Surgery (Austin & Northern Health) - Research Publications

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    Endoscopy training in Australia during COVID-19: Efficacy and knowledge assessment of gastroenterology and general surgery trainees
    Pu, LZCT ; Cox, DRA ; Be, KH ; Ng, J ; Yeaman, F ; Gilhotra, RA ; Efthymiou, M ; Vaughan, R ; Nestel, D ; Perini, M ; Muralidharan, V ; Chandran, S (WILEY, 2022-12)
    BACKGROUND AND AIM: During COVID-19, restrictions to elective endoscopy were introduced worldwide. A reduction in procedures may impact trainees' endoscopy learning. This study aims to assess Australian advanced gastroenterology and general surgery trainees' self-perceived efficacy and knowledge in endoscopy during the pandemic. METHODS: All Australian gastroenterology and general surgery trainees in their last 2 years of accredited training were invited to participate through email (2020-2021 and 2021-2022 training cycles). The primary outcome was to assess trainees' self-efficacy and knowledge regarding gastrointestinal endoscopy. Secondary outcomes included subgroup analysis between gastroenterology and general surgery trainees. Self-perceived efficacy was assessed with Likert-scale questions on 20 endoscopy procedures and knowledge was assessed through 21 endoscopy-related multiple choice questions. RESULTS: Eighty-one trainees responded to a self-efficacy questionnaire and 77 responded to the knowledge questionnaire. Over 90% of the trainees were confident or extremely confident in diagnostic endoscopy, but only half demonstrated similar efficacy for therapeutic endoscopy. The efficacy for basic endoscopy procedures was higher for gastroenterology trainees (64.0% vs 51.1%, P < 0.001). Last-year trainee achievement of conjoint committee requirements for upper gastrointestinal endoscopy was achieved in 95.8% of gastroenterology trainees versus 22.2% of surgical trainees (P < 0.001). The median score on the knowledge questionnaire was also higher for the gastroenterology subset (90.5% vs 71.4%, P < 0.001). CONCLUSION: During COVID-19, endoscopy trainees' self-efficacy in endoscopic diagnostic procedures was achieved for most trainees. The differences in self-perceived efficacy and knowledge between gastroenterology and surgical trainees may be reflective of the different opportunities for learning between the two groups.
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    SARS-CoV-2 infection and venous thromboembolism after surgery: an international prospective cohort study
    Li, E (WILEY, 2022-01)
    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 (5.4 (95%CI 4.3-6.7)). 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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    SARS-CoV-2 vaccination modelling for safe surgery to save lives: data from an international prospective cohort study
    Nepogodiev, D ; Bhangu, A (OXFORD UNIV PRESS, 2021-09-27)
    BACKGROUND: Preoperative SARS-CoV-2 vaccination could support safer elective surgery. Vaccine numbers are limited so this study aimed to inform their prioritization by modelling. METHODS: The primary outcome was the number needed to vaccinate (NNV) to prevent one COVID-19-related death in 1 year. NNVs were based on postoperative SARS-CoV-2 rates and mortality in an international cohort study (surgical patients), and community SARS-CoV-2 incidence and case fatality data (general population). NNV estimates were stratified by age (18-49, 50-69, 70 or more years) and type of surgery. Best- and worst-case scenarios were used to describe uncertainty. RESULTS: NNVs were more favourable in surgical patients than the general population. The most favourable NNVs were in patients aged 70 years or more needing cancer surgery (351; best case 196, worst case 816) or non-cancer surgery (733; best case 407, worst case 1664). Both exceeded the NNV in the general population (1840; best case 1196, worst case 3066). NNVs for surgical patients remained favourable at a range of SARS-CoV-2 incidence rates in sensitivity analysis modelling. Globally, prioritizing preoperative vaccination of patients needing elective surgery ahead of the general population could prevent an additional 58 687 (best case 115 007, worst case 20 177) COVID-19-related deaths in 1 year. CONCLUSION: As global roll out of SARS-CoV-2 vaccination proceeds, patients needing elective surgery should be prioritized ahead of the general population.
