Background This study aimed to determine the impact of pulmonary complications on death after surgery both before and during the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic. Methods This was a patient-level, comparative analysis of two, international prospective cohort studies: one before the pandemic (January–October 2019) and the second during the SARS-CoV-2 pandemic (local emergence of COVID-19 up to 19 April 2020). Both included patients undergoing elective resection of an intra-abdominal cancer with curative intent across five surgical oncology disciplines. Patient selection and rates of 30-day postoperative pulmonary complications were compared. The primary outcome was 30-day postoperative mortality. Mediation analysis using a natural-effects model was used to estimate the proportion of deaths during the pandemic attributable to SARS-CoV-2 infection. Results This study included 7402 patients from 50 countries; 3031 (40.9 per cent) underwent surgery before and 4371 (59.1 per cent) during the pandemic. Overall, 4.3 per cent (187 of 4371) developed postoperative SARS-CoV-2 in the pandemic cohort. The pulmonary complication rate was similar (7.1 per cent (216 of 3031) versus 6.3 per cent (274 of 4371); P = 0.158) but the mortality rate was significantly higher (0.7 per cent (20 of 3031) versus 2.0 per cent (87 of 4371); P < 0.001) among patients who had surgery during the pandemic. The adjusted odds of death were higher during than before the pandemic (odds ratio (OR) 2.72, 95 per cent c.i. 1.58 to 4.67; P < 0.001). In mediation analysis, 54.8 per cent of excess postoperative deaths during the pandemic were estimated to be attributable to SARS-CoV-2 (OR 1.73, 1.40 to 2.13; P < 0.001). Conclusion Although providers may have selected patients with a lower risk profile for surgery during the pandemic, this did not mitigate the likelihood of death through SARS-CoV-2 infection. Care providers must act urgently to protect surgical patients from SARS-CoV-2 infection.

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Introduction QFIT (Quantitative faecal immunochemical testing) has become the first-line screening tool for suspected colorectal cancer due to a lower risk profile, higher sensitivity and specificity than routine colonoscopy and faecal occult blood testing. Patients with QFIT measurements <10micrograms/ml are considered unlikely to have colorectal cancer and may be discharged from the 2-week wait (2WW) pathway without further investigations, in the absence of other concerning features including iron deficiency anaemia (IDA). We present our findings on the under-investigation of IDA in a cohort of QFIT-negative patients. Method We collected data on 100 patients in a district general hospital, referred via the 2WW suspected colorectal cancer pathway with QFIT measured as <10 micrograms/ml, over a 2-month period. Our data-points included whether iron, ferritin and haemoglobin were measured in the 6months preceding QFIT measurement. Results Our patients included 67 females and 33 males, with a median age of 67.5. 32 out of 100 patients underwent neither iron nor ferritin blood tests; 21 of which did not have their haemoglobin measured either. 25 out of 100 patients underwent iron, ferritin and haemoglobin blood tests in the specified time period. Discussion Failure to investigate IDA in QFIT-negative suspected colorectal cancer patients increases the risk of missed pathology. Studies have found patients with right sided colon cancer sometimes have false negative QFIT results but often present with IDA. We propose that mandatory investigation of IDA is incorporated into existing 2WW suspected colorectal cancer pathways, alongside QFIT measurement, to mitigate this risk.

Introduction Chronic tendinous mallet finger injuries are commonly treated with an open operative fixation. Aim To evaluate a new technique of closed reduction and fixation using a percutaneous figure of 8 suture for treating closed tendinous mallet finger injury. Method We conducted a retrospective analysis of prospectively collected data of 8 consecutive patients, undergoing percutaneous fixation of chronic mallet finger injuries. All patients had failed conservative splinting of duration 10.5 weeks (9–12 weeks) with a residual extensor lag of the distal interphalangeal joint greater than 30 degrees. Surgery was performed using a minimally invasive technique using a 3–0 proline suture in a percutaneous figure of 8 pattern, by going through the periosteum on both sides and providing rigid hyperextension. Patients were kept in a splint for 7 days followed by full mobilisation under supervision of hand therapists. Results The average age of our cohort was 51 (40–62 years old). At an average of 6.2 months All patients achieved correction of deformity to less than10 degrees. The overall functional outcome was good to excellent in all patients with no incidence of recurrence at last follow up. There was no instance of skin necrosis or wound complications in any of the patients. Conclusions The new figure of 8 percutaneous technique is an effective, safe, and minimally invasive approach for closed tendinous mallet finger injures. This needs further validation by analysing outcomes in a larger cohort.