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.

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OBJECTIVES: This study aimed to compare the risk of surgical site infection with open vs laparoscopic cholecystectomy. METHODOLOGY: This randomized control trial was done at the Department of Surgery, Hayatabad Medical Complex, Peshawar, for 12 months from 11/5/2018 to 11/5/2019. 116 patients were recruited for this study, 58 for each group randomly allocated to a group by lottery method and concealed Allocation. Patients in Group A underwent laparoscopic cholecystectomy, while patients in group B underwent open cholecystectomy. According to ward protocol, post-operative analgesia & antibiotics were given to patients in both groups. Expert consultant general surgeons did all the evaluation & procedures; all the patients were followed up to 30 days after the procedure & any surgical site infections, if found, were noted. RESULTS: The mean age was 36 years ± 12.19 SD and 38 years ± 11.88 SD in laparoscopic and open cholecystectomy, respectively. In laparoscopic cholecystectomy, 28% of patients were male, and 72% of patients were female, while in open cholecystectomy, 29% of patients were male, and 71% of patients were female. 07% of laparoscopic and 26% of open cholecystectomy patients had surgical site infections.  CONCLUSION: Our study concludes that the frequency of surgical site infection was found less in laparoscopic cholecystectomy than in open cholecystectomy.

Background: One of the most common complaint in the ER is colic due to Ureteric calculi. They usually pass out but stones > 5mmmay require intervention. ESWL and TPL are one of the treatment options.Objectives: To compare the effectiveness of transurethral pneumatic lithotripsy (TPL) and extracorporeal shock wavelithotripsy(ESWL) in treatment of lower ureteric stones.Material and Methods: Over period of six months a group of 70 patients presenting with ureteric calculi were randomly allocated intwo groups. Group Aunderwent TPL while Group B ESWL. Follow up was done to determine the effectiveness with regards to stoneclearance.Results: The mean age of the whole study sample was 35.6 + 8.5 years. The difference between mean age of both groups wasstatistically not significant (p 0.665). there were 70% males compared to 30% females in the overall sample and the difference ofgender across both groups was comparable (p 0.192). The mean size of stone of the whole study sample at presentation was 6.4 +2.5mm and the duration of illness was 4.8 + 1.8months. On follow up, the effectiveness of the procedure in terms of stone clearancewas recorded in 88.6% of TPL group and 77.1% of ESWL group (p 0.205).Conclusion: TPL is comparable to the ESWL in terms of its effectiveness for ureteric calculi of size less than or equal to 10mm.More research trials need to be done for conclusive outcome.Key Words: Urolithiasis, ureteric calculi, transurethral pneumatic lithotripsy, extracorporeal shock wave lithotripsy, stoneclearance