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To support the global restart of elective surgery, data from an international prospective cohort study of 8492 patients (69 countries) was analysed using artificial intelligence (machine learning techniques) to develop a predictive score for mortality in surgical patients with SARS-CoV-2. We found that patient rather than operation factors were the best predictors and used these to create the COVIDsurg Mortality Score (https://covidsurgrisk.app). Our data demonstrates that it is safe to restart a wide range of surgical services for selected patients.

Background: The aim of this scoping review is to assess the current evidence regarding periprosthetic shoulder infection to inform development of evidence and consensus-based guidelines. Methods: A search of Medline, Embase and PubMed was performed; two authors screened the results independently for inclusion. Results: Totally 88 studies were included. Incidence of periprosthetic shoulder infection ranged from 0.7% to 7%. The most common organisms to cause periprosthetic shoulder infection were Propionibacterium acnes, Staphylococcus aureus, Staphylococcus epidermidis and coagulase-negative Staphylococcus. Male gender and younger age are the most reported risk factors. Erythrocyte sedimentation rate, C-reactive protein and serum/synovial biomarkers had limited diagnostic accuracy. Thirty-nine studies reported the outcome of surgical management of periprosthetic shoulder infection. Eradication rates vary from 54% to 100% for debridement procedures; 66-100% for permanent spacers; 50-100% following single-stage revision; 60-100% following two-stage revision; and 66-100% following resection arthroplasty. Conclusion: There is wide heterogeneity in study designs and outcomes of studies are often contradictory and due to issues with methodology and small sample sizes the optimal pathways for diagnosis and management cannot be determined from this review. Future research should be based on larger cohorts and randomised trials where feasible to provide more valid research for guiding future treatment of periprosthetic shoulder infection.

Only four early years postgraduate surgical training posts in the UK meet nationally approved minimum quality standards. Specific recommendations are made to improve training in this cohort and to bolster recruitment and retention into Higher Surgical Training.

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This study aims to determine the epidemiology of shoulder dislocations in Teeside area to help organise upper limb service provision. A and E records were searched within two large university hospitals covering Teeside population to identify all presentations coded as shoulder dislocation between October 2005 and March 2015. Radiological imaging for all presentations was reviewed for radiological confirmation of dislocation. Census data has been used to calculate estimated catchment population for these hospitals at the mid-point of the study. 3616 A and E presentations were coded for shoulder dislocation. Radiological review confirmed 2686 presentations in 1997 patients with radiological evidence of shoulder dislocation. This included 1858 male presentations (69%), with a male:female ratio of 2.2:1, and a mean age of 42 years. There is a bimodal distribution, with a peak age for male presentation of 20 years and a second peak for female presentation at 86 years. Recurrent dislocation was associated with 916 presentations in 380 patients (19% of identified patients), mean age at presentation of 31 years and a male:female ratio of 3.4:1. Estimated catchment population of 6 98 332 gives an overall incidence of 40.7 per 1 00 000 person-years, and incidence of primary dislocation of 26.9 per 1 00 000 person years. Our incidence of primary shoulder dislocation is marginally higher than that reported in American literature but equivalent to previous Scandinavian data, possibly reflecting differences in healthcare structure. Recurrence rate remains high, suggesting that there is scope for improved management of patients with recurrent shoulder instability.

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