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.
While little difference was seen on quality of life assessment, body image is improved with the use of breast conservation and reconstruction. The high satisfaction and cosmesis scores in the breast reconstruction group are an indication of the superior results that can be achieved with breast reconstruction.
The effects of three variations in meal composition (a solid and a liquid meal consumed together, a liquid meal consumed alone, and a liquid meal consumed 90 min after a solid meal) on the rates and patterns of solid and liquid gastric emptying were examined in 13 volunteers. By including alcohol (0.5 g/kg body wt) in the liquid meal, the relationship between alcohol absorption and gastric emptying was also assessed. The lag phase and the initial emptying phase of the solid meal were prolonged (P less than 0.001) when the liquid meal was consumed with the solid meal, compared with when the liquid meal was consumed 90 min after the solid meal. In this latter situation, consumption of the liquid meal caused the cessation of emptying of solid food, and this second lag phase was followed by a slower (P less than 0.001) than initial emptying phase. Gastric emptying of the liquid meal was slower (P less than 0.005) when solid food was present and was slowest (P less than 0.05) when liquid was consumed 90 min after the solid meal. Alcohol absorption was fastest (P less than 0.05) when the liquid meal was consumed alone and slower (P less than 0.01) when alcohol was consumed with or after the solid meal. For all three meals there was a close correlation (r greater than or equal to 0.91; P less than 0.001) between alcohol absorption and liquid emptying. We conclude that gastric emptying of liquid may be influenced by solid food and that the rate and pattern of solid emptying may be modified by the presence of liquid.(ABSTRACT TRUNCATED AT 250 WORDS)
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