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.
BackgroundInflammatory myopathies are a group of rare systemic diseases characterised by muscle weakness and inflammation. Clinical manifestations, course and prognosis of these patologies are very heterogeneous.ObjectivesThe aim is to describe the main characteristics of patients diagnosed with inflammatory myositis fulfilling Bohan and Peter criteria.MethodsDescriptive analysis of a cohort of 34 patients from the same hospital with follow-up between January 2010 and December 2017. We recorded demographic characteristics, clinical manifestations, treatment, comorbidity and mortality.Results34 patients (73% female) were recruited with an average age at diagnosis of 56.3 years27–83 among adults and 10 years4–15 among children. Most of them were Caucasian (94%). 18% were smokers and 15% previous smokers.The most frequent type was dermatomyositis (DM) (40%) followed by antisynthetase syndrome (ASS) (15%), necrotizing myopathy (12%), inclusion body myopathy (12%), overlap myositis (9%) and polymyositis (9%). 2 patients (out of 4) with necrotizing myopathy were treated with statins.Clinical manifestation included muscle weakness (84%) and skin manifestations (48%) mainly among DM patients. 8 patients (24%) showed interstitial lung disease (4 non-specific interstitial pneumonia, 3 usual interstitial pneumonia and 1 cryptogenic organising pneumonia), especially among patients with overlap syndrome (n=3), DM (n=2) and ASS (n=2). Pulmonary hypertension occurred in 7 patients (21%), 30% among patients with overlap myositis associated to systemic sclerosis. The rest of extramuscular manifestations are expressed in the table 1.Muscle biopsy was performed in 57% of patients (77% compatible with myopathy). MRI was carried out in 45% (100% with active myositis). EMG was performed in 94% of patients with myopathic findings in 67% of them. 20 patients (60%) presented positive antinuclear antibodies, being the most frequent antiPML-SCL (18%), antiJo1 (18%), antiRo (12%) and anti-MDA5 (9%).All patients were treated with corticosteroids. Only 2 responded to corticosteroids in monotherapy. More than 90% needed additional immunosuppressive treatment and 65% received 2 or more immunosuppressants. The most commonly used drugs were methotrexate (72%), rituximab (28%), azathioprine (25%), immunoglobulins (21%) and cyclophosphamide (21%). Only in 12% treatment could be stopped because of sustained remission.3 cases of cancer (9%) were reported: myelodysplastic syndrome, lung neoplasm (in the case of paraneoplasic myositis) and lymphoma.During the follow-up period 4 deaths were registered (12%) due to infections and cancer.38% of patients required a multidisciplinary approach.ConclusionsInflammatory myopathies have frequent multiorganic involvement and represent a heterogeneous group of systemic diseases as shown in our registry and in the literature. Most patients need chronically combined immunosuppressive treatment and few achieve sustained remission. In consequence the collaboration of several specialties is necessary for the diagnosis a...
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