Contact Tracing of Healthcare Workers Exposed to COVID-19 Infection in a Tertiary-Care Hospital: Containing the Contagion.

Introduction: Healthcare workers (HCWs) are at higher risk of getting infected with COVID-19 infection due to their close proximity to COVID-19-positive patients. We studied the risk stratification and positivity rate in HCWs at risk of getting COVID-19 infection as well as the possible factors responsible for their being at risk of COVID-19 infection during the study period. Material and Methods: This prospective study was conducted after approval by the institutional ethics committee. The data regarding demographic variables, risk stratification, COVID-19 (reverse-transcription polymerase chain reaction) report, and possible sources of exposure for HCWs were recorded in a proforma by personal/telephonic interviews as well as from hospital records from March 2020 to June 2021. The data generated were entered into Microsoft Excel® software and analyzed using percentages, proportions, and Chi-square tests for qualitative variables. Results: COVID-19 infection's positivity rate was 19.5% among high-risk and 0.6% among low-risk HCW contacts. HCWs working in non-COVID-19 areas (67.9%) were more at risk than those working in COVID-19 areas (32.1%). In contrast, the COVID-19 positivity rate was significantly higher among high-risk contact HCWs from COVID-19 areas (34.2%) than in non-COVID-19 areas (12.6%). The maximum COVID-19 positivity rate was seen in high-risk contacts with body fluid exposure (21%), performing aerosol-generating procedures (20%), and close exposure in operation theaters (18%). Conclusions: Risk stratification is an important tool to contain infection among HCWs who had unprotected close contact with a COVID-19-positive case. With appropriate contact tracing, we were able to avoid over- and under-quarantine, save many man-hours as well as contain the spread of infection. HCWs should not only wear appropriate personal protective equipment (PPE) during work hours but should also practice mask-wearing and social distancing while they are in the community.

Analysis of trimodal pattern of mortality among hospitalized COVID-19 patients- Lessons from tertiary care hospital.

Background and Aims: Many patients with COVID-19 become critically ill and requireICU admission. Risk factors associated with mortality have been studied, but this study provides insight regarding disease progression and hence help to plan rescue strategies to improve patient outcome. Material and Methods: This retrospective, observational study included all patients with diagnosis of COVID-19 from March1 to June30,2021 who died in hospital. Results: During the study period, 1600 patients were admitted, with 1138 (71%) needing ICU care. There were 346 (21.6%) deaths, distributed as 15.8%(n = 55) within 48h of admission, 46.2%(n = 160) in next 10 days, and 37.8%(n = 131) thereafter. This trimodal mortality pattern of distribution was similar to polytrauma patients. Patients were divided into categories according to time duration from admission to death. In our cohort, 235 (14.7%) patients required mechanical ventilation, with a mortality of 85.4%(n = 201). Tachypnea was significantly (P < 0.001) associated with death at all times; however, hypotension was associated with early death and low oxygen saturation with poor outcome upto 10 days (P < 0.001). Refractory hypoxia was cause of death in all three groups, while other causes in group II were AKI (28%), sepsis (18%), and MODS (10%). Group III patients had different causes of mortality, including barotrauma (9%), pulmonary thromboembolism (8%), refractory hypercarbia (12%), MODS (13%), AKI (10%), sepsis (7%), and cardiac events (6%). Conclusion: While physiological dearrangements are associated with rapid progression and early death, complications related to hyper-coagulable state, lung injury, and organ failure lead to death later. Providing quality care to a high volume of patients is a challenge for all, but posthoc analysis such as air crash investigation can help find out potential areas of improvement and contribute to better outcomes and mortality reduction.

Importance of non-technical skills in anaesthesia education.

Rising concern about patient safety has resulted in growing interest in non-technical skills (NTS) among anaesthesiologists. Growing evidence suggesting the use of good NTS training in patient safety in simulated as well as real-world environment made them important in medical education. Both technical skills (TS) and NTS are interdependent. Successful task performance depends on effective integration of both TS and NTS for any given situation. Development of tools for assessing the NTS of an anaesthesiologist in improving health care outcomes is challenging. Teaching, understanding and evaluating NTS among anaesthesiologists in improving health care outcomes is a domain which is supposed to be a rich seam for future studies.

Tracheobronchial Injury: Role of Virtual Bronchoscopy.

