Browsing by Author "Simoes, J.F.,"

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    Effects of pre-operative isolation on postoperative pulmonary complications after elective surgery: an international prospective cohort study
    (Association of Anaesthestetics Great Britain and Ireland., 2021-07-14) Simoes, J.F.,; Li, E; Nepogodiev, D.,; Bhangu, A.,; Abdur-Rahman, LO., ...............; .......... Gwadabe Sadiya Musa........... et al
    Weaimedtodeterminetheimpactofpre-operativeisolationonpostoperativepulmonarycomplicationsafter electivesurgeryduringtheglobalSARS-CoV-2pandemic.Weperformedaninternationalprospectivecohort study includingpatientsundergoingelectivesurgery inOctober2020. Isolationwasdefinedastheperiod beforesurgeryduringwhichpatientsdidnotleavetheirhouseorreceivevisitorsfromoutsidetheirhousehold. Theprimaryoutcomewaspostoperativepulmonary complications, adjusted inmultivariablemodels for measuredconfounders.Pre-definedsub-groupanalyseswereperformedfortheprimaryoutcome.Atotalof 96,454patientsfrom114countrieswereincludedandoverall,26,948(27.9%)patientsisolatedbeforesurgery. Postoperativepulmonarycomplicationswererecordedin1947(2.0%)patientsofwhich227(11.7%)were associatedwithSARS-CoV-2infection.Patientswhoisolatedpre-operativelywereolder,hadmorerespiratory comorbiditiesandweremorecommonlyfromareasofhighSARS-CoV-2incidenceandhigh-incomecountries. Althoughtheoverall ratesofpostoperativepulmonarycomplicationsweresimilar inthosethat isolatedand thosethatdidnot (2.1%vs2.0%, respectively), isolationwasassociatedwithhigher ratesofpostoperative pulmonarycomplicationsafteradjustment(adjustedOR1.20,95%CI1.05–1.36,p=0.005).Sensitivityanalyses revealednofurtherdifferenceswhenpatientswerecategorisedby:pre-operativetesting;useofCOVID-19-free pathways; or community SARS-CoV-2 prevalence. The rate of postoperative pulmonary complications increasedwithperiodsofisolationlongerthan3days,withanOR(95%CI)at4–7daysor≥8daysof1.25(1.04 1.48), p=0.015and1.31 (1.11–1.55), p=0.001, respectively. Isolationbeforeelectivesurgerymightbe associatedwithasmall but clinically important increasedriskof postoperativepulmonarycomplications. Longerperiodsofisolationshowednoreductionintheriskofpostoperativepulmonarycomplications.These findingshavesignificantimplicationsforglobalprovisionofelectivesurgicalcare.