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.
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.
Objective: To determine whether maternal prepregnancy shoe size can be used to reliably predict infant birth weight.Method: This is a cross-sectional study of 111 consecutive patients admitted to the maternity care unit of a small community hospital. Data collected included prepregnancy height, maternal weight, maternal shoe size, maternal age, gravidity, parity, ethnicity, and method of delivery. Infant birth weight was recorded within the first 2 hours of life.Results: There was no correlation between maternal shoe size and birth weight (r ؍ 0.01; P ؍ NS). There was no correlation between shoe size and birth weight when corrected for parity and ethnicity. Medical practice is replete with urban legends and "old wives tales." Many of these pertain to issues of women's health and reproductive medicine. A unique set of these parameters centers on trying to predict the gender or size of the unborn fetus. For example, it has been widely rumored that women who carry the baby low will deliver a boy, whereas women who carry high will deliver a girl.Another less publicized legend suggests that a woman's shoe size, in standard Western measurements, correlates with (and therefore can be used to predict) her newborn baby's birth weight in pounds. For example, a woman with a prepregnancy shoe size of 7 will deliver a 7-pound baby. Although several studies have examined the relationship between shoe size and mode of delivery, [1][2][3][4] a focused review of the English-speaking literature reveals no prior studies specifically investigating a relationship between maternal shoe size and birth weight.The objective of the present investigation was to determine the scientific validity of the relationship between maternal prepregnancy shoe size and subsequent infant birth weight using an unselected prospective cohort of parturients. Our null hypothesis was that there is no correlation between maternal shoe size and birth weight. Materials and MethodsThis was a cross-sectional study. The subjects were a sample of patients who presented for maternity care at Naval Hospital Camp Lejeune, North Carolina. Naval Hospital Camp Lejeune is a military community hospital serving active-duty service members and their dependents. The hospital performs 1800 deliveries annually. Exclusion criteria included patients who presented at less than 36 weeks of gestation, and those with gestational diabetes. General descriptive statistics (SPSS version 11.0) were used for group demographics. Pearson's product correlation coefficient calculations were used to determine the linearity and strength of the relationship between maternal shoe size and birth weight. An a priori sample size calculation indicated that to show a correlation between maternal shoe size and infant birth weight, using a 95% CI and a  of 0.2, we would need to enroll 105 patients.Following approval from the institutional review board, consent was obtained from each participant the morning following her delivery. We collected
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