A tracheobronchial avulsion is a very rare and serious condition that occurs mostly due to blunt trauma chest caused by high-speed traffic accidents. In this article, we present a challenging case of a 20-year-old male who had a right tracheobronchial transection with carinal tear which was repaired on cardiopulmonary bypass (CPB) through right thoracotomy. Challenges faced and a review of literature will be discussed. How to cite this article: Kaur A, Singh VP, Gautam PL, Singla MK, Krishna MR. Tracheobronchial Injury: Role of Virtual Bronchoscopy. Indian J Crit Care Med 2022;26(7):879-880.

Short Term Outcomes of Head and Neck Oncology Surgery During Covid-19 Pandemic: Experience from a Tertiary Cancer Care Centre in North India.

With the entire world in the midst of COVID-19 pandemic, several health care facilities have stopped or delayed performing elective surgeries in order to cater to ever increasing number of COVID-19 patients. Moreover, there were initial reports of poor surgical outcomes in patients who underwent surgery and were found to be positive for COVID-19 infection in post-operative period. In this study, we have evaluated the short-term outcomes of head and neck oncology patients operated in our institute following a strict screening protocol and conducting COVID-19 testing by Reverse transcriptase polymerase chain reaction once the test was available. 68 patients operated between 1st April and 30th September, 2020 (COVID-19 era, study group) were compared with 59 patients operated during 1st October, 2019 to 31st March 2020 (Non COVID-19 era, control group). The comparison between the groups was done by measuring 30 days complication rate as defined by Dindo-Clavien classification. 10.3% of patients developed complications in study group as compared to 8.5% of patients in control group which was statistically non-significant (p = 0.7). Importantly, none of the patients developed any sign or symptom suggestive of COVID-19 infection in post-operative period in study group. Head and neck oncology related cancer procedures including complex reconstruction can safely be performed during COVID-19 era by proper screening and pre-operative testing for COVID-19. We also suggest use of N95 masks and face shields as bare minimum in order to ensure the safety of health care workers even after a negative COVID-19 report.

Comparison of Tocilizumab and High-dose Methylprednisolone Pulse on Outcomes in Severe Corona Virus Disease-2019: TAME-COVID, a Retrospective Multicentric Study.

BACKGROUND: India recently encountered fierce second wave of coronavirus disease (COVID-19), and scarcity of novel medications added to the management challenges. Various studies have highlighted the effectiveness of tocilizumab and high-dose steroids in severe COVIDs, but none has compared their efficacy. MATERIALS AND METHODS: This retrospective multi-centric analysis compares intravenous tocilizumab (8 mg/kg/day, maximum dose-800 mg), and intravenous Methylprednisolone Pulse (MPS-1 g/day for 3 days) in severe COVID-19. Both the groups had additionally received the standard of care COVID treatment as per protocol. Outcomes were assessed at 30 days. RESULTS: A total of 336 patients, with 249 receiving MPS and 87 receiving tocilizumab were compared. Majority of these were males (72.9%) with a mean age of 57.4 ± 13.6 years. Diabetes was the most common comorbidity. Patients in both groups had comparable age distribution, comorbidities, presenting mean-arterial pressures, d-Dimer levels, serum ferritin, serum leukocyte-dehydrogenase, and procalcitonin. However, the tocilizumab group had more number of males, higher incidence of coronary artery disease, more tachypnea and leukocytosis, more number of patients with severe acute respiratory disease syndrome (PaO2/FiO2 ratio <100), and higher C-reactive protein levels at presentation. Both groups had comparable adverse events' profile. Tocilizumab group had lesser requirement of invasive ventilation than MPS group (17% vs. 29%, P = 0.038), however mortality at the end of 30 days follow-up was similar (36% vs. 34% respectively; P = 0.678). CONCLUSIONS: Tocilizumab decreased the need for invasive ventilation in severe COVID-19; however, it did not translate to improved survival. A planned prospective randomized study is recommended in this respect to compare their efficacy.

Comparison of Intra-articular Analgesia and Femoral Nerve Block for Postoperative Pain Relief in Unilateral Total Knee Arthroplasty: A Randomized Clinical Study.

