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.

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 ). 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.

MYELUM INTENSITY ON MRI CERVICAL AS PROGNOSTIC FACTORS IN CERVICAL SPONDYLOSIS MYELOPATHY PATIENTSABSTRACTIntroduction: Cervical spondylosis myelopathy (CSM) is a stenosis condition in cervical canal due to the cervical structural changes that compress the myelum, thus causing spinal medulla ischemia. Other than clinical factors, myelum intensity changes on MRI T1-weighted images (T1W1) and T2W1 might be useful to predict the pos-operative outcome.Aims: Identify prognostic factors in post-operative patients with CSM based on clinical symptoms and myelum intensity on cervical MRI.Methods: Retrospective study on CSM patients who underwent surgery in Neurosurgery Department, Cipto Mangunkusumo hospital, Jakarta, from January 2013 to December 2016. Magnetic resonance imaging data was obtained before the surgery, while clinical symptoms were assessed by Nurick scale before and 1 year after the surgery to evaluate outcome.Results: There were 50 subjects included in this study with mean age 51.98±9.64 years, majority male (76%), have moderate myelopathy (Nurick scale pre-operative ≤2), and time between onset and surgery mostly ≤1 year (80%). Most subject (88%) had improvement clinically, but mostly without hypointensity on cervical T1W1 MRI.Discussion: Myelum hypointensity in cervical MRI is associated with poor outcome in CSM post-surgery patients.Keywords: Cervical spondylosis myelopathy, MRI, myelum hypointensity, Nurick scaleABSTRAKPendahuluan: Cervical spondylosis myelopathy (CSM) merupakan suatu kondisi stenosis kanal servikal akibat adanya perubahan struktur servikal yang menyebabkan kompresi mielum, sehingga timbul iskemia medula spinalis. Selain faktor-faktor klinis, perubahan intensitas mielum pada MRI T1-weighted images (T1W1) dan T2W1 dapat dijadikan modalitas untuk memprediksi luaran pascaoperasi.Tujuan: Mengidentifikasi faktor prognosis luaran pasien CSM pascaoperasi berdasarkan gejala klinis dan intensitas mielum pada gambaran MRI servikal.Metode: Penelitian retrospektif terhadap penderita CSM yang dilakukan operasi di Departemen Bedah Saraf RSUPN Dr. Cipto Mangunkusumo, Jakarta, pada bulan Januari 2013 hingga Desember 2016. Dilakukan penilaian klinis dan gambaran MRI awal, serta luaran 1 tahun pascaoperasi menggunakan skor Nurick.Hasil: Terdapat 50 subjek dengan rerata usia 51,98±9,64 tahun, terutama laki-laki (76%), memiliki derajat mielopati ringan (skor Nurick preoperasi ≤2), dan jarak antara onset dengan waktu operasi ≤1 tahun (80%). Sebagian besar subjek (88%) mengalami perbaikan skor pascaoperasi yang mayoritas (95,4%) tidak didapatkan gambaran hipointesintas pada T1W1 MRI servikal.Diskusi: Hipointensitas mielum pada MRI servikal merupakan faktor prognosis luaran buruk pascaoperasi pada pasien CSM.Kata kunci: Cervical spondylosis myelopathy, hipointens, mielum, MRI, skala Nurick

FIBRINOGEN VALUE AS PROGNOSTIC FACTOR IN SPONTANEOUS INTRACEREBRAL HEMORRHAGEABSTRACTIntroduction: Spontaneous intracerebral haemorrhage (SIH) refers as spontaneous bleeding in the brain paren- chyma due to injury of blood vessels. Thus causing tissue inflammatory and coagulation reaction, activating the release of fibrinogen. Fibrinogen, an active substrate of coagulation cascade, also considered as the most powerful indicator of acute inflammatory response in SIH. Elevated levels of fibrinogen may be the marker for the increasing degree of brain tissue damage.Aims: Determine the correlation of fibrinogen levels with outcomes of patients with SIH who went on operative procedures.Methods: The study was conducted in Dr. Cipto Mangunkusumo hospital and its affiliation hospitals from January until August 2017. Total sampling was conducted. Preoperative Glasgow Coma Scale (GCS), blood volume, preoperative and postoperative serum fibrinogen values, and modified Rankin Scale (mRS) data were obtained and analyzed using the Spearman correlation test.Results: Significant correlation were found between the preoperative and postoperative fibrinogen with mRS score. Positive correlation coefficients were shown in both parameters, whereas the increase of preoperative and postoperative fibrinogen would increase the mRS score.Discussion: Pre and postoperative fibrinogen value showed significant association with mRS score, thereby they could be considered as prognostic predictive factors. However, because of the limited number of subject of this study to fulfill the criteria of validity study, a future study with a larger scale should be carried out.Keyword: Fibrinogen, mRS, outcome, spontaneous intracerebral haemorrhageABSTRAKPendahuluan: Perdarahan intraserebral spontan (PISS) adalah perdarahan spontan pada parenkim otak akibat kerusakan pembuluh darah pada jaringan otak. Kerusakan tersebut menimbulkan reaksi inflamasi jaringan dan koagulasi yang mengaktivasi pelepasan fibrinogen. Fibrinogen merupakan substrat aktif kaskade koagulasi yang juga merupakan penanda paling kuat respons akut inflamasi pada PISS. Adanya peningkatan kadar fibrinogen dapat menggambarkan peningkatan derajat kerusakan jaringan otak.Tujuan: Mengetahui korelasi kadar fibrinogen dengan luaran pasien dengan PISS yang dilakukan tindakan operatif.Metode: Penelitian dilakukan di RSUPN Dr. Cipto Mangunkusumo dan rumah sakit jejaring pendidikan dalam periode Januari–Agustus 2017. Sampel diambil dengan total sampling, data yang diambil adalah, Glasgow Coma Scale (GCS) preoperasi, volume perdarahan, kadar fibrinogen serum preoperasi dan pascaoperasi, dan modified Rankin Scale(mRS), kemudian dianalisis dengan tes Spearman correlation.Hasil: Dari uji statistik didapatkan hasil bermakna antara fibrinogen preoperasi mau pun pascaoperasi dengan skor mRS. Koefisien korelasi, menunjukkan korelasi positif pada keduanya, dimana peningkatan fibrinogen preoperasi dan pascaoperasi akan meningkatkan skor mRS.Diskusi: Fibrinogen pre dan pascaoperasi sebagai faktor prediksi prognostik memiliki hubungan bermakna dengan skor mRS. Namun dengan jumlah sampel penelitian yang masih belum mencukupi untuk memenuhi kriteria validitas untuk dapat diajukan sebagai faktor yang bersifat pasti, diperlukan penelitian lebih lanjut dengan sampel yang lebih besar.Kata kunci: Fibrinogen, luaran, mRS, perdarahan intraserebral spontan