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.

Short-time low PEEP challenge (SLPC, application of additional 5 cmH 2 O PEEP to patients for 30 s) is a novel functional hemodynamic test presented in the literature. We hypothesized that SLPC could predict fluid responsiveness better than stroke volume variation (SVV) in mechanically ventilated intensive care patients. Heart rate, mean arterial pressure, stroke volume index (SVI) and SVV were recorded before SLPC, during SLPC and before and after 500 mL fluid loading. Patients whose SVI increased more than 15% after the fluid loading were defined as fluid responders. Reciever operating characteristics (ROC) curves were generated to evaluate the abilities of the methods to predict fluid responsiveness. Fifty-five patients completed the study. Twenty-five (46%) of them were responders. Decrease percentage in SVI during SLPC (SVIΔ%-SLPC) was 11.6 ± 5.2% and 4.3 ± 2.2% in responders and non-responders, respectively (p < 0.001). A good correlation was found between SVIΔ%-SLPC and percentage change in SVI after fluid loading (r = 0.728, P < 0.001). Areas under the ROC curves (ROC-AUC) of SVIΔ%-SLPC and SVV were 0.951 (95% CI 0.857-0.991) and 0.747 (95% CI 0.611-0.854), respectively. The ROC-AUC of SVIΔ%-SLPC was significantly higher than that of SVV (p = 0.0045). The best cut-off value of SVIΔ%-SLPC was 7.5% with 90% sensitivity and 96% specificity. The percentage change in SVI during SLPC predicts fluid responsiveness in intensive care patients who are ventilated with low tidal volumes; the sensitivity and specificity values are higher than those of SVV.

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ÖZETAmaç: Bu prospektif gözlem çalışmasında elektif sezaryen olgularında, cerrahlarda var olan spinal blok uygulama süresinin eğitim hastanesinde ameliyat odası kullanım süresini uzattığına dair yaygın kanının sorgulanması hedeflenmiştir.Gereç ve Yöntem: Elektif sezaryen operasyonu planlanan ASA I-II 120 gebe, spinal ve genel anestezi olarak 2 grupta ça-lışmaya alınmıştır. Her iki anestezi tekniği de eğitmen gözetiminde benzer deneyimdeki tıpta uzmanlık öğrencileri tarafından uygulanmıştır. Hastaların demografik verileri, gebelik özellikleri, t hazır (ameliyat odasına giriş-ameliyat için hazır olma süresi), t insizyon (giriş-cerrahi insizyon), t histerotomi (cerrahi insizyon-histerotomi), t histerotomi-doğum (histerotomi-göbek kordonuna klemp konulması), t derlenme (cerrahi bitiş-uyanma odasına giriş süresi), t operasyon (cerrahi başlangıç-bitiş), t ameliyat odası (ameliyat odası giriş-çıkış) süreleri, operasyon sırasında kullanılan sıvı ve efedrin miktarı kaydedilmiş. Ayrıca yenidoğanların demografik verileri, Apgar skorları ve umbilikal ven kan gazı verileri değerlendirilmiştir.Bulgular: Gebelerin demografik verileri ve gebelik özellikleri benzer bulunmuştur. Spinal anestezi grubunda t hazır , t insizyon , t histerotomi ve t histerotomi-doğum süresi, genel anestezi grubunda ise t derlenme süresi anlamlı derecede uzun olarak saptanmıştır. Ameliyat odası kullanım süreleri spinal ve genel anestezi grubunda benzer bulunmuştur (72.9±16.7 ve 70.2±12.9 dk.). Spinal anestezi alan gebelerde sıvı tüketimi ve efedrin gereksinimi daha fazla olmuştur. Yenidoğanların demografik verileri, PCO 2 değerleri arasında fark saptanmamıştır. Genel anestezi grubunda spinale oranla yenidoğanların PO 2 değerleri daha yüksek (36.7±14.2 ve 28.1±7.8 mmHg; p<0.001), pH değerleri ise daha düşük (7.32±0.04 ve 7.34±0.06; p=0.049) olmuştur, ancak bu deği-şiklikler Apgar skorlarına yansımamıştır.Sonuç: Cerrahi kanının aksine, eğitim hastanesinde spinal anestezi uygulaması ameliyat odası kullanım süresini arttırma-maktadır.Anahtar kelimeler: Obstetrik anestezi, sezaryen, genel anestezi, spinal anestezi, ameliyat odası SUMMARY The Effect of Anesthetic Technique on Operating Room Usage Time in Elective Cesarean Section: Spinal or General?Objective: This prospective observational study aimed to investigate the surgical claim that spinal anesthesia in elective cesarean section in educational setting increases operating room time.Material and Methods: ASA I-II 120 elective cesarean section parturients were grouped into spinal and general anesthesia groups. Both techniques were performed by residents under consultant supervision. Demographic characteristics of parturients, different time intervals as abbreviated with t ready (entry of the patient into operating room-readiness for surgery), t incision (entry of the patient-skin incision), t hysterotomy (skin incision-hysterotomy), t hysterotomy-delivery (hysterotomy-cord clamping), t emergence (end of the operation-entry to the postoperative care unit), t operation (start-end of surgery), t operating r...