BACKGROUND AND AIMS: Femoral nerve block (FNB) and intra-articular analgesia (IAA) are used for postoperative analgesia after total knee arthroplasty (TKA). AIMS AND OBJECTIVES: We aimed to determine the better technique among the two, with regard to duration and quality of postoperative analgesia along with 24-h rescue analgesic consumption. The functional recovery in the early postoperative period was also assessed. SETTINGS AND DESIGN: This was a prospective double-blind study comprising 40 American Society of Anesthesiologists I-III patients undergoing elective TKA who were randomly assigned to two groups (n = 20). METHODOLOGY: In Group A, 20 mL ropivacaine 0.5%, containing dexmedetomidine (1 µg.kg - 1), was given by FNB, and in Group B, intra-articular administration of the same drug was done. Analgesic effect was evaluated by measuring the Visual Analog Scale (VAS) and duration of analgesia. Quadriceps muscle strength was noted. STATISTICAL ANALYSIS: Observation data obtained were reported as mean value and analyzed using Student's t-test or Wilcoxon/Mann-Whitney rank test. RESULTS: The mean VAS on passive movement at the 2nd, 6th, and 16th h postoperatively was 1.75 ± 0.44, 2.90 ± 0.72, and 2.75 ± 0.44 in Group A as compared to 2.25 ± 0.72, 4.30 ± 2.05, and 2.20 ± 0.77 in Group B (P = 0.026, 0.043, and 0.014, respectively). In Group A, the first request for analgesic (rescue analgesic) was at 637 ± 119 min and the total consumption of tramadol was 50.00 mg. In Group B, the first request for analgesic was at 404.44 ± 136 min, with a total dose of 63.89 mg. The Pvalue for the time of rescue analgesic was <0.001, while for total drug consumption, it was 0.018. CONCLUSION: We concluded that the duration and quality of analgesia (VAS) were significantly superior and rescue analgesic requirement less in patients who received FNB as compared to IAA.

Assessment of knowledge gaps and perceptions about COVID-19 among health care workers and general public-national cross-sectional study.

BACKGROUND AND AIMS: COVID-19 has impacted everyone's life and livelihood in one way or the other. Individual response to measures taken to control the rapid spread of this disease depend on their knowledge and perceptions. Hence, we proposed to evaluate responses about COVID-19 among the health care workers (HCWs) as well as general public participants (GPPs). MATERIAL AND METHODS: This was a cross-sectional, observational survey conducted during the peak of the pandemic. The 35-items questionnaire was prepared using Google forms and distributed through e-mails and social media. RESULTS: The 1,026 responses comprised of 558 HCWs (54.4%) and 468 GPPs (45.6%). The most reliable source of information was TV news for 43% GPPs, whereas it was HCWs/Local health authorities for 36.8% HCWs. HCWs had sufficient knowledge regarding COVID-19, while it was relatively low among GPPs (average correct response 65% and 53%, respectively). Intra-group analysis with respect to age, sex, qualification, and socioeconomic status showed that knowledge about mode of transmission by airborne aerosols was significantly low with respect to qualification among GPPs while younger age group (<40 years) HCWs had significantly more knowledge about mode of transmission and asymptomatic carriers. Paranoia of contracting the infection was significantly higher in GPPs with upper and middle socioeconomic status and younger HCWs. CONCLUSION: HCWs had moderate level of knowledge, whereas GPPs had low to moderate knowledge, with large scope of improvement in both groups. Continued education, both at professional and community level will not only be helpful but also necessary to improve knowledge, avert negative attitudes and control the devastating pandemic.

Retrospective Evaluation of Patients Who Leave against Medical Advice in a Tertiary Teaching Care Institute.

CONTEXT: Discharge against medical advice or leave against medical advice (DAMA or LAMA) is a global phenomenon. The magnitude of LAMA phenomenon has a wide geographical variation. LAMA reasons are an area of concern for all involved in health-care delivery system. AIMS AND OBJECTIVES: The study aimed to evaluate cases of LAMA retrospectively in a tertiary teaching care institute (1) to find the magnitude of LAMA cases (2) to evaluate demographic and patient characteristics of these cases. SUBJECTS AND METHODS: We screened hospital record of a referral institute over 1 year after approval from IEC and ICMR, New Delhi. Patient demographics and disease characteristics were noted and statistically analyzed after compilation. RESULTS: A total of 47,583 patients were admitted in the year 2015 through emergency and outpatient department. One thousand five hundred and fifty-six (3.3%) patients got DAMA. The mean age of patient excluding infants was 46.64 ± 20.55 years. There were 62.9% of males. Average hospital stay of these cases was 4.09 ± 4.39 days. Most of the patients (70%) belonged to medical specialties and had longer stay as compared to surgical specialties. Most of LAMA patients were suffering from infections, trauma, and malignancies. Most of the patients had LAMA from ward (62%) followed by Intensive Care Unit (ICU) (28.8%) and emergency (9.2%). In 592 (38%) of LAMA patients, the reason for leaving was not clear. The common cited reasons for LAMA were financial (27.6%) and poor prognosis (20.5%). CONCLUSIONS: About 3.3% of patients left hospital against medical advice in our retrospective analysis. Most of these cases did so from ward followed by ICU. Financial reasons and expected poor outcome played a significant role.

