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.

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Bu çalışmada mediastinal kistik lezyonların tedavisinde video yardımlı torakoskopik cerrahi ve torakotominin sonuçları karşılaştırıldı. Ça lış ma pla nı: Kliniğimizde Ocak 1997 ve Aralık 2016 tarihleri arasında mediastinal kist tedavisi nedeniyle torakotomi veya video yardımlı torakoskopik cerrahi uygulanan 60 hasta (28 erkek, 32 kadın; ort. yaş 36.1±19.4 yıl; dağılım, 2 gün-82 yıl) retrospektif olarak değerlendirildi. Tanı için tüm katılımcılarda göğüs radyografisi ve toraks bilgisayarlı tomografi kullanıldı. Yirmi üç katılımcıda ek olarak manyetik rezonans görüntüleme kullanıldı. Bul gu lar: Mediastinal kistler hastaların 19'unda (%31.7) anteriorsüperior mediasten, 19'unda (%31.7) orta mediasten ve 22'sinde (%36.6) posterior mediasten yerleşimli idi. Histopatolojik olarak 17 bronkojenik kist, 15 kist hidatik, 10 perikardiyal kist, yedi kistik teratom, dört enterik kist, dört timik kist, iki lenfanjiom ve bir torasikus duktus kisti tespit edildi. Hastaların 34'üne (%56.7) torakotomi uygulanır iken 26'sına (%43.3) video yardımlı torakoskopik cerrahi uygulandı. Torakotomilerin ve video yardımlı torakoskopik cerrahilerin ortalama süresi sırasıyla 123.6±24.7 dakika ve 87.4±17.6 dakika idi (p<0.01). Ortalama hastanede yatış süresi torakotomi sonrası 8.2±4.3 gün, video yardımlı torakoskopik cerrahi sonrası 4.3±1.2 gün idi (p<0.01). Ameliyat sonrasında hastaların dördünde komplikasyon (iki pnömotoraks, bir plevral effüzyon, bir şilotoraks) gelişirken hiçbirinde mortalite gözlemlenmedi. So nuç: Mediastinal kistlerde asıl tedavi yöntemi cerrahidir. Torakoskopik yaklaşım hastanın cerrahi işlem süresini ve ameliyat sonrası hastanede yatış süresini anlamlı olarak azaltır. Yakın gelecekte mediastinal kistlerde açık cerrahilere kıyasla minimal invaziv cerrahilerin daha sık uygulanacağını düşünüyoruz.

Objective In this study, we aimed to compare the results of patients who underwent surgery by thoracotomy and Video-assisted thoracoscopic surgery (VATS) in mediastinal neurogenic tumors. Materials and Methods Twenty-six consecutive cases (12 males and 14 females; mean age 39.4 ± 22.3 years; range 1–72 years) who were histopathologically diagnosed as having mediastinal neurogenic tumors between January 2000 and August 2020 were included in a single-center, retrospective study. Results There were 5 (19.2%) children and 21 (80.8%) adults. Lesions in all cases were located in the posterior mediastinum. Schwannoma was detected histopathologically in 18 cases (69.2%), and all of these cases were adult patients. Resection was performed by thoracotomy in 14 cases (7 right and 7 left) and 12 cases by thoracoscopy (7 right and 5 left). The mean tumor size was 7.4 ± 1.9 cm (range 5–12 cm) in the thoracotomy group and 4.3 ± 1.9 cm (range 2–7 cm) in the VATS group ( P = .001). Mean operative time was 101.7 ± 27.8 min (range 70–150 min) in the thoracotomy group and 77.9 ± 24.3 min (range 60–150 min) in the VATS group ( P = .014). Mean postoperative hospital stay was 7.4 ± 4.0 days (range 3–20 days) in the thoracotomy group and 4.7 ± 1.7 days (range 2–7 days) in the VATS group ( P = .040). Conclusion Most of the mediastinal neurogenic tumors are benign and surgical resection is required in their treatment. With increasing experience, resection can be performed thoracoscopically in most cases.