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.
The superiority of ranked set sampling (RSS) over simple random sampling (SRS) for estimating the mean of a population is well known. This paper introduces and investigates a bivariate version of RSS for estimating the means of two characteristics simultaneously. It turns out that this technique is always superior to SRS and the usual univariate RSS of the same size. The performance of this procedure for a specific distribution can be evaluated using simulation or numerical computation. For the bivariate normal distribution, the efficiency of the procedure with respect to that of SRS is evaluated exactly for set size m = 2 and 3. The paper shows that the proposed estimator is more efficient than the regression RSS estimators proposed by Yu &Lam (1997) andChen (2001). Real data that consist of heights and diameters of 399 trees are used to illustrate the procedure. The procedure can be generalized to the case of multiple characteristics.
SUMMARYA modification of ranked set sampling (RSS) called moving extremes ranked set sampling (MERSS) is considered parametrically, for the location parameter of symmetric distributions. A maximum likelihood estimator (MLE) and a modified MLE are considered and their properties are studied. Their efficiency with respect to the corresponding estimators based on simple random sampling (SRS) are compared for the case of normal distribution. The method is studied under both perfect and imperfect ranking (with error in ranking). It appears that these estimators can be real competitors to the MLE using (SRS). The procedure is illustrated using tree data.
Three measures of overlap, namely Matusita's measure ρ , Morisita's measure λ and Weitzman's measure Δ are investigated in this article for two exponential populations with different means. It is well that the estimators of those measures of overlap are biased. The bias is of these estimators depends on the unknown overlap parameters. There are no closed-form, exact formulas, for those estimators variances or their exact sampling distributions. Monte Carlo evaluations are used to study the bias and precision of the proposed overlap measures. Bootstrap method and Taylor series approximation are used to construct confidence intervals for the overlap measures.
Abstract. In this paper we consider three measures of overlap, namely Matusia's measure ρ, Morisita's measure λ and Weitzman's measure ∆. These measures are usually used in quantitative ecology and stress-strength models of reliability analysis. Herein we consider two Weibull distributions having the same shape parameter and different scale parameters. This distribution is known to be the most flexible life distribution model with two parameters. Monte Carlo evaluations are used to study the bias and precision of some estimators of these overlap measures. Confidence intervals for the measures are also constructed via bootstrap methods and Taylor series approximation.Mathematics Subject Classification. 62F10, 62F40.
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