribution, Aged, COVID-19, Cohort Studies, Female, Humans, Internationality, Male, Middle Aged, Postoperative Complications, Prospective Studies, SARS-CoV-2, Sex Distribution, Venous Thromboembolism, Young Adult, COVIDSurg Collaborative, GlobalSurg Collaborative, deep vein thrombosis, pulmonary embolism, venous thromboembolism, Clinical Sciences, Neurosciences, Anesthesiology
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.

Published
2022

32. Trauma and nontrauma damage-control laparotomy: The difference is delirium (data from the Eastern Association for the Surgery of Trauma SLEEP-TIME multicenter trial).

Author

McArthur, Kaitlin, Krause, Cassandra, Kwon, Eugenia, Luo-Owen, Xian, Cochran-Yu, Meghan, Swentek, Lourdes, Burruss, Sigrid, Turay, David, Krasnoff, Chloe, Grigorian, Areg, Nahmias, Jeffry, Butt, Ahsan, Gutierrez, Adam, LaRiccia, Aimee, Kincaid, Michelle, Fiorentino, Michele N, Glass, Nina, Toscano, Samantha, Ley, Eric, Lombardo, Sarah R, Guillamondegui, Oscar D, Bardes, James M, DeLa'O, Connie, Wydo, Salina M, Leneweaver, Kyle, Duletzke, Nicholas T, Nunez, Jade, Moradian, Simon, Posluszny, Joseph, Naar, Leon, Kaafarani, Haytham, Kemmer, Heidi, Lieser, Mark J, Dorricott, Alexa, Chang, Grace, Nemeth, Zoltan, and Mukherjee, Kaushik

Subjects
Humans, Delirium, Abdominal Injuries, Postoperative Complications, Analgesics, Opioid, Length of Stay, Laparotomy, Injury Severity Score, Incidence, Linear Models, Risk Factors, Retrospective Studies, Sleep, Adult, Middle Aged, Intensive Care Units, United States, Female, Male, Young Adult, Physical Injury - Accidents and Adverse Effects, Traumatic Head and Spine Injury, Infectious Diseases, Clinical Research, Patient Safety, Clinical Trials and Supportive Activities, Trauma, damage-control laparotomy, sedation, delirium, nontrauma, Cardiorespiratory Medicine and Haematology, Clinical Sciences, Nursing, Emergency & Critical Care Medicine
Abstract

BackgroundDamage-control laparotomy (DCL) has been used for traumatic and nontraumatic indications. We studied factors associated with delirium and outcome in this population.MethodsWe reviewed DCL patients at 15 centers for 2 years, including demographics, Charlson Comorbidity Index (CCI), diagnosis, operations, and outcomes. We compared 30-day mortality; renal failure requiring dialysis; number of takebacks; hospital, ventilator, and intensive care unit (ICU) days; and delirium-free and coma-free proportion of the first 30 ICU days (DF/CF-ICU-30) between trauma (T) and nontrauma (NT) patients. We performed linear regression for DF/CF-ICU-30, including age, sex, CCI, achievement of primary fascial closure (PFC), small and large bowel resection, bowel discontinuity, abdominal vascular procedures, and trauma as covariates. We performed one-way analysis of variance for DF/CF-ICU-30 against traumatic brain injury severity as measured by Abbreviated Injury Scale for the head.ResultsAmong 554 DCL patients (25.8% NT), NT patients were older (58.9 ± 15.8 vs. 39.7 ± 17.0 years, p < 0.001), more female (45.5% vs. 22.1%, p < 0.001), and had higher CCI (4.7 ± 3.3 vs. 1.1 ± 2.2, p < 0.001). The number of takebacks (1.7 ± 2.6 vs. 1.5 ± 1.2), time to first takeback (32.0 hours), duration of bowel discontinuity (47.0 hours), and time to PFC were similar (63.2 hours, achieved in 73.5%). Nontrauma and T patients had similar ventilator, ICU, and hospital days and mortality (31.0% NT, 29.8% T). Nontrauma patients had higher rates of renal failure requiring dialysis (36.6% vs. 14.1%, p < 0.001) and postoperative abdominal sepsis (40.1% vs. 17.1%, p < 0.001). Trauma and NT patients had similar number of hours of sedative (89.9 vs. 65.5 hours, p = 0.064) and opioid infusions (106.9 vs. 96.7 hours, p = 0.514), but T had lower DF/CF-ICU-30 (51.1% vs. 73.7%, p = 0.029), indicating more delirium. Linear regression analysis indicated that T was associated with a 32.1% decrease (95% CI, 14.6%-49.5%; p < 0.001) in DF/CF-ICU-30, while achieving PFC was associated with a 25.1% increase (95% CI, 10.2%-40.1%; p = 0.001) in DF/CFICU-30. Increasing Abbreviated Injury Scale for the head was associated with decreased DF/CF-ICU-30 by analysis of variance (p < 0.001).ConclusionNontrauma patients had higher incidence of postoperative abdominal sepsis and need for dialysis, while T was independently associated with increased delirium, perhaps because of traumatic brain injury.Level of evidenceTherapeutic study, level IV.

