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.

OBJECTIVES Our study aimed to evaluate the safety and efficacy of laparoscopic drainage as a management of complex pyogenic liver abscesses in comparison to open surgical drainage. METHODOLOGY The comparative research design was used to compare the outcomes, complications, perioperative morbidity, mortality, and potential recurrence of 60 patients with a complex pyogenic liver abscess who were hospitalized at the General Surgery Department of Hayatabad Medical Complex Peshawar and treated either laparoscopically or openly from January 2019 to December 2020. 30 patients had open drainage management, while 30 patients received laparoscopic drainage management. For all patients, pus was examined for culture sensitivity. Patients with a small, solitary and unilocular pyogenic liver abscess that improved with antibiotic therapy and or/and percutaneous drainage were excluded. Each patient had a thorough clinical evaluation, lab tests, ultrasound, computed tomography, or magnetic resonance imaging of the pelvis and abdomen. RESULTS All patients underwent abdominal ultrasonography & sonographic diagnosis was made in 43(71.7%), followed by a computed tomography scan (CT) in 12(20%) & magnetic resonance imaging (MRI) diagnosis was made in 5(8.3%) patients respectively. Diabetes mellitus was present in 15(25%) patients, severe chronic obstructive pulmonary disease in 10(16.7%) and severe anemia in 9(15%) patients. All individuals associated with co-morbidity were considered high-risk patients. CONCLUSION Laparoscopic drainage of liver abscess has a shorter surgical time, lower morbidity rate, and shorter hospital stay as compared to open surgical drainage.

OBJECTIVES This study aimed to assess the factors that affect post-laparoscopic cholecystectomies PSI and determine which characteristics can be changed to prevent PSI in a trial to maximize the benefits of laparoscopic surgery.METHODOLOGY The study included all patients who experienced port site infection following laparoscopic cholecystectomy. All patients received Inj Ceftriaxone 1gm pre-operatively & then twice a day postoperatively for 03 days. In all operations, the gallbladder is removed from the epigastric port without using a retrieval bag by skilled surgeons employing four-port methods and reusable equipment. Most patients had the sub-hepatic tube drain placed and were discharged the day after surgery.RESULTSAcute cholecystitis was the most common operative finding with port-site infection, i.e. 6(42.8%), second being empyema that was seen in 3(21.4%) patients, 2(14.3%) patients had bad adhesions, mucocele in 2(14.3%) patients and thick walled gall bladder with stones was found in 1(7.1%) patients respectively, indicating that the relationship between infection and acute cholecystitis is significant. Regarding the spills of bile, stones, or pus, 3(21.4%) patients had infections despite there being no spillage, while 11(78.6%) patients developed an infection while the spillage happened during their procedures. The p-value was 0.0001, meaning that the spillage might be considered a risk factor for the development of port site infection.CONCLUSIONThe spilling of bile, stones, or pus, the port of gallbladder removal, and acute cholecystitis are all strongly associated with port site infection. Given that Mycobacterium tuberculosis may be the source of chronic deep surgical site infections, more care should be exercised. The majority of PSIs are superficial and more prevalent in men.