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 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...

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To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

Background: Although coronavirus disease-2019 (COVID-19) is predominantly a respiratory disease, cardiac involvement occurs commonly, especially in those with more severe illness. Echocardiography is the preferred imaging modality for diagnosing cardiac involvement in COVID-19. However, there are currently no data to describe echocardiographic abnormalities in Indian patients with COVID-19. Methodology: A cross-sectional observational analysis was performed among adult patients admitted to a tertiary care center between May 2020 and August 2020. Patients were included if they underwent transthoracic echocardiography during the hospitalization after a positive reverse transcriptase–polymerase chain reaction diagnosis for COVID-19 pneumonia. Demographic and clinical data were obtained and analyzed along with echocardiographic data. Results: During the study period, consecutive 245 patients were evaluated with echocardiography, of whom 11 were excluded due to nondiagnostic images. The remaining 234 (mean age 57 ± 16 years, 71.7% of men) were included in this analysis. All patients were admitted to intensive care unit or high-dependency unit. Right ventricular (RV) dilatation and/or dysfunction (37%) was the most common finding, followed by left ventricular (LV) systolic and diastolic dysfunction (27.7% and 23.1%, respectively). Pericardial effusion was present in 12% of cases. A total of 49 (20.9%) patients had preexisting LV systolic dysfunction (LVSD). After excluding them, the LVSD and LV diastolic dysfunction were observed in 8.6% and 2.7% of patients, respectively. Conclusions: This study demonstrates that RV dilatation/dysfunction is the most common echocardiographic abnormality in hospitalized patients with severe COVID-19. Further, larger, multicentric studies with systematic data collection and comparison with non-COVID patients are needed to determine the true incidence of echocardiographic abnormalities in COVID-19.