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.

SummaryBackgroundSurgical site infection (SSI) is one of the most common infections associated with health care, but its importance as a global health priority is not fully understood. We quantified the burden of SSI after gastrointestinal surgery in countries in all parts of the world.MethodsThis international, prospective, multicentre cohort study included consecutive patients undergoing elective or emergency gastrointestinal resection within 2-week time periods at any health-care facility in any country. Countries with participating centres were stratified into high-income, middle-income, and low-income groups according to the UN's Human Development Index (HDI). Data variables from the GlobalSurg 1 study and other studies that have been found to affect the likelihood of SSI were entered into risk adjustment models. The primary outcome measure was the 30-day SSI incidence (defined by US Centers for Disease Control and Prevention criteria for superficial and deep incisional SSI). Relationships with explanatory variables were examined using Bayesian multilevel logistic regression models. This trial is registered with ClinicalTrials.gov, number NCT02662231.FindingsBetween Jan 4, 2016, and July 31, 2016, 13 265 records were submitted for analysis. 12 539 patients from 343 hospitals in 66 countries were included. 7339 (58·5%) patient were from high-HDI countries (193 hospitals in 30 countries), 3918 (31·2%) patients were from middle-HDI countries (82 hospitals in 18 countries), and 1282 (10·2%) patients were from low-HDI countries (68 hospitals in 18 countries). In total, 1538 (12·3%) patients had SSI within 30 days of surgery. The incidence of SSI varied between countries with high (691 [9·4%] of 7339 patients), middle (549 [14·0%] of 3918 patients), and low (298 [23·2%] of 1282) HDI (p<0·001). The highest SSI incidence in each HDI group was after dirty surgery (102 [17·8%] of 574 patients in high-HDI countries; 74 [31·4%] of 236 patients in middle-HDI countries; 72 [39·8%] of 181 patients in low-HDI countries). Following risk factor adjustment, patients in low-HDI countries were at greatest risk of SSI (adjusted odds ratio 1·60, 95% credible interval 1·05–2·37; p=0·030). 132 (21·6%) of 610 patients with an SSI and a microbiology culture result had an infection that was resistant to the prophylactic antibiotic used. Resistant infections were detected in 49 (16·6%) of 295 patients in high-HDI countries, in 37 (19·8%) of 187 patients in middle-HDI countries, and in 46 (35·9%) of 128 patients in low-HDI countries (p<0·001).InterpretationCountries with a low HDI carry a disproportionately greater burden of SSI than countries with a middle or high HDI and might have higher rates of antibiotic resistance. In view of WHO recommendations on SSI prevention that highlight the absence of high-quality interventional research, urgent, pragmatic, randomised trials based in LMICs are needed to assess measures aiming to reduce this preventable complication.FundingDFID-MRC-Wellcome Trust Joint Global Health Trial Development Grant,...

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.

Este artículo puede ser consultado en versión completa en: www.medigraphic.com/neumologia RESUMEN. La utilidad de la biopsia pulmonar abierta en la obtención de material tisular para diagnóstico histológico es innegable, aun cuando los avances tecnológicos nos encauzan hacia los métodos de mínima invasión. El objetivo del estudio es mostrar la eficiencia de la biopsia pulmonar abierta y debatir la necesidad del drenaje pleural cuando la pleura ha sido transgredida. Material y métodos: Estudio prospectivo longitudinal realizado del 01 de enero del 2017 al 31 de diciembre del 2018, en 41 pacientes intervenidos de biopsia pulmonar abierta por minitoracotomía. Resultados: El estudio incluyó 41 pacientes sometidos a biopsia pulmonar abierta. La evolución fue satisfactoria en el 97.5% de los casos y únicamente un paciente requirió la colocación de drenaje posoperatorio inmediato por neumotórax mayor del 10%. En 39 (95%) pacientes se obtuvo diagnóstico histológico independiente del sitio de la toma de biopsia y en dos (5%) se reportó la muestra sin anormalidades. Conclusiones: La elección del sitio de toma de biopsia del parénquima pulmonar y la localización anatómica de la lesión no es impedimento para el abordaje por minitoracotomía y permite obtener tejido pulmonar adecuado para diagnóstico histológico en la mayoría de los casos. La indicación del drenaje pleural puede ser selectiva de acuerdo con criterios transoperatorios y de la experiencia del equipo quirúrgico.Palabras clave: Biopsia pulmonar, minitoracotomía, drenaje pleural. ABSTRACT.The usefulness of open lung biopsy in obtaining tissue material for histological diagnosis is undeniable even when technological advances direct us towards minimally invasive methods. The aim of the study is to show the efficiency of open lung biopsy and to discuss the need for pleural drainage when the pleura has been transgressed. Material and methods: Prospective longitudinal study carried out from in 41 patients undergoing open lung biopsy by mini-thoracotomy. Results: The study included 41 patients with open lung biopsies. The evolution was satisfactory in 97.5% of the cases and only one patient required the placement of immediate postoperative drainage due to pneumothorax greater than 10%. In 39 (95%) patients, histological diagnosis was obtained independent of the site of the biopsy and two (5%) the sample was reported without abnormalities. Conclusions: The choice of the lung parenchyma biopsy site and the anatomic location of the lesion is not an impediment to the mini-thoracotomy approach and allows obtaining adequate lung tissue for histological diagnosis in the majority of cases. The indication of pleural drainage can be selective according to transoperative criteria and the experience of the surgical team.

Los nódulos pulmonares múltiples representan un reto diagnóstico por la multiplicidad de etiologías, que van desde el cáncer a diversos agentes infecciosos. Se reporta un caso con fuerte sospecha de toxocariasis pulmonar en una joven de 17 años que presentó múltiples nódulos pulmonares bilaterales. Fue tratada con albendazol y tuvo remisión total. La toxocariasis responde bien al tratamiento antiparasitario.