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.

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PURPOSE: anastomosis leak still being a handicap in colorectal surgery. Bowel mechanical preparation and oral antibiotics are not a practice recommended in many clinical practice guides. The aim is to analyze the decrease in frequency and severity of postoperative complications, mainly related to anastomotic leak, after the establishment of a bundle. METHODS: Single-center, before-after study. A bundle was implemented to reduce anastomotic leaks and their consequences. The Bundle group were matched to Pre-bundle group by propensity score matching. Mechanical bowel preparation, oral and intravenous antibiotics, inflammatory markers measure and early diagnosis algorithm were included at the bubdle. RESULTS: The bundle group shown fewer complications, especially in Clavien Dindo´s Grade IV complications (23% vs 6.2% p<0.01), as well as a lower rate of anastomotic leakage (15.5% vs 2.2% p<0.01). A significant decrease in reinterventions, less intensive unit care admissions, a shorter hospital stay and fewer readmissions were also observed. In multivariate analysis, the application of a bundle was an anastomotic leakage protective factor (OR 0.121, p>0.05) CONCLUSIONS: The implementation of our bundle in colorectal surgery which include oral antibiotics, mechanical bowel preparation and inflammatory markers, significantly reduces morbidity adjusted to severity of complications, the anastomotic leakage rate, hospital stay and readmissions.

Backgroundanastomosis leak still being a handicap in colorectal surgery. Bowel mechanical preparation and oral antibiotics are not a practice recommended in many clinical practice guides. The aim is to analyse the decrease in frequency and severity of postoperative complications, mainly related to anastomotic leak, after the establishment of a bundle.MethodsSingle-center, before-after study. A bundle was implemented to reduce anastomotic leaks and their consequences. The Bundle group were matched to Pre-bundle group by propensity score matching. Mechanical bowel preparation, oral and intravenous antibiotics, inflammatory markers measure and early diagnosis algorithm were included at the bundle.ResultsThe bundle group shown fewer complications, especially in Clavien Dindós Grade IV complications (2.3% vs. 6.2% p &lt; 0.01), as well as a lower rate of anastomotic leakage (15.5% vs. 2.2% p &lt; 0.01). A significant decrease in reinterventions, less intensive unit care admissions, a shorter hospital stay and fewer readmissions were also observed. In multivariate analysis, the application of a bundle was an anastomotic leakage protective factor (OR 0.121, p &gt; 0.05)ConclusionsThe implementation of our bundle in colorectal surgery which include oral antibiotics, mechanical bowel preparation and inflammatory markers, significantly reduces morbidity adjusted to severity of complications, the anastomotic leakage rate, hospital stay and readmissions.Register studyThe study has been registered at clinicaltrials.gov Code: nct04632446.

We write this letter regarding the article retrospective analysis of clinical pathway in management of laparoscopic cholecystectomy in a tertiary care centre in South India, article we have read with interest, and because of the citation of our centre’s article clinical pathway for laparoscopic cholecystectomy.