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.
LAR with ileostomy has certain advantages over LAR without ileostomy in terms of anastomotic leak, postoperative ileus, resumption of diet, wound infection, small bowel obstruction and in terms mortality and recurrence. However stoma related complications were main disadvantage in LAR with ileostomy.
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.
Background: Mechanical bowel preparation (MBP) of gut is routinely done before colorectal surgeries in most surgical departments all over the globe. This gut preparation is aimed at reducing the risk of postoperative infections in patients undergoing colorectal surgery. Even though recent studies are more in favor of operating on gut without bowel preparation, controversies still exist. The aim of our study was to assess whether elective colorectal surgeries can be performed safely without preoperative MBP. Methods: Patients undergoing elective colorectal surgeries were prospectively randomized into two groups with the help of random number table method; Group-1 had mechanical bowel preparation with polyethylene glycol (MBP group) before surgery, and Group-2 had no mechanical bowel preparation (NMBP group) before surgery. All patients in the study groups were followed up for at least 2 months after surgery for wound infection, anastomotic leak and intra-abdominal infections. Results: Two hundred fourteen patients were included in this hospital-based systematic prospective randomized trial: 104 patients in Group-1 and 98 patients in Group-2. Twelve patients were excluded from the study. The type of surgical procedure and type of anastomosis did not significantly differ between two groups. There was no difference in surgical infections between two groups. The overall infection rate was 39.4% in Group-1 and 32.6% in Group-2 (p = 0.31). Wound infection (p = 0.45), anastomotic leak (p = 0.45) and intra-abdominal/pelvic collection (p = 0.62) occurred in 3.8%, 3.8% and 6.7% versus 6.1%, 2% and 5.1% in Group-1 (MBP group) and Group-2 (NMBP group) respectively. Our results showed that MBP does not offer any specific benefit in elective colorectal surgeries but in real sense may add to some problems, which, however, did not achieve a statistical significance. Conclusions: Our study proved that no advantage is gained by pre-operative mechanical bowel preparation in elective colorectal surgery and can be easily avoided in order to save patients from unwanted exhaustion, distress and adverse effects related to it. It is actually the mindset that makes us to believe that MBP will reduce the incidence of infections rather than the evidence from literature. We conclude from our study that all types of elective colorectal surgeries can be performed safely without subjecting patients to mechanical bowel preparation before surgery. Highlights:
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