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.
Introducción: La peritonitis aguda generalizada es el proceso séptico de la cavidad abdominal donde las bacterias, toxinas, invaden dos o más compartimientos abdominales, las causas más frecuentes de peritonitis secundaria en nuestro medio son: apendicular, peritonitis postoperatoria, úlcera gastroduodenal perforada, perforación de asas delgadas, de origen ginecológico. Metodología: fue un estudio observacional descriptivo llevado a cabo en la Primera Cátedra de Clínica Quirúrgica del Hospital de Clínicas, San Lorenzo – Paraguay en el año 2017. Las variables estudiadas fueron: edad, sexo, complicaciones, índice pronóstico de Mannheim (IPM) y mortalidad. Resultados: La muestra estuvo conformada por 103 pacientes, de los cuales el 61,2% fueron del sexo masculino. El origen más frecuente de la peritonitis fue apendicular (59,2%) seguido por el de perforación (19,4%), el 34% presentó algún tipo de complicación, donde la de mayor frecuencia es la colección. La mortalidad encontrada en este grupo de pacientes fue del 2,9%. En el IPM el puntaje mínimo fue de 6 y el máximo de 33 con una media de 17 ± 6 puntos. Puntajes mayores a 26 puntos estuvieron presentes en el 8,7% de los pacientes estudiados. Conclusión: los resultados son acordes a la literatura médica sobre el tema, sin embargo, es necesario profundizar el análisis y recolección de los datos a fin de poder realizar estudios analíticos, como de cohorte para establecer factores de riesgo y medidas de dichos riesgos. Palabras clave: peritonitis; índice pronóstico de Mannheim; Paraguay.
Introduction: Crural hernia is due to a defect of the fascia transversalis, which makes the hernia sac becomes exteriorized in the femoral region. Patients and methods: 32 cases of patients with a diagnosis of crural hernia from the Surgical Clinical Chair at Hospital de Clínicas, Paraguay from 2015 through 2021. This was a retrospective, descriptive, cross-sectional study whose objective is to determine the clinical and surgical characteristics of Crural Hernias in the I Surgical Clinical Chair at Hospital de Clínicas, Paraguay from 2015 through 2021. Results: 78.1% were women. Mean age was 68.1 +/-14 years, the most common reason for consultation was pain in the inguinocrural region in 56.3% of the patients. In 78.1% of them, pain was confirmed in the right sid. Infrainguinal approach was attempted in 68.8% of the cases. Conclusion: The current challenge is always for the surgeon to achieve an accurate diagnosis and follow the correct course of action in each patient. Since the group of patients diagnosed with crural hernia is limited we should provide them with proper treatment and know all the options available.
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