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    Timing of surgery following SARS-CoV-2 infection: an international prospective cohort study
    Nepogodiev, D ; Simoes, JFF ; Li, E ; Picciochi, M ; Glasbey, JC ; Baiocchi, G ; Blanco-Colino, R ; Chaudhry, D ; AlAmeer, E ; El-Boghdadly, K ; Wuraola, F ; Ghosh, D ; Gujjuri, RR ; Harrison, EM ; Lule, H ; Kaafarani, H ; Khosravi, M ; Kronberger, I ; Leventoglu, S ; Mann, H ; Mclean, KA ; Mengesha, MG ; Marta Modolo, M ; Ntirenganya, F ; Norman, L ; Outani, O ; Pius, R ; Pockney, P ; Qureshi, AU ; Roslani, AC ; Satoi, S ; Shaw, C ; Bhangu, A ; Omar, OM ; Ahmed, W-U-R ; Argus, L ; Ball, A ; Bywater, EP ; Blanco-Colino, R ; Brar, A ; Chaudhry, D ; Dawson, BE ; Duran, I ; Elhadi, M ; Glasbey, JC ; Gujjuri, RR ; Jones, CS ; Harrison, EM ; Kamarajah, SK ; Keatley, JM ; Lawday, S ; Mann, H ; Marson, EJ ; Mclean, KA ; Norman, L ; Ots, R ; Outani, O ; Picciochi, M ; Santos, I ; Shaw, C ; Taylor, EH ; Trout, IM ; Varghese, C ; Venn, ML ; Xu, W ; Dajti, I ; Gjata, A ; Kacimi, SEO ; Boccalatte, L ; Cox, D ; Pockney, P ; Townend, P ; Aigner, F ; Kronberger, IE ; Samadov, E ; Alderazi, A ; Hossain, K ; Padmore, G ; van Ramshorst, G ; Lawani, I ; Cerovac, A ; Delibegovic, S ; Baiocchi, G ; Ataide Gomes, GM ; Buarque, IL ; Gohar, M ; Slavchev, M ; Nwegbu, C ; Agarwal, A ; Brar, A ; Martin, J ; Ng-Kamstra, J ; Olivos, M ; Lou, W ; Ren, D-L ; Andres Calvache, J ; J-Perez Rivera, C ; Hadzibegovic, AD ; Kopjar, T ; Mihanovic, J ; Aviles Jimenez, PM ; Gouvas, N ; Klat, J ; Novysedlak, R ; Amisi, N ; Christensen, P ; El-Hussuna, A ; Batista, S ; Lincango-Naranjo, E ; Emile, S ; Arevalo Sandoval, DA ; Dhufera, H ; Hailu, S ; Mengesha, MG ; Kauppila, JH ; Arnaud, AP ; Demetrashvili, Z ; Albertsmeier, M ; Lederhuber, H ; Loeffler, MW ; Acquah, DK ; Ofori, B ; Tabiri, S ; Metallidis, S ; Tsoulfas, G ; Aguilera-Arevalo, M-L ; Recinos, G ; Mersich, T ; Wettstein, D ; Ghosh, D ; Kembuan, G ; Milan, PB ; Khosravi, MH ; Mozafari, M ; Hilmi, A ; Mohan, H ; Zmora, O ; Gallo, G ; Pata, F ; Pellino, G ; Fujimoto, Y ; Kuroda, N ; Satoi, S ; Abou Chaar, MK ; Ayasra, F ; Fakhradiyev, I ; Hamdun, IHS ; Jin-Young, J ; Jamal, M ; Karout, L ; Elhadi, M ; Gulla, A ; Rasoaherinomenjanahary, F ; Samison, LH ; Roslani, AC ; Duran Sanchez, II ; Samantha Gonzalez, D ; Martinez, L ; Jose Martinez, M ; Nayen, A ; Ramos-De la Medina, A (WILEY, 2021-06)
    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.
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    Pancreatic mass in a patient undergoing immunotherapy for metastatic renal cell carcinoma: dilemmas in management
    Goh, SK ; Cox, DRA ; Weickhardt, A ; Muralidharan, V ; Perini, M (WILEY, 2022-07)
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    Elevated levels of circulating mitochondrial DNA predict early allograft dysfunction in patients following liver transplantation
    Yoshino, O ; Wong, BKL ; Cox, DRA ; Lee, E ; Hepworth, G ; Christophi, C ; Jones, R ; Dobrovic, A ; Muralidharan, V ; Perini, M (WILEY, 2021-12)
    BACKGROUND AND AIM: The role of circulating mitochondrial DNA (cmtDNA) in transplantation remains to be elucidated. cmtDNA may be released into the circulation as a consequence of liver injury; yet recent work also suggests a causative role for cmtDNA leading to hepatocellular injury. We hypothesized that elevated cmtDNA would be associated with adverse events after liver transplantation (LT) and conducted an observational cohort study. METHODS: Twenty-one patients were enrolled prospectively prior to LT. RESULTS: Postoperative complications were observed in 47.6% (n = 10). Seven patients (33.3%) had early allograft dysfunction (EAD), and six patients (28.5%) experienced acute cellular rejection within 6 months of LT. cmtDNA levels were significantly elevated in all recipients after LT compared with healthy controls and preoperative samples (1 361 937 copies/mL [IQR 586 781-3 399 687] after LT; 545 531 copies/mL [IQR 238 562-1 381 015] before LT; and 194 562 copies/mL [IQR 182 359-231 515] in healthy controls) and returned to normal levels by 5 days after transplantation. cmtDNA levels were particularly elevated in those who developed EAD in the early postoperative period (P < 0.001). In all patients, there was initially a strong overall positive correlation between cmtDNA and plasma hepatocellular enzyme levels (P < 0.05). However, the patients with EAD demonstrated a second peak in cmtDNA at postoperative day 7, which did not correlate with liver function tests. CONCLUSIONS: The early release of plasma cmtDNA is strongly associated with hepatocellular damage; however, the late surge in cmtDNA in patients with EAD appeared to be independent of hepatocellular injury as measured by conventional tests.