Formulation of a multivariate predictive model for difficult intubation: A double blinded prospective study.

BACKGROUND AND AIMS: Various models were devised for prediction of difficult intubation but have low positive predictive value, sensitivity and specificity. We aimed to predict difficult intubation from various airway predictive indices, in isolation and combination, and to formulate a multivariate model that can aid in accurate prediction of difficult intubation. MATERIAL AND METHODS: A prospective double blinded study was conducted on 500 adult patients scheduled for elective surgery under general anaesthesia. Preoperatively, they were assessed for airway screening tests. After standardized induction of anaesthesia, laryngoscopic view was classified according to the Modified Cormack and Lehane (MCL) classification. Variables' association with intubation findings was evaluated using Chi-square statistic. Stepwise logistic regression identified the multivariate independent predictors of difficult intubation and combinations were made using forward selection process. 8 models were formulated and a receiver-operating characteristic (ROC) curve worked out for them. Sensitivity and specificity analysis validated the final model. RESULTS: Age, sex, weight, BMI, snoring, obstructive sleep apnea (OSA), diabetes, hypertension, upper lip bite test (ULBT), Mallampati grade (MPS), thyromental distance (TMD), sternomental distance (SMD), neck movements (NM), neck circumference (NC) and inter-incisor gap (IIG) had significant correlation with difficult intubation. Based upon sensitivity and specificity analysis, model comprising of MPS, NM, NC and SMD was found to be most accurate. It had highest sensitivity 80%, specificity 87% and area under curve 0.90, thus validating the model. CONCLUSIONS: Our study found that a combination of MPS, SMD, NM and NC permits reliable, accurate and quick preoperative prediction of difficult intubation.

Evaluation of Myocardial Injury using Standard Diagnostic Tools and Tissue Doppler Imaging in Blunt Trauma Chest.

INTRODUCTION: Myocardial contusion is an entity in chest trauma which is difficult to diagnose. Current practice relies more on cardiac-specific biochemical markers and standard echocardiography, but no gold standard test exists. The application of Tissue Doppler imaging is yet unexplored. AIM: The present study was designed to evaluate cardiac injury in patients with blunt trauma chest using conventional trans-thoracic echocardiography parameters and Tissue Doppler imaging. MATERIALS AND METHODS: After ethical approval was taken from the Hospital and University and a written informed consent from all patients/attendants, this prospective study was conducted on a total of 30 patients in range of 15-60 years of age with blunt trauma chest. Patients with positive Trop-T and raised CPK (> 308 IU/L), raised CK-MB (> 24 IU/L) levels were suspected to have myocardial injury and were enrolled in the study. All patients fulfilling the inclusion criteria then underwent 2D-Echo and Tissue Doppler Imaging. Results of the observations were analysed using chi-square test. RESULTS: Out of the total of 30 patients, 63.3% showed ECG changes suggestive of cardiac injury. A 76.7% patients suffered systolic dysfunction and 36.6% patients suffered diastolic dysfunction irrespective of ECG changes. On comparison of early filling velocity wave i.e., E wave (measured by transthoracic echocardiography) and tricuspid annular velocity Em wave (measured by tissue Doppler echocardiography) at tricuspid valve, we found statistically significant difference among two techniques. (p = 0.04). CONCLUSION: Echocardiography is very sensitive parameter for evaluation of myocardial contusion. Tissue Doppler imaging provides additional and reliable information.

Hot Climate and Perioperative Outcome in Trauma Patients.