Published
2021

34. Timing of surgery following SARS‐CoV‐2 infection: an international prospective cohort study

Author

Nepogodiev, Dmitri, Simoes, Joana FF, Li, Elizabeth, Picciochi, Maria, Glasbey, James C, Baiocchi, Glauco, Blanco‐Colino, Ruth, Chaudhry, Daoud, AlAmeer, Ehab, El‐Boghdadly, Kariem, Wuraola, Funmilola, Ghosh, Dhruva, Gujjuri, Rohan R, Harrison, Ewen M, Lule, Herman, Kaafarani, Haytham, Khosravi, Mohammad, Kronberger, Irmgard, Leventoğlu, Sezai, Mann, Harvinder, Mclean, Kenneth A, Mengesha, Mengistu Gebreyohanes, Modolo, Maria Marta, Ntirenganya, Faustin, Norman, Lisa, Outani, Oumaima, Pius, Riinu, Pockney, Peter, Qureshi, Ahmad Uzair, Roslani, April Camilla, Satoi, Sohei, Shaw, Catherine, Bhangu, Aneel, Omar, Omar M, Ahmed, Waheed‐Ul‐Rahman, Argus, Leah, Ball, Alasdair, Bywater, Edward P, Brar, Amanpreet, Dawson, Brett E, Duran, Irani, Elhadi, Muhammed, Jones, Conor S, Kamarajah, Sivesh K, Keatley, James M, Lawday, Samuel, Marson, Ella J, Ots, Riinu, Santos, Irène, Taylor, Elliott H, Trout, Isobel M, Varghese, Chris, Venn, Mary L, Xu, William, Dajti, Irida, Gjata, Arben, Kacimi, Salah Eddine Oussama, Boccalatte, Luis, Cox, Daniel, Townend, Philip, Aigner, Felix, Kronberger, Irmgard Elisabeth, Samadov, Elgun, Alderazi, Amer, Hossain, Kamral, Padmore, Greg, van Ramshorst, Gabrielle, Lawani, Ismaïl, Cerovac, Anis, Delibegovic, Samir, Gomes, Gustavo Mendonça Ataíde, Buarque, Igor Lima, Gohar, Muhammad, Slavchev, Mihail, Nwegbu, Chukwuemeka, Agarwal, Arnav, Martin, Janet, and Ng‐Kamstra, Joshua

Subjects
Infectious Diseases, Clinical Research, Patient Safety, Lung, Vaccine Related, Pneumonia & Influenza, Biodefense, Pneumonia, Prevention, Emerging Infectious Diseases, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Infection, Good Health and Well Being, Adolescent, Adult, Aged, Aged, 80 and over, COVID-19, Child, Child, Preschool, Cohort Studies, Female, Humans, Infant, Internationality, Male, Middle Aged, Practice Guidelines as Topic, Prospective Studies, SARS-CoV-2, Surgical Procedures, Operative, Time, Young Adult, delay, surgery, timing, COVIDSurg Collaborative, GlobalSurg Collaborative, Clinical Sciences, Neurosciences, Anesthesiology
Abstract

Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

Published
2021

40. Preoperative nasopharyngeal swab testing and postoperative pulmonary complications in patients undergoing elective surgery during the SARS-CoV-2 pandemic

