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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.

New Delhi, Jan 17: E-commerce major Amazon on Friday said it plans to create one million new jobs in India over the next five years through investments in technology, infrastructure and its logistics network.

These jobs are in addition to the seven lakh jobs Amazon's investments have enabled over the last six years in the country.

"Amazon plans to create one million new jobs in India by 2025," the company said in a statement, adding that the jobs - created both directly and indirectly - will be across industries, including information technology, skill development, content creation, retail, logistics, and manufacturing.

Amazon.com Inc chief Jeff Bezos had on Wednesday announced USD 1 billion (over Rs 7,000 crore) investment in India to help bring small and medium businesses online and committed to exporting USD 10 billion worth of India-made goods by 2025.

"We are investing to create a million new jobs here in India over the next five years," Bezos said.

"We’ve seen huge contributions from our employees, extraordinary creativity from the small businesses we've partnered with, and great enthusiasm from the customers who shop with us—and we’re excited about what lies ahead," Bezos added.

India has prioritised job creation and skilling initiatives – including the training of more than 400 million people by 2022 – in rural and urban areas.

"Amazon’s job creation commitment and investment in traders and micro, small and medium enterprises (MSMEs) complement this social inclusion and social mobility efforts by creating more opportunities for people in India to find employment, build skills, and expand entrepreneurship opportunities," the statement said.

The new investments will help to hire talent to fill roles across Amazon in India, including software development engineering, cloud computing, content creation, and customer support.

Since 2014, Amazon has grown its employee base more than four times, and last year inaugurated its new campus building in Hyderabad – Amazon’s first fully-owned campus outside the United States and the largest building globally in terms of employees (15,000) and space (9.5 acres).

The investments will also help in expanding growth opportunities for the more than 5,50,000 traders and micro, small, and medium-sized businesses – including local shops – through programs like Saheli, Karigar, and “I Have Space”.

New Zealand's research institute in Antarctica is scaling back the number of projects planned for the upcoming season, in an effort to keep the continent free of coronavirus, it was reported on Tuesday.

The government agency, Antarctica New Zealand, told the BBC on Tuesday that it was dropping 23 of the 36 research projects.

Only long-term science monitoring, essential operational activity and planned maintenance will go ahead.

The upcoming research season runs from October to March.

"As COVID-19 sweeps the planet, only one continent remains untouched and (we) are focused on keeping it that way," Antarctica New Zealand told the BBC.

The organisation's chief executive Sarah Williamson said the travel limits and a strict managed isolation plan were the key factors for keeping Scott Base - New Zealand's research facility - virus free.

"Antarctica New Zealand is committed to maintaining and enhancing the quality of New Zealand's Antarctic scientific research. However, current circumstances dictate that our ability to support science is extremely limited this season" she said.

Earlier in April, Australia announced that it would scale back its activity in the 2020-21 summer season.

This included decreasing operational capacity and delaying work on some major projects.