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    Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study
    Simoes, JFF ; Nepogodiev, D ; Ademuyiwa, A ; Buarque, I ; El-Boghdadly, K ; Gebreyohanes, M ; Glasbey, JC ; Kronberger, E ; Kruijff, S ; Li, E ; Loeffler, M ; Mashbari, H ; Pata, F ; Smart, N ; Sayyed, R ; Shu, S ; Sund, M ; Bhangu, A ; Simoes, J ; Ahmed, W-U-R ; Argus, L ; Ball, A ; Bhangu, A ; Bywater, EP ; Blanco-Colino, R ; Brar, A ; Chaudhry, D ; Dawson, BE ; Duran, I ; Elhadi, M ; Glasbey, JC ; Gujjuri, RR ; Jones, CS ; Harrison, EM ; Kamarajah, SK ; Keatley, JM ; Lawday, S ; Li, E ; Mann, H ; Marson, EJ ; Mclean, KA ; Nepogodiev, D ; Norman, L ; Ots, R ; Outani, O ; Picciochi, M ; Santos, I ; Shaw, C ; Simoes, JFF ; Taylor, EH ; Trout, IM ; Varghese, C ; Venn, ML ; Xu, W ; Dajti, I ; Gjata, A ; Kacimi, SEO ; Boccalatte, L ; Cox, D ; Pockney, P ; Townend, P ; Aigner, F ; Kronberger, IE ; Samadov, E ; Alderazi, A ; Hossain, K ; Padmore, G ; van Ramshorst, G ; Lawani, I ; Cerovac, A ; Delibegovic, S ; Baiocchi, G ; Ataide Gomes, GM ; Buarque, IL ; Gohar, M ; Slavchev, M ; Nwegbu, C ; Agarwal, A ; Brar, A ; Martin, J ; Ng-Kamstra, J ; Marta Modolo, M ; Olivos, M ; Lou, W ; Ren, D-L ; Andres Calvache, J ; Rivera, CJ-P ; Hadzibegovic, AD ; Kopjar, T ; Mihanovic, J ; Aviles Jimenez, PM ; Gouvas, N ; Klat, J ; Novysedlak, R ; Amisi, N ; Christensen, P ; El-Hussuna, A ; Batista, S ; Lincango-Naranjo, E ; Emile, S ; Arevalo Sandoval, DA ; Dhufera, H ; Hailu, S ; Mengesha, MG ; Kauppila, JH ; Arnaud, AP ; Demetrashvili, Z ; Albertsmeier, M ; Lederhuber, H ; Loeffler, MW ; Acquah, DK ; Ofori, B ; Tabiri, S ; Metallidis, S ; Tsoulfas, G ; Aguilera-Arevalo, M-L ; Recinos, G ; Mersich, T ; Wettstein, D ; Ghosh, D ; Kembuan, G ; Milan, PB ; Khosravi, MH ; Mozafari, M ; Hilmi, A ; Mohan, H ; Zmora, O ; Gallo, G ; Pata, F ; Pellino, G ; Fujimoto, Y ; Kuroda, N ; Satoi, S ; Abou Chaar, MK ; Ayasra, F ; Fakhradiyev, I ; Hamdun, IHS ; Jin-Young, J ; Jamal, M ; Karout, L ; Elhadi, M ; Gulla, A ; Rasoaherinomenjanahary, F ; Samison, LH ; Roslani, AC ; Duran Sanchez, II ; Samantha Gonzalez, D ; Martinez, L ; Jose Martinez, M ; Nayen, A ; Ramos-De la Medina, A ; Nunez, J ; Outani, O ; Nashidengo, PR ; Shah, R ; Shrestha, AL ; Jonker, P ; Kruijff, S ; Noltes, M ; Steinkamp, P ; Varghese, C ; Wright, D ; Abdur-Rahman, L ; Ademuyiwa, A ; Adisa, A ; Osinaike, B ; Seyi-Olajide, J ; Williams, O ; Williams, E ; Pejkova, S ; Al Balushi, Z ; Qureshi, AU ; Sayyed, R ; Mohsen, MA ; Abukhalaf, SA ; Cukier, M ; Gomez-Fernandez, H ; Shu Yip, S ; Vasquez Ojeda, XP ; Dione Sacdalan, M ; Major, P ; Azevedo, J ; Cunha, MF ; Santos, I ; Zarour, A ; Bonci, E-A ; Negoi, I ; Efetov, S ; Kochetkov, V ; Litvin, A ; Ingabire, JA ; Bucyibaruta, G ; Faustin, N ; Habumuremyi, S ; Imanishimwe, A ; de Dieu, HJ ; Munyaneza, E ; Ncogoza, I ; Alameer, E ; Ndong, A ; Radenkovic, D ; Chew, MH ; Koh, F ; Ngu, J ; Panyko, A ; Bele, U ; Kosir, JA ; Daoud, H ; Blanco-Colino, R ; Minaya Bravo, AM ; Jayarajah, U ; Wickramasinghe, D ; Adam, MEAE ; Rutegard, M ; Sund, M ; Adamina, M ; Gialamas, E ; Horisberger, K ; Alshaar, M ; Huang, A ; Lohsiriwat, V ; Charles, S ; Jlassi, H ; Isik, A ; Leventoglu, S ; Lekuya, HM ; Lule, H ; Kopetskyi, S ; Alsaadi, H ; Alshryda, S ; Alser, O ; Bankhead-Kendall, B ; Breen, K ; Kaafarani, H ; Mashbari, H ; Cal, FB ; Al-Naggar, H ; Maimbo, M ; Mazingi, D ; Abbott, T ; Adamina, M ; Akhbari, M ; Benson, R ; Bhanderi, S ; Biccard, B ; Caruana, E ; Chakrabortee, S ; Chapatwala, R ; Costas-Chavarri, A ; Demetriades, AK ; Desai, A ; Di Saverio, S ; Drake, T ; Edwards, J ; Evans, J ; Fiore, M ; Ford, S ; Fotopoulou, C ; Fowler, A ; Futaba, K ; Ganly, I ; James, HG ; Griffiths, E ; Gronchi, A ; Hutchinson, P ; Hyman, GY ; Incorvia, J ; Jain, R ; Jenkinson, M ; Khan, T ; Knight, SR ; Kolias, A ; Kudsk-Iversen, S ; Kwan, TY ; Leung, E ; Mayol, J ; McKay, S ; Meara, JG ; Mills, E ; Moug, S ; Patel, A ; Perinotti, R ; Rice, HE ; Roberts, K ; Schache, A ; Shaw, R ; Smart, N ; Stephens, M ; Stewart, GD ; Teasdale, E ; Vaughan-Shaw, P ; Vidya, R ; Wright, N ; Wuraola, F ; Zimmelman, N ; Agastra, E ; Thereska, D ; Martin Lucchini, S ; Laudani, V ; Boccalatte, L ; Chwat, C ; Pedraza Salazar, II ; Pantoja Pachajoa, DA ; Duro, A ; Calderon Arancibia, JA ; Cox, D ; D'Aulerio, G ; Dudi-Venkata, N ; Egoroff, N ; Farik, S ; Lott, N ; Moss, J-L ; Pockney, P ; Rennie, S ; Tan, L ; Varghese, C ; Vo, UG ; Watson, D ; Watters, D ; Wright, D ; Bright, T ; Hollington, P ; Zhou, X ; Kroon, HM ; Farfus, A ; Barker, J ; Watson, E ; Stevens, S ; Latif, H ; Dawson, AC ; Chuan, A ; Muralidharan, V ; Wong, E ; Ackermann, T ; Pacilli, M ; Hodgson, R ; Heriot, A ; Choong, P ; Brown, W ; Lidder, S ; Yeung, J ; Traeger, L ; Regalo, G ; Gourlay, R ; Pockney, P ; Badiani, S ; Koh, C ; Putnis, S ; Dawson, AC ; Haider, F ; Mitul, AR ; Komen, N ; Dhondt, B ; Cappeliez, S ; Pigeolet, M ; van Ramshorst, G ; Schoneveld, M ; Stijns, J ; Oosterlinck, W ; Flamey, N ; Kpangon, C ; Agbadebo, M ; Tobome, SR ; Cerovac, A ; Barros, AV ; Aguiar Junior, S ; Baiocchi, G ; do Amaral Campos, HG ; Gross, J ; Fernandez Coimbra, FJ ; Kowalski, LP ; Makdissi, F ; Nakagawa, S ; Duprat Neto, JP ; Vartanian, JG ; Yazbek, G ; Zequi, SC ; Flumignan, R ; Slavchev, M ; Jaworska, N ; Dell, A ; Shanthanna, H ; Martin, J ; Behzadi, A ; Nessim, C ; Mozel, M ; St-germain, P ; Russell, C ; Groot, G ; Safieddine, N ; Wijeysundera, D ; Eskander, A ; Chadi, S ; MacKenzie, S ; Flexman, A ; Heredia, F ; Marta Modolo, M ; Villanueva, J ; Waissbluth, S ; Macchiavello, R ; Escudero, MI ; Fuentes, T ; Mimica, X ; Olivos, M ; Bolivar Saenz, D ; Caicedo, L ; Pablo Alzate, J ; Luna, J ; Pedraza Alonso, NF ; Ortiz Silva, C ; Rodriguez, J ; Silva-Igua, L ; Torres, ML ; Maria Trujillo, L ; Nieto Calvache, AJ ; Balanta-Melo, J ; Figueroa-Casanova, R ; Garcia-Montoya, O-J ; Marulanda Toro, CA ; Velez Botero, M ; Mendoza Arango, MC ; Diaz Martinez, E ; Gutierrez Perdomo, V ; Montenegro, E ; Mihanovic, J ; Aviles Jimenez, PM ; Gouvas, N ; Novysedlak, R ; Rodriguez-Abreu, J ; Mejia, D ; Lincango-Naranjo, E ; Abouelnagah, G ; Shehata, S ; Rida, AHEF ; Hassan, RA ; Saad, MM ; Loaloa, MR ; Mostafa, B ; Qassem, M ; Fahmy, M ; Abozied, H ; Azzam, AY ; Ghozy, S ; Sallam, A ; Shehta, A ; Emile, S ; Abdelkhalek, M ; Samaka, R ; Morsy, A ; Sherif, AE ; Negussie, A ; Fisseha, T ; Shumbash, K ; Abebe, M ; Hailu, S ; Yasin, SM ; Akililu, YB ; Megersa, A ; Tefera, T ; Assefa, M ; Atnafu, B ; Tsegaye, B ; Bezabih, YS ; Sisay, S ; Bekele, K ; Jira, M ; Mengesha, MG ; Derilo, H ; Degefa, E ; Tadesse, A ; Nidaw, M ; Sarjanoja, E ; Kauppila, JH ; Testelin, S ; Boucher, S ; Jouffret, L ; Lakkis, Z ; Le Bian, AZ ; Harper, L ; des Deserts, MD ; Andre, B ; Slim, K ; Verhaeghe, R ; Police, A ; Girard, E ; Chebaro, A ; Nkembi, AS ; Arnalsteen, L ; Ballouhey, Q ; Mege, D ; Jeandel, C ; Duchalais, E ; Bouche, P-A ; Manceau, G ; Cretolle, C ; Hervieux, E ; Girard, N ; Seguin-Givelet, A ; Gaujoux, S ; De Simone, B ; Boisson, M ; Bergeat, D ; Arnaud, AP ; Fredon, F ; Nappi, F ; Kassir, R ; Scalabre, A ; Migliorelli, F ; Verhaeghe, R ; Ezanno, A-C ; Seeliger, B ; Vaysse, C ; Charbonneau, H ; Misrai, V ; Abbo, O ; Angeles, MA ; Brunaud, L ; Demetrashvili, Z ; Modabber, A ; Wolf, S ; Kamphues, C ; Hoehn, P ; Glowka, TR ; Rokohl, AC ; Bork, U ; Fluegen, G ; Horch, RE ; Schmedding, A ; Schnitzbauer, A ; Eberbach, H ; Schlager, D ; Spelsberg, F ; Keppler, L ; Hecker, A ; Wolfer, S ; Ronellenfitsch, U ; Nitschke, C ; Peiper, C ; Hakami, I ; Welter, S ; Nikolaieva, K ; Roth, A ; Lindert, J ; Gousias, K ; Rissmann, A ; Linz, VC ; Rahbari, N ; Rassweiler-Seyfried, M-C ; Gut, AE ; Gempt, J ; Reim, D ; Wagner, A ; Albertsmeier, M ; Keppler, AM ; Stoleriu, MG ; Saier, T ; Stadler, J ; Kaiser, JC ; Brunner, SM ; Pfister, K ; Herzberg, J ; Nowak, K ; Reinhard, T ; Stavrou, GA ; Koenigsrainer, A ; Konrads, C ; Quante, M ; Laban, S ; von Pusch, S ; Hirschburger, M ; Doerner, J ; Wiegering, A ; Tampaki, EC ; Gutierrez Ruiz, A ; Rodas, A ; Lucia Portilla, A ; Recinos, G ; Aguilera-Arevalo, M-L ; Carrera, J ; Duarte, AB ; Lowey, M ; Barillas, S ; Suroy, A ; Vaishnav, D ; Chowdappa, RG ; Madabhavi, I ; Bhat, D ; Venkatappa, SK ; Thakar, S ; Jain, K ; Kumar, A ; Nagar, M ; Mishra, T ; Sekar, A ; Gupta, A ; Kaman, L ; Karthigeyan, M ; Tripathi, M ; Rammohan, A ; Vayoth, SO ; Rajanbabu, A ; Subbian, A ; Gupta, R ; Raut, M ; Evelyn R, N ; Kannaiyan, L ; Matai, A ; Misra, S ; Bhende, V ; Muthu, S ; Ghosh, I ; Sharma, A ; Bajaj, A ; Rajan, S ; Agarwal, G ; Pawar, P ; Alexander, P ; Vijayakumar, MV ; Hameed, BMZ ; Badareesh, L ; Chaudhry, NK ; Baliarsing, L ; Dharap, S ; Kulkarni, A ; Thyavihally, Y ; Sharma, RD ; Pramesh, CS ; Soni, R ; Dube, SK ; Sharma, S ; Singh, H ; Bains, L ; Ghodke, R ; Kumar, A ; Sodhai, V ; Maji, S ; Basu, S ; Mahakalkar, C ; Kannan, R ; Mehraj, A ; Ranganath, N ; Phadnis, A ; Yadev, I ; Kavalaka, A ; Mittal, R ; Vallam, KC ; Akhavizadegan, H ; Maleki, ER ; Kandevani, NY ; Ikele, H ; McNestry, C ; Fleming, C ; O'Brien, S ; Abd Elwahab, S ; Davis, N ; Javadpour, M ; McDonnell, B ; Connor, CO ; Bolger, J ; Clancy, C ; Croghan, SM ; Donlon, N ; Cullinane, C ; Creavin, B ; Muheilan, M ; Earley, H ; Kabir, SMU ; Fahadullah, M ; Ryan, E ; Connelly, T ; Zmora, O ; Hashimoto, D ; Alqudah, MA ; Alajalen, A ; Omari, RY ; Ayasra, F ; Qasem, A ; Alawneh, Y ; Ahmad, A ; Aladawi, O ; Alrayes, B ; Haidar, H ; Husain, S ; Qassem, F ; Sumadi, A ; Abu Salhiyeh, A ; Al-Manaseer, BM ; Alsunna, Z ; Ra'ed, H ; Hamad, FRB ; Abuleil, A ; Abou Chaar, MK ; Jimaale, EAM ; Abu-Mehsen, M ; Olaywah, N ; Wafi, O ; Ababneh, H ; Abu-Ismail, L ; Khamees, A ; Alkhatib, A ; Bolatbekova, R ; Kulimbet, M ; Nurgozhin, T ; Saliev, T ; Zhussupov, B ; Almabayev, Y ; Fakhradiyev, I ; Saliev, T ; Kaidarova, D ; Tamoos, K ; Aqeelah, A ; Mohammed, AAK ; Al Maadany, F ; Alkadeeki, G ; Gahwagi, M ; Aldressi, W ; Amnaina, M ; Alansari, AHA ; Alkaseek, A ; Yagoub, G ; Ben Amer, A ; Salem, M ; Almugaddami, A ; Burgan, D ; Abdelkabir, M ; Alshareef, K ; Ben Jouira, RAI ; Meelad, A ; Bouhuwaish, A ; Dwaga, SE ; Khalifa, H ; Almiqlash, B ; Suliaman, T ; Alawami, M ; Elhajdawe, F ; Aboazamazem, H ; Ellojli, I ; Msherghi, A ; Saleh, IA ; Alayan, M ; Roslani, AC ; Ndayishyigikiye, MD ; Munyika, A ; Plarre, P ; Borowski, DW ; Nashidengo, PR ; Noltes, M ; Steinkamp, P ; Wells, C ; Teague, R ; Elliott, B ; Kieser, D ; Mohyieldin, O ; Varghese, C ; McIntosh, N ; Haran, C ; Rennie, S ; King, J ; Ha, J ; McGuinness, MJ ; Adesanya, O ; Olaogun, J ; Akinmade, A ; Bwala, K ; Agbonrofo, P ; Afolabi, A ; Usang, U ; Ekenze, S ; Olori, S ; Lawal, TA ; Seyi-Olajide, J ; Okunlola, A ; Ekiti, I ; Williams, O ; Adisa, A ; Abdur-Rahman, L ; Kache, S ; Sale, D ; Anyanwu, L-J ; Okereke, C ; Tolani, MA ; Filipce, V ; Todorovic, L ; Pejkova, S ; Stavridis, S ; Massoud, JG ; Alsibai, S ; Sultan, R ; Altaf, HN ; Bhatti, ABH ; Waqar, SH ; Aziz, A ; Kerawala, AA ; Rai, L ; Anwer, M ; Tariq, A ; Ayub, B ; Niazi, SU ; Naseem, MY ; Sarwar, MZ ; Khokhar, MI ; Zahid, IA ; Majid, HJ ; Talat, N ; Asif, M ; Chaudhary, MH ; Farooq, U ; Ahmad, S ; Mabood, W ; Bukhari, SI ; Tariq, M ; Yaqoob, E ; Javed, S ; Malik, MU ; Yaqoob, HN ; Cukier, M ; Falcon Pacheco, GM ; Mas Melendez, R ; Paucar Urbina, ADP ; Rios Chiuyari, J ; Otiniano Alvarado, CE ; Rivera Lau, LF ; Borda-Luque, G ; Niquen-Jimenez, M ; Arias, C ; Zegarra, S ; Betalleluz Pallardel, J ; Ugarte Oscco, RA ; Mendiola, G ; Carpio Colmenares, YT ; Zapata, CS ; Rosa Ortiz, M ; Dione Sacdalan, M ; Major, P ; Borges, FC ; Viveiros, O ; Serralheiro, P ; Santos-Costa, P ; Mendes, F ; Melo, MR ; Cardoso, P ; Soares, A ; Azevedo, J ; Pereira, RG ; Silva, N ; Caiado, A ; Sacras, ML ; Azevedo, P ; Almeida-Reis, R ; Cunha, MF ; Oliveira, J ; Nogueiro, J ; Sampaio-Alves, M ; Costa, LC ; Baia, C ; Deus, AC ; Branquinho, R ; Marcal, A ; Tojal, A ; Zarour, A ; Makkai-Popa, ST ; Mironescu, A ; Grama, F ; Toma, EA ; Negoi, I ; Filipescu, D ; Bacalbasa, N ; Motas, N ; Ionescu, S ; Ginghina, O ; Costea, R ; Zarnescu, NO ; Drasovean, R ; Bonci, E-A ; Dimofte, M-G ; Porumb, V ; Kirov, M ; Molitvin, Y ; Litvin, A ; Pykhteev, V ; Raevskaya, M ; Efetov, S ; Butyrskii, A ; Alshahrani, M ; Althumairi, A ; Alzerwi, N ; Al Ameer, A ; Madkhali, T ; Almulhim, AS ; Ghazwani, S ; Ayoub, A ; Iskander, O ; Ghunaim, M ; Alharthi, M ; Alzaidi, TM ; Althumairi, A ; Alyami, M ; Al Amri, A ; Althumairi, A ; AlFakhri, A ; Alhefdhi, A ; Chowdhury, S ; Nouh, T ; Alshehri, A ; Alzahrani, A ; Alalawi, Y ; Awad, S ; Konate, I ; Ndong, A ; Tendeng, J ; Teo, NZ ; Koh, F ; Kosir, JA ; Bele, U ; Aqil, S ; Barrena Lopez, C ; Sanchez Mozo, A ; Rodriguez Infante, A ; Caja Vivancos, P ; Prieto, M ; Alberdi San Roman, I ; Gomez Fernandez, L ; Munoz Vives, JM ; Carreras-Castaner, A ; Diaz-Feijoo, B ; Sieira-Gil, R ; Turrado-Rodriguez, V ; Sanchez Lopez, A ; Sanchez-Cabus, S ; Jimenez Toscano, M ; Canals Sin, MP ; Garcia Laura, S ; Martin Sole, O ; Palazon Bellver, P ; Perez-Bertolez, S ; Prat-Ortells, J ; Riba Martinez, M ; Rubio-Palau, J ; Tarrado, X ; Nunez, J ; Alonso Mendoza, V ; Bescos, C ; Espin-Basany, E ; Espinosa-Bravo, M ; Gil-Sala, D ; Gonzalez-Suarez, S ; Montferrer Estruch, N ; Porteiro Marino, L ; Rodriguez-Tesouro, A ; Rojas Portilla, F ; Tormos Perez, MP ; Vives, I ; Garcia De Cortazar, U ; Tudela, K ; Landaluce-Olavarria, A ; Estaire Gomez, M ; Almoguera, J ; Ugarte-Sierra, B ; Jimenez, V ; Bertrand, M ; Cardenas Puiggros, L ; Delisau-Puig, O ; Garcia-Adamez, J ; Julia Bergkvist, D ; Maldonado-Marcos, E ; Diego Garcia, L ; Roldon Golet, M ; Soto-Darias, I ; Cristina Rahy-Martin, A ; Enjuto, D ; Ramos-Luengo, A ; Delgado Fernandez, J ; Lugo Duarte, C ; Ojeda Thies, C ; Marquez, L ; Crego Vita, D ; Dziakova, J ; Minaya Bravo, AM ; Canno Velasco, J ; Mateo-Sierra, O ; Quintana-Villamandos, B ; Rey Valcarcel, C ; Rio, J ; Roman Garcia de Leon, L ; Di Martino, M ; Prada, J ; Serrano Gonzalez, J ; Losada, M ; Castell Gomez, JT ; Corripio-Sanchez, R ; Forero-Torres, A ; Manuel Morales-Puebla, J ; Perez-Chrzanowska, H ; Valderrabano Gonzalez, S ; Yebes, A ; Zapardiel, I ; Diez Alonso, M ; Morales Palacios, N ; Cabanero Sanchez, A ; Sanchez Fernandez, F ; Abad Gurumeta, A ; Abad-Motos, A ; Corella, F ; Ripolles-Melchor, J ; Sanz-Gonzalez, R ; Alcaraz Fuentes, M ; Fernandez Martin, MT ; Calvo Espino, P ; Carrasco Prats, M ; Fernandez-Lopez, A-J ; Garcia Escudero, D ; Garcia Soria, V ; Martinez Alonso, JA ; Ruiz-Marin, M ; Gomez Perez, B ; Moya-Angeler, J ; Fernandez Martinez, D ; Llaquet Bayo, H ; Colas-Ruiz, E ; Bella Romera, S ; Gavalda Pellice, MT ; Jorda Sole, M ; Ruiz Velasquez, EJ ; Nunez, B ; Jimenez, R ; Zabaleta, J ; Jose Gonzalez-Gimeno, M ; Ortega Vazquez, I ; Perez Ferrer, A ; Martin-Laez, R ; Moreno Suarez, M ; Freiria Eiras, MA ; Ramallo-Solis, I ; Gomez-Rosado, J-C ; Oliver Guillen, JR ; Achalandabaso Boira, M ; Catala Bauset, JC ; Domenech, J ; Badenes, R ; Carlos Bernal-Sprekelsen, J ; Sancho-Muriel, J ; De Andres-Asenjo, B ; Tejero-Pintor, FJ ; Vallve-Bernal, M ; Vazquez Melero, A ; Das, A ; Ganapathy, T ; Gunarasa, Y ; Mariapan, K ; Muniandy, M ; Osman, MF ; Azmi, MAFM ; Soh, JY ; Zain, WZW ; Zakaria, AD ; Zakaria, Z ; Chan, KH ; Hayati, F ; Johan, S ; Mah, JJ ; Sriram, RK ; Subramaniam, S ; Shahimi, NSBM ; Hamdan, KH ; Ibrahim, MR ; Muthkumaran, G ; Tan, JA ; Thanapal, MR ; Aziz, DAA ; Bastion, M-L ; Harun, MHN ; Imran, F-H ; Din, NM ; Zain, AM ; Mustapha, M ; Nabil, S ; Naffi, AA ; Nazimi, AJ ; Ramli, R ; Soon, BH ; Bal, P ; Cheng, JQ ; Draman, MR ; Fadzli, AN ; Ghauth, S ; Hung, W ; Jamaris, S ; Koh, PS ; Krishnasamy, S ; Lee, YS ; Liew, YT ; Lim, JZ ; Lim, RCS ; Lim, HC ; Pauzi, SFM ; Nah, SA ; Nair, AK ; Ng, DSW ; Yong, YJNW ; Ramayah, K ; Roslani, AC ; Saaid, R ; Sanmugam, A ; See, MH ; Seevalingam, KK ; Sethi, N ; Singaravel, S ; Ganapathy, T ; Gunarasa, Y ; Mariapan, K ; Muniandy, M ; Osman, MF ; Azmi, MAFM ; Soh, JY ; Zain, WZW ; Zakaria, AD ; Zakaria, Z ; Chan, KH ; Hayati, F ; Johan, S ; Mah, JJ ; Sriram, RK ; Subramaniam, S ; Zaidi, SNSJH ; Tang, CY ; Teoh, LY ; Wong, KB ; Xavier, R ; Yahaya, AS (WILEY, 2021-11)
    We aimed to determine the impact of pre-operative isolation on postoperative pulmonary complications after elective surgery during the global SARS-CoV-2 pandemic. We performed an international prospective cohort study including patients undergoing elective surgery in October 2020. Isolation was defined as the period before surgery during which patients did not leave their house or receive visitors from outside their household. The primary outcome was postoperative pulmonary complications, adjusted in multivariable models for measured confounders. Pre-defined sub-group analyses were performed for the primary outcome. A total of 96,454 patients from 114 countries were included and overall, 26,948 (27.9%) patients isolated before surgery. Postoperative pulmonary complications were recorded in 1947 (2.0%) patients of which 227 (11.7%) were associated with SARS-CoV-2 infection. Patients who isolated pre-operatively were older, had more respiratory comorbidities and were more commonly from areas of high SARS-CoV-2 incidence and high-income countries. Although the overall rates of postoperative pulmonary complications were similar in those that isolated and those that did not (2.1% vs 2.0%, respectively), isolation was associated with higher rates of postoperative pulmonary complications after adjustment (adjusted OR 1.20, 95%CI 1.05-1.36, p = 0.005). Sensitivity analyses revealed no further differences when patients were categorised by: pre-operative testing; use of COVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increased with periods of isolation longer than 3 days, with an OR (95%CI) at 4-7 days or ≥ 8 days of 1.25 (1.04-1.48), p = 0.015 and 1.31 (1.11-1.55), p = 0.001, respectively. Isolation before elective surgery might be associated with a small but clinically important increased risk of postoperative pulmonary complications. Longer periods of isolation showed no reduction in the risk of postoperative pulmonary complications. These findings have significant implications for global provision of elective surgical care.