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.

Introduction: The number of female residents in orthopaedic surgery is rising; however, orthopaedics currently has the lowest percentage of women among all medical specialties. The Hirsch index (h-index) is a metric used to determine research productivity, an important factor for academic promotion in the field of orthopaedics. The purpose of this study was to compare research productivity (using the h-index) among male and female orthopaedic surgeons at academic residency programs within the United States. Methods: The websites for all Accreditation Council for Graduate Medical Education-accredited orthopaedic surgery residency programs in the United States were evaluated and the following information was collected: geographic region of the institution, sex, specialty, academic rank, and institutional leadership positions of faculty members. The h-index for each faculty member was collected from the Web of Science Database. Results: H-indices of 4,323 academic orthopaedic surgeons from 160 residency programs in the United States were collected. In total, 1,587 faculty members were assistant professors (220, 13.9% women), 839 were associate professors (91, 10.8% women), 902 were professors (50, 5.5% women), and academic rank was not specified for 991 (74, 7.5% women). One hundred forty-three faculty members held the position of department chair (2, 1.4% women) and 701 were division chiefs (58, 8.3% women). In geographic regions with a greater proportion of female orthopaedic faculty members, women had greater research productivity. Among Department Chairs, associate professors, and professors there was no difference in research productivity between male and female academic orthopaedic surgeons. By contrast, among assistant professors, there was a significant difference in research productivity. Conclusion: A higher proportion of female faculty in an orthopaedic department was positively associated with increased female research productivity. Female faculty at the highest ranks and leadership positions are as academically productive as their male counterparts. Despite similar research productivity, female orthopaedic surgeons are not nearly as well represented as their male counterparts in orthopaedics in general and in leadership positions within the field. In addition, a significantly smaller research productivity among female assistant professors disappears at the higher ranks in comparison to their male counterparts. This indicates a critical gap in factors that influence research productivity according to sex at the most junior faculty rank. Level of Evidence: Level III