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May 30: Patients undergoing surgery after contracting the novel coronavirus are at an increased risk of postoperative death, according to a new study published in The Lancet journal which may lead to better treatment guidelines for COVID-19.

In the study, the scientists, including those from the University of Birmingham in the UK, examined data from 1,128 patients from 235 hospitals from a total of 24 countries.

Among COVID-19 patients who underwent surgery, they said the death rates approach those of the sickest patients admitted to intensive care after contracting the virus.

The scientists noted that SARS-CoV-2 infected patients who undergo surgery, experience substantially worse postoperative outcomes than would be expected for similar patients who do not have the infection.

According to the study, the 30-day mortality among these patients was nearly 24 per cent.

The researchers noted that mortality was disproportionately high across all subgroups, including those who underwent elective surgery (18.9 per cent), and emergency surgery (25.6 per cent).

Those who underwent minor surgery, such as appendicectomy or hernia repair (16.3 per cent), and major surgery such as hip surgery or for colon cancer also had higher mortality rates (26.9 per cent), the study said.

According to the study, the mortality rates were higher in men versus women, and in patients aged 70 years or over versus those aged under 70 years.

The scientists said in addition to age and sex, risk factors for postoperative death also included having severe pre-existing medical problems, undergoing cancer surgery, undergoing major procedures, and undergoing emergency surgery.

"We would normally expect mortality for patients having minor or elective surgery to be under 1 per cent, but our study suggests that in SARS-CoV-2 patients these mortality rates are much higher in both minor surgery (16.3%) and elective surgery (18.9%)," said study co-author Aneel Bhangu from the University of Birmingham.

Bhangu said these mortality rates are greater than those reported for even the highest-risk patients before the pandemic.

Citing an example from the 2019 UK National Emergency Laparotomy Audit report, he said the 30-day mortality was 16.9 per cent in the highest-risk patients.

Based on an earlier study across 58 countries, Bhangu said the 30-day mortality was 14.9 per cent in patients undergoing high-risk emergency surgery.

"We recommend that thresholds for surgery during the SARS-CoV-2 pandemic should be raised compared to normal practice," he said.

"For example, men aged 70 years and over undergoing emergency surgery are at particularly high risk of mortality, so these patients may benefit from their procedures being postponed," Bhangu added.

The study also noted that patients undergoing surgery are a vulnerable group at risk of SARS-CoV-2 exposure in hospital.

It noted that the patients may also be particularly susceptible to subsequent pulmonary complications, due to inflammatory and immunosuppressive responses to surgery and mechanical ventilation.

The scientists found that overall in the 30 days following surgery 51 per cent of patients developed a pneumonia, acute respiratory distress syndrome, or required unexpected ventilation.

Nearly 82 per cent of the patients who died had experienced pulmonary complications, the researchers said.

"Worldwide an estimated 28.4 million elective operations were cancelled due to disruption caused by COVID-19," said co-author Dmitri Nepogodiev from the University of Birmingham.

"Our data suggests that it was the right decision to postpone operations at a time when patients were at risk of being infected with SARS-CoV-2 in hospital," Nepogodiev said.

According to the researchers, there's now an urgent need for investment by governments and health providers in to measures which ensure that as surgery restarts patient safety is prioritised.

They said this includes the provision of adequate personal protective equipment (PPE), establishment of pathways for rapid preoperative SARS-CoV-2 testing, and consideration of the role of dedicated 'cold' surgical centres.

Mumbai, Jun 27: The Bombay High Court observed that COVID-19 patients from poor and indigent sections cannot be expected to produce documentary proof to avail subsidised or free treatment while getting admitted to hospitals.

The court on Friday was hearing a plea filed by seven residents of a slum rehabilitation building in Bandra, who had been charged ₹ 12.5 lakh by K J Somaiya Hospital for COVID-19 treatment between April 11 and April 28.

The bench of Justices Ramesh Dhanuka and Madhav Jamdar directed the hospital to deposit ₹10 lakh in the court.

The petitioners had borrowed money and managed to pay ₹10 lakh out of ₹12.5 lakh that the hospital had demanded, after threatening to halt their discharge if they failed to clear the bill, counsel Vivek Shukla informed the court.

According to the plea, the petitioners were also overcharged for PPE kits and unused services.

On June 13, the court had directed the state charity commissioner to probe if the hospital had reserved 20% beds for poor and indigent patients and provided free or subsidised treatment to them.

Last week, the joint charity commissioner had informed the court that although the hospital had reserved such beds, it had treated only three poor or indigent persons since the lockdown.

It was unfathomable that the hospital that claimed to have reserved 90 beds for poor and indigent patients had treated only three such persons during the pandemic, advocate Shukla said.

He further argued that COVID-19 patients, who are in distress, cannot be expected to produce income certificate and such documents as proof.

However, senior advocate Janak Dwarkadas, who represented the hospital, said the petitioners did not belong to economically weak or indigent categories and had not produced documents to prove the same.

A person who is suffering from a disease like COVID-19 cannot be expected to produce certificates from a tehsildar or social welfare officer before seeking admission in the hospital, the bench noted and asked the hospital to deposit ₹10 lakh in court within two weeks.

New Delhi, Feb 26: With the government pushing for the disinvestment of Air India, industrial conglomerate Adani Group may emerge as one of the bidders for the debt-laden national carrier, sources said.

According to highly placed sources, the Group has held internal rounds of deliberations on whether or not to submit an Expression of Interest (EoI) and the discussions are still in the preliminary stage.

If the company actually submits an EoI, it would be a major move towards further diversification of the company which has business interests across sectors right from edible oil, food to mining and minerals. 

It also entered into airport operations and maintenance business and won bids for privatisation of six airports, Ahmedabad, Lucknow, Jaipur, Guwahati, Thiruvananthapuram and Mangaluru in 2019. 

On being contacted by IANS, the company did not comment on the matter.

Air India is one of the most important divestment proposals for the current fiscal to reach the huge Rs 2.1 lakh crore target.

The government in January restarted the divestment process of the airline and invited bids for selling 100 per cent of its equity in the state-owned airline, including Air India's 100 per cent shareholding in AI Express Ltd. and 50 per cent in Air India SATS Airport Services Private Ltd.

After its unsuccessful bid to sell Air India in 2018, the government this time has decided to offload its entire stake. In 2018, it had offered to sell its 76 per cent stake in the airline.

Of the total debt of Rs 60,074 crore as of March 31, 2019, the buyer would be required to absorb Rs 23,286 crore.

Air India, along with its subsidiary Air India Express, has a total operational fleet of 146 aeroplanes.

Further, the disinvestment department has extended the last date for submission of written queries on the Performance Information Memorandum and Share Purchase Agreement to March 6.

The last date for submission of written queries on PIM and SPA was originally set for February 11, following which the Department of Investment and Public Asset Management (DIPAM) on February 21 issued 20 clarifications on the queries raised and expected.

Any delay in the tentatively rolled out timeline would also delay DIPAM's plan to identify the pre-qualified bidders by March 31 and the financial bids invitation as well. It is expected to take more than two months after the selection of the pre-qualified bidders to complete Air India's sale.