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.
PurposeThe study examines the relationship between consumers’ ethical sensitivity, corporate social responsibility (CSR) practices and impulse behaviors. Ethical behavior has been a subject of increasing research interest. However, there is an imperious need to inspect ethical decision-making through holistic attention to impulse purchasing.Design/methodology/approachThe study develops a set of hypotheses to understand the relationships. The online survey method was used to collect data, and 420 valid questionnaires, in total, were retrieved. In a two-step process, first, reliability and validity were initially measured. Second, confirmatory factor analysis (CFA) and structural equation modeling (SEM) were used to test the hypotheses.FindingsThe analyses support the social marketing theory (SMT) and the general theory of marketing (GTM) ethics related to business strategy. Moreover, the study examines the mediating role of organizational trust, organizational identification and eco-branding in these relationships. The ethical and CSR practices for stakeholders positively affect organizational identification and trust that mediate the relationship between impulse buying and ethical attempts. Furthermore, from an ethical and climate change perspective, eco-branding positively mediates the relationship between impulse buying and environmental advertising. The moderating role of trust is significant in the relationship between impulse buying behavior (IBB) and repurchase behavior.Originality/valueA critical factor explaining individuals’ behaviors has never been investigated using a holistic approach to IBB with ethical and CSR practices. The study profoundly contributes to knowledge about consumer ethics, with potential effects for ethical public relations, while also offering new research avenues for future exploration.
This objective of this study is to explore the influence of corporate social responsibility (CSR) on consumer's impulse buying behavior and to examine the most dominant practices for CSR which enforce to impulse buying. To check the relationship of CSR practices (environmental well-being, social well-being, and economic well-being) with impulse buying, a set of hypotheses developed. Using online survey method data has been collected. The valid replies (301 responses) were processed using, CFA and SEM methods. Results indicate that environmental well-being has a constructive relationship for trust which further leads to impulse buying and economic well-being has a positive significant association with impulse buying directly. However, the actions of social well-being having no impact on consumer's impulse buying behavior. By taking gender as a moderator, the actions of environmental well-being influence positively. No effect was found for social well-being, whereas economic well-being was partially supported. Further, theoretical and managerial implications were discussed. K E Y W O R D Sbrand, consumer, corporate social responsibility, firms, impulse buying
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