INTRODUCTION: Extreme hot climatic conditions constitute a major public health threat. Recent studies have shown higher rate of perioperative complications during hot weather. Although a lot of researches have been carried out to evaluate effect of hot climatic conditions and its correlation with other medical conditions, but very little has been studied in trauma patients. AIM: To evaluate the impact of hot climatic conditions on perioperative morbidity in trauma patients. MATERIALS AND METHODS: We enrolled 100 trauma patients scheduled for surgery after approval by the Hospital and University Ethical Committee. Patients were grouped as Control Group (C) when outdoor temperature ranged in comfortable zone i.e., 20-29(0)C and Study Group (S) when outdoor temperature ranged 40(0)C or more. Patients living in regular air conditioned atmosphere (more than 18 hours per day) and with co-morbid conditions or on drugs interfering with temperature regulation were excluded. Student's t-test, z-test and chi-square tests were used for statistical analysis. RESULTS: Both groups were comparable in terms of demographics, age (control group C=38.2±12.93 years and in group S= 40.14 ± 15.98 years), sex, socioeconomic status and type of surgery. Mean Trauma Index Score (TIS) were 6.20±1.56 and 5.80±1.31 respectively. All patients were of low risk as per Shoe Maker's risk criteria. Post Anaesthesia Care Unit (PACU) stay was similar. Mean duration of hospital stay was 12.16 ± 8.50 days in group C and 10.98 ± 6.90 days in group S (p-value 0.21). 20% patients in group C whereas 54% in group S had complications (p= 0.009). There was a higher incidence of infections as well as respiratory distress in group S. On multiple logistic regression analysis peak environmental temperature was found to be the single independent risk factor for predicting perioperative morbidity. CONCLUSION: High ambient temperature adversely affects the outcome of surgery even in low risk young trauma patients belonging to American Society of Anaesthesia (ASA) physical status I and II categories. So we opine that it may be probably helpful to either postpone non-emergency surgery till fair adaptation is achieved in air conditioned environment of hospital or be cautious for complications to reduce the heat related perioperative morbidity in days of heat waves.

Comparison of patient-ventilator asynchrony during pressure support ventilation and proportional assist ventilation modes in surgical Intensive Care Unit: A randomized crossover study.

BACKGROUND: The patient-ventilator asynchrony is almost observed in all modes of ventilation, and this asynchrony affects lung mechanics adversely resulting in deleterious outcome. Innovations and advances in ventilator technology have been trying to overcome this problem by designing newer modes of ventilation. Pressure support ventilation (PSV) is a commonly used flow-cycled mode where a constant pressure is delivered by ventilator. Proportional assist ventilation (PAV) is a new dynamic inspiratory pressure assistance and is supposed to be better than PSV for synchrony and tolerance, but reports are still controversial. Moreover, most of these studies are conducted in chronic obstructive pulmonary disease patients with respiratory failure; the results of these studies may not be applicable to surgical patients. Thus, we proposed to do compare these two modes in surgical Intensive Care Unit (ICU) patients as a randomized crossover study. AIMS: Comparison of patient-ventilator asynchrony between PSV and PAV plus (PAV+) in surgical patients while weaning. SUBJECTS AND METHODS: After approval by the Hospital Ethics Committee, we enrolled twenty patients from surgical ICU of tertiary care institute. The patients were ventilated with pressure support mode (PSV) and PAV+ for 12 h as a crossover from one mode to another after 6 h while weaning. RESULTS: Average age and weight of patients were 41.80 ± 15.20 years (mean ± standard deviation [SD]) and 66.50 ± 12.47 (mean ± SD) kg, respectively. Comparing the asynchronies between the two modes, the mean number of total asynchronous recorded breaths in PSV was 7.05 ± 0.83 and 4.35 ± 5.62, respectively, during sleep and awake state, while the same were 6.75 ± 112.24 and 10.85 ± 11.33 in PAV+. CONCLUSION: Both PSV and PAV+ modes of ventilation performed similarly for patient-ventilator synchrony in surgical patients. In surgical patients with acute respiratory failure, dynamic inspiratory pressure assistance modalities are not superior to PSV with respect to cardiorespiratory function.

Fluid Administration Before Caesarean Delivery: Does Type and Timing Matter?