Author

Glasbey, James C, Omar, Omar, Nepogodiev, Dmitri, Minaya-Bravo, Ana, Bankhead-Kendall, Brittany Kay, Fiore, Marco, Futaba, Kaori, Gabre-Kidan, Alodia, Gujjuri, Rohan R, Isik, Arda, Kaafarani, Haytham MA, Kamarajah, Sivesh K, Li, Elizabeth, Löffler, Markus W, McLean, Kenneth A, Outani, Oumaima, Ntirenganya, Faustin, Satoi, Sohei, Shaw, Richard, Simoes, Joana FF, Stewart, Grant D, Tabiri, Stephen, Trout, Isobel M, Bhangu, Aneel A, Siaw-Acheampong, Kwabena, Benson, Ruth A, Bywater, Edward, Chaudhry, Daoud, Dawson, Brett E, Evans, Jonathan P, Heritage, Emily, Jones, Conor S, Khatri, Chetan, Khaw, Rachel A, Keatley, James M, Knight, Andrew, Lawday, Samuel, Mann, Harvinder S, Marson, Ella J, Mckay, Siobhan C, Mills, Emily C, Pellino, Gianluca, Picciochi, Maria, Taylor, Elliott H, Tiwari, Abhinav, Venn, Mary L, Wilkin, Richard JW, Bhangu, Aneel, Smart, Neil J, Gallo, Gaetano, Moug, Susan, Pata, Francesco, Pockney, Peter, Di Saverio, Salomone, Vallance, Abigail, Vimalchandran, Dale, Griffiths, Ewen A, Evans, Richard PT, Townend, Philip, Roberts, Keith, McKay, Siobhan, Isaac, John, Edwards, John, Coonar, Aman S, Marchbank, Adrian, Caruana, Edward J, Layton, Georgia R, Patel, Akshay, Brunelli, Alessandro, Ford, Samuel, Desai, Anant, Gronchi, Alessandro, 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, and Lippa, Laura

Subjects
Clinical Research, Emerging Infectious Diseases, Vaccine Related, Cancer, Patient Safety, Biodefense, Prevention, Lung, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Good Health and Well Being, Aged, Aged, 80 and over, COVID-19, COVID-19 Nucleic Acid Testing, Elective Surgical Procedures, Female, Humans, Lung Diseases, Male, Middle Aged, Nasopharynx, Neoplasms, Pandemics, Postoperative Complications, Risk Assessment, SARS-CoV-2, COVIDSurg Collaborative, Medical and Health Sciences, Surgery
Abstract

BackgroundSurgical 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.MethodsThis 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.ResultsOf 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.ConclusionPreoperative 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.

Published
2021

41. Elective Cancer Surgery in COVID-19-Free Surgical Pathways During the SARS-CoV-2 Pandemic: An International, Multicenter, Comparative Cohort Study.

Author

Glasbey, James C, Nepogodiev, Dmitri, Simoes, Joana FF, Omar, Omar, Li, Elizabeth, Venn, Mary L, PGDME, Abou Chaar, Mohammad K, Capizzi, Vita, Chaudhry, Daoud, Desai, Anant, Edwards, Jonathan G, Evans, Jonathan P, Fiore, Marco, Videria, Jose Flavio, Ford, Samuel J, Ganly, Ian, Griffiths, Ewen A, Gujjuri, Rohan R, Kolias, Angelos G, Kaafarani, Haytham MA, Minaya-Bravo, Ana, McKay, Siobhan C, Mohan, Helen M, Roberts, Keith J, San Miguel-Méndez, Carlos, Pockney, Peter, Shaw, Richard, Smart, Neil J, Stewart, Grant D, Sundar, MRCOG, Sudha, Vidya, Raghavan, Bhangu, Aneel A, Chaar, Mohammad Abou, Ganyli, Ian, Roberts, Keith, Sundar, Sudha, Siaw-Acheampong, Kwabena, Benson, Ruth A, Bywater, Edward, Dawson, Brett E, Heritage, Emily, Jones, Conor S, Kamarajah, Sivesh K, Khatri, Chetan, Khaw, Rachel A, Keatley, James M, Knight, Andrew, Lawday, Samuel, Mann, Harvinder S, Marson, Ella J, McLean, Kenneth A, Mills, Emily C, Pellino, Gianluca, Picciochi, Maria, Taylor, Elliott H, Tiwari, Abhinav, Trout, Isobel M, and Wilkin, Richard JW

Subjects
Lung, Pneumonia, Pneumonia & Influenza, Patient Safety, Clinical Research, Prevention, Cancer, Evaluation of treatments and therapeutic interventions, 6.4 Surgery, Good Health and Well Being, Aged, Aged, 80 and over, COVID-19, Cohort Studies, Critical Care, Elective Surgical Procedures, Epidemics, Female, Humans, International Cooperation, Logistic Models, Male, Middle Aged, Neoplasms, Outcome Assessment, Health Care, Postoperative Complications, SARS-CoV-2, COVIDSurg Collaborative, Clinical Sciences, Oncology and Carcinogenesis, Oncology & Carcinogenesis
Abstract

PurposeAs 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 methodsThis 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).ResultsOf 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).ConclusionWithin 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.

