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.

For many decades, kriging and deterministic interpolation techniques, such as inverse distance weighting and nearest neighbour interpolation, have been the most popular spatial interpolation techniques. Kriging with external drift and regression kriging have become basic techniques that benefit both from spatial autocorrelation and covariate information. More recently, machine learning techniques, such as random forest and gradient boosting, have become increasingly popular and are now often used for spatial interpolation. Some attempts have been made to explicitly take the spatial component into account in machine learning, but so far, none of these approaches have taken the natural route of incorporating the nearest observations and their distances to the prediction location as covariates. In this research, we explored the value of including observations at the nearest locations and their distances from the prediction location by introducing Random Forest Spatial Interpolation (RFSI). We compared RFSI with deterministic interpolation methods, ordinary kriging, regression kriging, Random Forest and Random Forest for spatial prediction (RFsp) in three case studies. The first case study made use of synthetic data, i.e., simulations from normally distributed stationary random fields with a known semivariogram, for which ordinary kriging is known to be optimal. The second and third case studies evaluated the performance of the various interpolation methods using daily precipitation data for the 2016–2018 period in Catalonia, Spain, and mean daily temperature for the year 2008 in Croatia. Results of the synthetic case study showed that RFSI outperformed most simple deterministic interpolation techniques and had similar performance as inverse distance weighting and RFsp. As expected, kriging was the most accurate technique in the synthetic case study. In the precipitation and temperature case studies, RFSI mostly outperformed regression kriging, inverse distance weighting, random forest, and RFsp. Moreover, RFSI was substantially faster than RFsp, particularly when the training dataset was large and high-resolution prediction maps were made.

California, with its mild wet winters and hot dry summers, experiences a Mediterranean type climate, similar to the Mediterranean region, South Africa, central Chile, and Southwest Australia. With overall semi-arid conditions resulting from highly seasonal precipitation, water shortage has always been a major societal concern in these regions. Also increasing concentrations of greenhouse gases (GHGs) and general subtropical drying led to even more severe water shortages in several Mediterranean-type climates (

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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