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.

Background The use of multiple medications and/or the administration of more medications that are clinically indicated, representing unnecessary drug use (polypharmacy) increases the risk of non-adherence, adverse drug reaction and drug interaction. These problems are specially common and relevant in older hospitalised patients. Purpose Analyse the prevalence of polypharmacy at hospital admission and at hospital discharge in a group of older patients, and how the hospital stay modifies this prevalence. Materials and methods Patients enrolled in our retrospective study were hospitalised at the Internal Medicine Department during October 2010. Only Patients ³ 75 years old were enrolled. Polypharmacy was defined as the concomitant use of five or more medications and high-level polypharmacy was defined as concomitant use of ten or more medications. The following data were recorded for each patient: sociodemographic details, functional status, Charlson co-morbidity index (predicts the ten-year mortality for a patient who may have a range of co-morbid conditions), diagnoses at discharge, and treatments at hospital admission and discharge. Results Of the 109 patients enrolled, 61 were women. The average age was 82,69±5,15 years. At admission, 29,4% of patients were independents. The average of Charlson index was 4,62±2,3. On average, the patients studied were taking 9,01±4,01 drugs at the time of hospital admission and 9,84±3,83 drugs at discharge. Hospitalisation led to a significant increase in the number medications (p=0,001). Polypharmacy on admission and at discharge was observed in 87,2% and 91,8% of patients, respectively; and 42,2% were taking ten or more different drugs at admission and 53,2% at discharge, existing statistically significant difference between high-level polypharmacy at admission and discharge (p=0,036). Conclusions Our study confirmed a relatively high prevalence of polypharmacy in older hospitalised patients at the Internal Medicine Department. Hospitalisation led to a significant increase in the number of medications and in the prevalence of the high-level polypharmacy. The high prevalence of polypharmacy in elderly patients shows the need to reevaluate the pharmacotherapy during hospital stay.

Background Polypharmacy and the use of a particular group of drugs including benzodiazepines, neuroleptics, antidepressants, antihypertensives, diuretics, acetylcholinesterase inhibitors and proton pump inhibitors have been associated with the risk of falls and subsequent hip fracture (HF). Purpose Assess the association between polypharmacy and the use of drugs related to falls and analyse the mortality in older patients with HF. Materials and methods This is a population-based retrospective case-control study. The case group consists of patients aged≥75 years admitted to a tertiary hospital with HF after accidental fall during the year 2010. 61 patients without HF of internal medicine service were randomised as the control group. To compare comorbidity between both groups Charlson index was used. SPSS was used to estimate update Bayesian OR and 95% credible intervals (CI). Results 61 patients were admitted with HF. The relationship in the control group was 1:1. Mean age 83.3±4.8 years (60.7% women) for the case group versus 81.97±4.04, p=0.12. The number of drugs consumed was 7.2±3.3 in older with HF versus 4.9±2.1, p<0.05. Statistically significant differences were founded (p<0.05) in: benzodiazepines (OR 3.87, CI 1.77 to 8.46); antidepressants (OR 3.26, CI 1.18 to 9.02) and diuretics (OR 2.58, CI 1.24 to 5.39). The 34.42% of patients with HF died before 1 year, compared to 9.8% in the control group (p <0.05, OR 5.7, 95% CI 2.1 to 15). Mean Charlson index was 4.16 for HF and 3.62 for control group (p=0.14). Conclusions The risk of HF in the older increases with the number of medications taken and the use of benzodiazepines, antidepressants and diuretics. The mortality in the older with HF is three times higher than the control group, which is consistent with published studies. These studies show death rate among 17–33% after the first year of suffering HF>.