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 study investigated the ability of transdermal electric stimulation to prevent the formation of intraabdominal adhesions in the combination with Seprafilm Ò (anti-adhesive agent). One hundred and twenty-eight (128) rabbits were subjected to a surgical procedure to simulate the adhesion processes. After the simulation, the animals were divided into 4 groups (32 animals each), depending on the application of the methods of prevention: (1) control group (no anti-adhesives or electro-stimulation) (CG); (2) comparison group (applications of Seprafilm Ò ) (SF); (3) comparison group 2 (transdermal electric stimulation of the abdominal muscles) TES; (4) group (transdermal electric stimulation ? Seprafilm Ò ) (TES ? SF). We observed that the application of the Seprafilm Ò alone led to a significant decrease in the adhesive process compared to the control group (CG) (p \ 0.01). The adhesion process in the group underwent transdermal electrical stimulation (TES) was significantly lower compared to the Seprafilm Ò group (SF) (p B 0.05). The results demonstrated a significant decrease in the adhesion processes in the SF ? TES group on days 1, 3, 7 and 14 in comparison with the CG group (p = 0.001), SF group (p = 0.001) and TES group (p = 0.01) group of animals. This study showed the efficacy of transdermal electrical muscle stimulation for the prevention of intraabdominal adhesions. Moreover, the combination of Seprafilm Ò anti-adhesion agent and electrical muscle stimulation resulted in the complete absence of adhesions. Our findings indicate the potential of such strategy for further clinical application.

BIOELECTRIC STIMULATION OF THE ANTERIOR ABDOMINAL WALL IN EARLY PREVENTION OF POSTOPERATIVE ADHESIVE PROCESS IN THE ABDOMINAL CAVITY AND ITS INTRODUCTION INTO CLINICAL PRACTICE (DESIGN OF THE STUDY)

In the original version of this article, Ydyrys Almabayev's, Timur Saliev's, Aygul Almabayeva's, Baimakhan Tanabayev's, Maral Yergazina's, and Zhandos Serikpayev's first and last names were transposed.