To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

Open TAA(A) repair as a secondary procedure after previous endovascular aortic therapy is an important treatment option even in the endovascular era. It represents a durable treatment that can produce respectable outcomes. Yet the peri-operative morbidity and mortality are relevant and a specialised team and infrastructure are mandatory for these complex procedures. Therefore, centralisation is required.

WHAT THIS PAPER ADDS This study confirms that staged open and hybrid surgery of type II thoraco-abdominal aortic aneurysm (TAAA) may be related to favourable results in terms of decreased mortality rates versus one stage type II TAAA open repair. Objective: This study compared the outcomes of open one stage with open two stage repair of type II thoracoabdominal aortic aneurysms (TAAA). Methods: This retrospective study included 94 patients (68 men) with a mean AE SD age of 54.5 AE 14 years who underwent open type II TAAA repair from March 2006 to January 2016. The mean aneurysm diameter was 65 AE 14.4 mm. The median follow up was 42 months (range 12e96). Seventy-six patients received one stage open repair and 18 patients were treated in two steps: 12 received two open procedures (thoracic and abdominal) and six received hybrid repair (one open and one endovascular procedure). This study focused on the comparison of open one stage and open two stage TAAA repair. The median time between the two steps was 31.5 days (range 1e169). Results: In hospital mortality after open one stage repair versus open two stage type II repair was 22.4% versus 0% (odds ratio 7.352, 95% confidence interval [CI] 0.884e959.1]; p ¼ .19). The one year survival rate after one stage repair versus open two stage repair was 74.7% (95% CI 62.7e83.3) versus 90.9% (95% CI 50.8e98.7 [p ¼ .225]). The five year survival rate after one stage repair versus open two stage repair was 53.0% (95% CI 37.2e66.5) versus 90.9% (95% CI 50.8e98.7 [p ¼ .141]). The hazard ratio for survival after one stage repair and after open two stage repair was 4.563 (95% CI 96.9e81.4 [p ¼ .137]). Paraplegia was observed after open one stage repair versus open two stage in 10.5% vs. 8% (p ¼ 1). Acute kidney injury requiring permanent dialysis and myocardial infarction were assessed for after open one stage repair and open two stage and were seen in 3.9% vs. 0% (p ¼ 1) and in 5.3% vs. 0% (p ¼ 1), respectively. Conclusion: Open two stage repair may be recommended as a treatment option for type II TAAAs if anatomically feasible, as it has a lower mortality and similar complication rates to one stage repair.

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Objective/Background: Sarcopenia is a predictor of mortality in elderly patients. Masseter area (MA) reflects sarcopenia in trauma patients. It was hypothesised that MA and Masseter density (MD) could be evaluated reliably from pre-operative computed tomography angiography (CTA) scans and that they predict post-operative survival in carotid endarterectomy (CEA) patients.Methods: This was an observational registry study. Patients (n = 242) were operated on for asymptomatic stenosis (n = 32; 13.2%), amaurosis fugax (n = 41; 16.9%), transient ischaemic attack (n = 85; 35.1%), or ischaemic stroke (n = 84; 34.7%). Internal carotid artery stenoses were graded angiographically. Intraclass correlation coefficient (ICC) was used to analyse measurement reliability by three independent observers. Cox regression analysis was used to study the effect of MA and MD on survival (hazard ratio [HR]).Results: Median patient age was 71.0 years (interquartile range [IQR] 13.0) and follow up time was 68.5 months (range 3e163 months); at the end of follow up (1 October 2017), 104 (43.0%) patients had died according to the National Population Register. The average MA (MAavg, the mean of left and right MA [median 394.0 mm 2 ; IQR 110.1 mm 2 ]) and MD (MDavg, the mean of left and right MD [median 53.5 HU; IQR 16.5 HU]) could be measured with excellent reliability (ICC > 0.865, p < .001 for all). In multivariable analyses only body surface area (BSA) (p < .001) and dental status were associated with MAavg (p = .021). Increased MAavg predicted lower mortality (HR 0.76, 95% confidence interval [CI] 0.61e0.96; p = .023) independent of age (HR 1.05, 95% CI 1.02e1.07; p = 0.001), female sex, body mass index, renal insufficiency, ipsilateral stenosis, indication category, and presence of teeth. MDavg was not associated with mortality. After further adjustment, BSA (the most significant determinant of MAavg) did not alter the association between MAavg and mortality (0.75, 95% CI 0.58e0.97; p = .031).Conclusion: Average MA but not MD measured from the pre-operative CTA scan provides a reliable estimate of post-operative long-term survival in CEA patients independent of other risk factors, anthropometric measurements, and dental status.