Published
2021

48. Colorectal resection in emergency general surgery: An EAST multicenter trial.

Author

Aicher, Brittany O, Hernandez, Matthew C, Betancourt-Ramirez, Alejandro, Grossman, Michael D, Heise, Holly, Schroeppel, Thomas J, Kongkaewpaisan, Napaporn, Kaafarani, Haytham MA, Wagner, Afton, Grabo, Daniel, Scott, Michael, Peck, Gregory, Chang, Gloria, Matsushima, Kazuhide, Cullinane, Daniel C, Cullinane, Laura M, Stocker, Benjamin, Posluszny, Joseph, Simonoski, Ursula J, Catalano, Richard D, Vasileiou, Georgia, Yeh, D Dante, Agrawal, Vaidehi, Truitt, Michael S, Pickett, MaryAnne, Dultz, Linda, Muller, Alison, Ong, Adrian W, San Roman, Janika L, Barth, Nadine, Fackelmayer, Oliver, Velopulos, Catherine G, Hendrix, Cheralyn, Estroff, Jordan M, Gambhir, Sahil, Nahmias, Jeffry, Jeyamurugan, Kokila, Bugaev, Nikolay, Portillo, Victor, Carrick, Matthew M, O'Meara, Lindsay, Kufera, Joseph, Zielinski, Martin D, and Bruns, Brandon R

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Cancer, Colo-Rectal Cancer, Digestive Diseases, Patient Safety, Clinical Research, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Good Health and Well Being, Aged, Anastomosis, Surgical, Colectomy, Colorectal Surgery, Diverticulitis, Colonic, Emergencies, Female, General Surgery, Hospital Mortality, Humans, Logistic Models, Male, Middle Aged, Multivariate Analysis, Postoperative Complications, Practice Patterns, Physicians', Prospective Studies, Treatment Outcome, United States, Emergency general surgery, colon resection, ostomy, colon anastomosis, Clinical sciences, Nursing
Abstract

ObjectiveEvidence comparing stoma creation (STM) versus anastomosis after urgent or emergent colorectal resection is limited. This study examined outcomes after colorectal resection in emergency general surgery patients.MethodsThis was an Eastern Association for the Surgery of Trauma-sponsored prospective observational multicenter study of patients undergoing urgent/emergent colorectal resection. Twenty-one centers enrolled patients for 11 months. Preoperative, intraoperative, and postoperative variables were recorded. χ, Mann-Whitney U test, and multivariable logistic regression models were used to describe outcomes and risk factors for surgical complication/mortality.ResultsA total of 439 patients were enrolled (ANST, 184; STM, 255). The median (interquartile range) age was 62 (53-71) years, and the median Charlson Comorbidity Index (CCI) was 4 (1-6). The most common indication for surgery was diverticulitis (28%). Stoma group was older (64 vs. 58 years, p < 0.001), had a higher CCI, and were more likely to be immunosuppressed. Preoperatively, STM patients were more likely to be intubated (57 vs. 15, p < 0.001), on vasopressors (61 vs. 13, p < 0.001), have pneumoperitoneum (131 vs. 41, p < 0.001) or fecal contamination (114 vs. 33, p < 0.001), and had a higher incidence of elevated lactate (149 vs. 67, p < 0.001). Overall mortality was 13%, which was higher in STM patients (18% vs. 8%, p = 0.02). Surgical complications were more common in STM patients (35% vs. 25%, p = 0.02). On multivariable analysis, management with an open abdomen, intraoperative blood transfusion, and larger hospital size were associated with development of a surgical complication, while CCI, preoperative vasopressor use, steroid use, open abdomen, and intraoperative blood transfusion were independently associated with mortality.ConclusionThis study highlights a tendency to perform fecal diversion in patients who are acutely ill at presentation. There is a higher morbidity and mortality rate in STM patients. Independent predictors of mortality include CCI, preoperative vasopressor use, steroid use, open abdomen, and intraoperative blood transfusion. Following adjustment by clinical factors, method of colon management was not associated with surgical complications or mortality.Level of evidenceTherapeutic study, level IV.

Published
2020

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