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.
EVT provides thrombosis of FAs of celiac trunk and superior mesenteric artery branches in patients with chronic pancreatitis, as well as hemostasis for postoperative bleeding after pancreatectomy.
Фгбу «Институт хирургии им. а.в. вишневского» (дир.-акад. ран а.ш. ревишвили) Минздрава россии, Москва, россия Панкреатодуоденальная резекция (ПДр)-одна из наиболее сложных операций в хирургии поджелудочной железы. Путем улучшения результатов лечения больных, перенесших ПДр, является рациональное периоперационное ведение и стандартизация техники оперативного вмешательства. Цель-улучшить результат лечения больных, перенесших ПДр. Материал и методы. в отделении абдоминальной хирургии Фгбу «Институт хирургии им. а.в. вишневского» в 2014-2015 гг. выполнено 87 ПДр по поводу опухолей панкреатодуоденальной области. Традиционных способом (Тр) оперированы 72 больных, робот-ассистированным (ра)-15. госпитализировали больных за 1-2 дня до операции; механическую подготовку кишечника не проводили; объем принимаемой жидкости ограничивали за 2 ч до начала операции. антибактериальную и тромбоэмболическую профилактику начинали перед операцией. Методологические приемы техники операции не зависели от способа ее выполнения и заключались в экстрафасциальном удалении комплекса органов с предварительной сосудистой изоляцией и лимфаденэктомией. Результаты. результаты хирургического лечения после Тр и ра операций были сходными, количество удаленных лимфатических узлов колебалось в среднем от 18 до 24. Специфические послеоперационные осложнения (гастростаз, панкреатический свищ, аррозивное кровотечение) возникли у 29 больных и были связаны с послеоперационным панкреатитом. умерли 5 (5,7%) больных. отдаленный результат сроком 1-25 мес (медиана 12 мес) прослежен у 57 больных: у 50 была аденокарцинома (прогрессирование заболевания отмечено у 6 больных, из которых 4 умерли), у 7-с нЭо рецидива заболевания не обнаружено. Заключение. Периоперационное ведение больных, перенесших ПДр, требует систематизации с распределением ролей анестезиолога, хирургической бригады и реаниматолога. рациональное периоперационное ведение больных и использование миниинвазивных методик может стать одним из направлений в ранней реабилитации после тяжелого хирургического вмешательства. введение протокола периоперационного ведения больных и стандартизация техники вмешательства позволяют минимизировать частоту неспецифических осложнений, а также адекватно оценить результаты лечения. Ключевые слова: панкреатодуоденальная резекция, робот-ассистированная хирургия, послеоперационные осложнения, наружный панкреатический свищ, аррозивное кровотечение.
It was performed a retrospective analysis of the results of distal pancreatic resections (DPR) in 89 patients with different tumors. Conventional open operations were performed in 60 patients, robot-assisted - in 19 patients, laparoscopic - in 10 cases. Absolute indication for open surgery was pancreatic cancer T3-4 stages. Mini-invasive distal resections (robot-assisted and laparoscopic) were performed in cases of pancreatic cancer T1-2 stages, benign tumors and tumors with low potential of malignancy and diameter up to 4-5 cm. Results of robot-assisted and laparoscopic interventions are similar but robot-assisted technique provides more precise surgery. It improves quality of lymphadenectomy, decreases probability of intraoperative bleeding. Duration of robot-assisted and open operation did not differ significantly. Blood loss was significantly lower in group of robot-assisted method (mean 470 ml) while in cases of open and laparoscopic techniques this parameter was 1013.8 and 833.3 ml respectively. Postoperative complications in open, laparoscopic and robot-assisted groups developed in 45.1, 52.6 and 50% of observations respectively. Pancreatic fistulas were revealed in 58.8, 80 and 58.3% of cases respectively. There were not deaths after laparoscopic and robot-assisted pancreatic resections. 2 patients died after open surgery.
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