BACKGROUND: The effectiveness of fluid preloading is in doubt, so co-loading has been attempted to reduce the incidence of spinal anaesthesia induced hypotension in caesarean patients. AIM: To compare crystalloid preloading, colloid preloading and colloid co-loading for prevention of maternal hypotension in caesarean delivery. SETTINGS AND DESIGN: Study conducted in tertiary level hospital on 90 ASA I/II term parturients posted for elective caesarean section. Patients were randomly allocated to three Groups. MATERIALS AND METHODS: Group A (n=30) was given 10 ml/kg of 6% hydroxyethyl starch (HES) 20 minutes prior to spinal anaesthesia, Group B (n=30) was given 10 ml/kg of 6% HES by rapid infusion in 10 minutes immediately after spinal anaesthesia and Group C (n=30) was given 10 ml/kg of Ringer's Lactate 20 minutes prior to spinal anaesthesia. Intraoperatively, Heart rate, systolic, diastolic and mean arterial pressure were recorded every five minutes. Episodes of hypotension were recorded and treated with bolus of 5 mg of ephedrine and total amount of ephedrine was noted. Adverse effects, if any were recorded. STATISTICAL ANALYSIS: ANNOVA for Quantitative Analysis and chi-Square test and Z-test for Qualitative Analysis. RESULTS: Baseline parameters were similar in all the three Groups. Heart rate decreased from the baseline in all the three Groups, however, mean heart rate was highest in Group C. Heart rate was statistically similar in Groups A and B. MAP decreased in all three Groups from baseline, however, highest fall was recorded in Group C whereas, MAP was statistically similar in Groups A and B. Incidence of hypotension was 66.66% in Group C as compared to 36.66% in Groups A and 40% in Group B respectively. Group C patients received 5.33±4.54 mg of ephedrine as compared to 2.00±2.82 mg in Group A and 2.33±3.14 mg in Group B. Thus, the incidence of hypotension and ephedrine consumption was significantly higher in Group C as compared to Groups A and B whereas, this difference was statistically not significant among Groups A and B. CONCLUSION: Colloid preloading and co-loading are equally effective and both are superior to crystalloid preloading for prevention of maternal hypotension in caesarean section patients.

Repositioning of Misplaced Central Venous Catheter with Saline Injection Under C-Arm Imaging.

Malposition of central venous catheter is a well known technical complication. Misplaced catheter often requires reinsertion for proper placement of the catheter in the superior vena cava (SVC) to support safe delivery of care and minimize complications. But reinsertion exposes the patient once again to risks of complications related to the procedure including potential of misplacement. Literature describes only a few techniques for repositioning a misplaced central venous catheter (CVC). We tried old simple method of saline injection with force under image intensifier using hydrostatic force of intravenous fluid to straighten the CVC. We could successfully reposition two misplaced CVC's using this method.

A rare case of survival from primary amebic meningoencephalitis.

Primary amebic meningoencephalitis (PAM) is a rare and fatal disease of central nervous system (CNS) caused by Naegleria fowleri, an ameba found in soils and warm waters. It enters the CNS after insufflation of infected water by attaching itself to the olfactory nerves. The infection is usually difficult to diagnose and has a poor prognosis. The present case is one such case in which CSF examination led us to the diagnosis of PAM and finally to a favorable outcome when treated with Amphoterracin B and antibiotics.

Large mediastinal tumor in a neonate: an anesthetic challenge.

Mediastinal tumors pose a grave risk of cardiopulmonary complications during the perioperative course, particularly in neonates and small children. These tumors can cause displacement and compression of vital thoracic structures such as the tracheobronchial tree, the heart, and the great vessels. Catastrophic complications often occur during induction of anesthesia, use of muscle relaxants, positioning, and at the time of extubation. We present our experience of anesthetic management of a neonate with a mediastinal mass who had features of both airway and vascular obstruction.

Hot climate and perioperative outcome in elderly patients.

BACKGROUND: It is well known that heat wave is a major cause of weather related mortality in extreme of ages. While auditing our hospital mortality record, we found higher surgical mortality in the months of summer season which inspired us to look into the impact of hot climate in elderly surgical patients. MATERIALS AND METHODS: An observational prospective cohort study was undertaken to study the impact of hot climate on elderly (age > 60 yrs) surgical patients over one year when outside temperature was more than 20°C. 98 elderly patients requiring general anaesthesia for surgery were enrolled. Patients were grouped on the basis of peak outdoor temperature with a cut off value of 30°C. Group I- when peak outdoor temperature ranged between 20-30°C (comfortable zone) and Group II - when peak outdoor temperature ranged above 30°C. To reduce the bias, inclusion and exclusion criterion were defined. Meteorological factors, patient characteristics, surgical risk factors and other related data were noted. Data was analyzed using student's't' and z-test for statistical significance. RESULTS: There were statistically significant complications and prolonged hospital stay in group II as compared to I (13.21±6.44 Vs 9.81±3.54 days, P value =0.01) on univariate analysis. High risk patients had more complications in hot weather. Stepwise multivariate regression analysis showed higher adverse impact of poor physical and cardiac status than hot climate. CONCLUSION: Hot and humid weather adversely affect the perioperative outcome in elderly surgical patients. Patients with poor reserves are at greater perioperative risk during hot and humid climate.