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.

Background:Scoliosis refers to deviation of spine greater than 10 degrees in the coronal plane. Idiopathic Scoliosis is the most common spinal deformity that develops in otherwise healthy children. The sub types of scoliosis are based on the age of the child at presentation. Adolescent idiopathic scoliosis (AIS) by definition occurs in children over the age of 10 years until skeletal maturity.Objective: The objective of this review is to outline the features of AIS to allow the physician to recognise this condition and commence early treatment, thereby optimizing patient outcome.Method: A thorough literature search was performed using available databases, including Pubmed and Embase, to cover important research published covering AIS.Conclusion:AIS results in higher incidence of back pain and discontent with body image. Curves greater than 50 degrees in thoracic region and greater than 30 degrees in lumbar region progress at a rate of 0.5 to 1 degree per year into adulthood. Curves greater than 60 degrees can lead to pulmonary functional deficit. Therefore once the disease is recognized, effective treatment should be instituted to address the deformity and prevention of its long-term sequelae.

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.

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Background ContextCorrective surgery for adolescent idiopathic scoliosis (AIS) leads to vertical growth arrest of the instrumented spine. This might be offset by the immediate gain in spinal height (SH) as a result of correction of the curvature. PurposeTo identify predictors of gain in spinal height following corrective surgery for AIS. We present a unique model to predict height gain prior to intervention, which could contribute to the preoperative counselling and consenting process. Study DesignThis was a retrospective case series. All surgeries were performed by one of four substantive paediatric spinal surgeons within a single regional centre over a three-and-a-half year period.Patient Sample 104 patients who had instrumented posterior spinal fusion for AIS were included. There were 93 females and the age range was 11 to 17 years. All patients had posterior instrumented fusion using rods and anchors (pedicle screws +/-hooks).Outcome Measures Postoperative spinal height was the primary outcome measure. SH (C7 to L5) and Cobb angles were measured from a pre-and-postoperative standing X-ray of each patient. MethodsVariables associated with patients (demographic and radiological) and the surgical constructs were analysed for predictability of height gain. A model was derived including only significant predictors of substantive importance using hierarchical regression methods.Cross-validation procedures verified the adequacy of the model fit. Analysis was performed using SPSS version 20.0. ResultsThe major curve was thoracic in 90% of cases. The number of vertebrae fused ranged from 5 to 15. T (SD 2.13 cm). The model presented included preoperative height, preoperative Cobb angle and number of vertebrae within the construct, with coefficients of 1.00 (95% CI: 0.90, 1.09), 0.067 (95% CI: 0.039, 0.095), and 0.26 (95% CI: 0.11, 0.41) respectively. This model had an adjusted-R2value of 0.83 and a R2 for prediction of 0.79; and can be shown to have similar predictive capability as a model comprising a wider range of predictors. ConclusionsThe greatest postoperative height values following posterior spinal fusion for AIS could be expected from a patient with greater preoperative height and Cobb angle, and whose construct spans a large number of vertebrae. Many thanks for giving us the further opportunity to revise our manuscript. We have revised the manuscript in the hope of addressing the outstanding concerns. We hope that you find this revision suitable for publication in The Spine Journal. We remain happy to address any further suggestions.We have copied the review comments and responded (in red text) to each:1. Please limit all significant digits following the decimal to two in the text and tables. The only exception can be p-values up to 0.001 and then <0.001 as indicated. We have applied this throughout.2. The residuals plot is unnecessary and can be removed from a revised work. The plot itself has been removed.3. The results and discussion are still overly technical for this clinical journal. Please f...