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.

No abstract

Background. Bariatric surgery programs are recognized as the best alternative for patients with severe obesity. Many studies conclude that bariatric surgery programs that include these pre- and postoperative consultations (PPC) by the multidisciplinary team have better overall outcome. The purpose of the present study was to evaluate factors that affect PPC during a bariatric surgery program in Mexico and assess the possible impact on the patients’ post-operative course. Materials and methods. In accordance with the the International Federation for the Surgery of Obesity and Metabolic Disorders guidelines, all patients included were between 18 and 65 age when bariatric surgery was performed. Preoperative assessment of patient eligibility for bariatric surgery included consultation with the main surgeon, a dietician, an internist, and a psychologist. If non-eligible cases were detected, these issues were addressed and fully treated before surgery was considered. Results. A total of 110 patients were included in this study. Eighty-one (74 %) patients were women and 29 (26 %) were men. We observed that women had significantly more consultation attendance than men (54.3 % versus 24.1 %, p = 0.005). Patients with higher initial BMI had significantly more consultation attendance than those with lower BMI (42.9 kg/m2 versus 38.6 kg/m2, p = 0.007). When consultation attendance was evaluated according to occupation, teaching workers had significantly (p = 0.003) more consultation attendance (71.4 %) while the students group had less consultation attendance (0). Patients who had higher percentage of excess of weight loss (EWL) had significantly more general, medical, nutritional and psychological consultation attendance than those with lower percentage of EWL (p = 0.04, p = 0.032, p = 0.039 and p < 0.001). Conclusions. Consultation attendance with the multidisciplinary team is associated with better outcomes after bariatric surgery. “Nonattending” patients are at least partly responsible for any suboptimal results observed. Although this is certainly a factor for some patients, many other non-dependent reasons, such as cultural, social, economic or motivational reasons can also affect the loss of consultations in other patients.

Introducción. La miniderivación (mini-bypass) gástrica por laparoscopia es un procedimiento bariátrico que recientemente ha cobrado popularidad. Las alteraciones del tubo digestivo generadas por estos procedimientos pueden ocasionar diversas complicaciones, algunas raras, como los bezoares. Caso clínico. Se presenta el caso de una mujer de 52 años de edad con antecedentes de diabetes mellitus y obesidad, que fue tratada con una miniderivación gástrica por laparoscopia. Nueve meses después del procedimiento, presentó dolor en el epigastrio, intolerancia a los alimentos y vómito, por lo cual se dio tratamiento sintomático sin obtener mejoría. Se practicó una endoscopia de vías digestivas altas, cuyo hallazgo fue un bezoar de coco que obstruía parcialmente la anastomosis. El bezoar se trituró y se extrajo por endoscopia. Discusión. Los pacientes con antecedentes de cirugía bariátrica tienen mayor riesgo de presentar bezoares por la modificación del tubo digestivo. Estos pacientes presentan frecuentemente síntomas de dispepsia, por lo que la sintomatología inespecífica puede confundirse o subestimarse. Se debe considerar practicar una endoscopia en todos aquellos con antecedentes de cirugía bariátrica que presenten vómito persistente después de ingerir alimentos o síntomas de obstrucción gástrica.