Introduction The COVID-19 pandemic has led to changes in NHS surgical service provision, including reduced elective surgical and endoscopic activity, with only essential emergency surgery being undertaken. This, combined with the government-imposed lockdown, may have impacted on patient attendance, severity of surgical disease, and outcomes. The aim of this study was to investigate a possible ‘lockdown’ effect on the volume and severity of surgical admissions and their outcomes. Methods Two separate cohorts of adult emergency general surgery inpatient admissions 30 days immediately before (16 th February 2020 to 15 th March 2020), and after UK government advice (16 th March 2020 to 15 th April 2020). Data were collected relating to patient characteristics, severity of disease, clinical outcomes, and compared between these groups. Results Following lockdown, a significant reduction in median daily admissions from 7 to 3 per day (p<0.001) was observed. Post-lockdown patients were significantly older, frailer with higher inflammatory indices and rates of acute kidney injury, and also were significantly more likely to present with gastrointestinal cancer, obstruction, and perforation. Patients had significantly higher rates of Clavien-Dindo Grade ≥3 complications (p=0.001), all cause 30-day mortality (8.5% vs. 2.9%, p=0.028), but no significant difference was observed in operative 30-day mortality. Conclusion There appears to be a “lockdown” effect on general surgical admissions with a profound impact; fewer surgical admissions, more acutely unwell surgical patients, and an increase in all cause 30-day mortality. Patients should be advised to present promptly with gastrointestinal symptoms, and this should be reinforced for future lockdowns during the pandemic.

Attrition and weight loss outcomes for patients with complex obesity, anxiety and depression attending a weight management programme with targeted psychological treatment. Clinical Obesity, 6(2), pp. 133-142. (doi:10.1111/cob.12136) This is the author's final accepted version.There may be differences between this version and the published version. You are advised to consult the publisher's version if you wish to cite from it.http://eprints.gla.ac.uk/118709/ What is already known about this subject?• Baseline depression is associated with greater attrition rates from weight management programmes and is also with poorer weight loss success.• There is little evidence regarding the role of baseline anxiety as a predictor of attrition or weight loss in weight management programmes.• There is some evidence that patients with baseline mood disorders achieve similar weight loss to controls in weight management programmes with an integrated psychological component What this study adds• This study confirms that baseline anxiety and depression (identified using HADS) is associated with higher attrition of patients from a weight management programme with an integrated psychology service.• Despite a significantly less favourable case-mix of risk-factors for poor weight loss:o Patients with severe anxiety at baseline achieve similar weight loss outcomes to those without baseline anxiety.o Significantly greater weight loss is seen in participants with severe baseline depression at all stages of follow-up in the Glasgow and Clyde Weight Management Service. AbstractObjective: To investigate the effect of baseline anxiety and depression, using different definitions for caseness, on attrition and weight outcomes following a multidisciplinary weight management programme.Design: Prospective observational study. The Hospital Anxiety and Depression Scale (HADS) was used to measure anxiety and depression with 'caseness' scoring ≥11 and severity ≥14. Participants:All patients who began a weight management programme between 1 October 2008 and September 2009 (n=1838).Setting: Glasgow and Clyde Weight Management Service (GCWMS) is a specialist multidisciplinary service, which aims to achieve a minimum of ≥5kg weight loss. Patients with HADS score ≥14 were referred to the integrated psychology service for psychological assessment/intervention. Results:Patients with caseness (HADS ≥11) for anxiety (33%) and depression (27%) were significantly younger, heavier, more socioeconomically deprived and a higher proportion were female.There was a significant positive correlation between HADS anxiety and depression scores and increasing BMI (r 2 =0.094, p<0.001 and r 2 =0.175, p<0.001, respectively). Attendance and completion was lower throughout follow-up amongst patients with anxiety or depression. More patients with HADS score ≥11 achieved ≥5kg or ≥5% weight loss and by 12 months those with anxiety had a significantly higher mean weight loss (p=0.032). Participants who scored for severe anxiety (HADS ≥14) achieved similar weight loss to those ...

LVMR using Permacol is associated with low morbidity and mortality, recurrence and, additionally, significantly improved constipation, faecal incontinence and prolapse functional and quality of life outcomes, with associated improvement in urogynaecological symptoms.

The workload of emergency general surgery in the elderly is becoming more complex. This challenge is already being addressed with improvements in outcomes. The data presented here reinforces the need for new models of care with increased multidisciplinary geriatric care input into elderly surgical patient care in the perioperative period.

BackgroundThere is currently conflicting evidence surrounding the effects of obesity on postoperative outcomes. Previous studies have found obesity to be associated with adverse events, but others have found no association. The aim of this study was to determine whether increasing body mass index (BMI) is an independent risk factor for development of major postoperative complications.MethodsThis was a multicentre prospective cohort study across the UK and Republic of Ireland. Consecutive patients undergoing elective or emergency gastrointestinal surgery over a 4‐month interval (October–December 2014) were eligible for inclusion. The primary outcome was the 30‐day major complication rate (Clavien–Dindo grade III–V). BMI was grouped according to the World Health Organization classification. Multilevel logistic regression models were used to adjust for patient, operative and hospital‐level effects, creating odds ratios (ORs) and 95 per cent confidence intervals (c.i.).ResultsOf 7965 patients, 2545 (32·0 per cent) were of normal weight, 2673 (33·6 per cent) were overweight and 2747 (34·5 per cent) were obese. Overall, 4925 (61·8 per cent) underwent elective and 3038 (38·1 per cent) emergency operations. The 30‐day major complication rate was 11·4 per cent (908 of 7965). In adjusted models, a significant interaction was found between BMI and diagnosis, with an association seen between BMI and major complications for patients with malignancy (overweight: OR 1·59, 95 per cent c.i. 1·12 to 2·29, P = 0·008; obese: OR 1·91, 1·31 to 2·83, P = 0·002; compared with normal weight) but not benign disease (overweight: OR 0·89, 0·71 to 1·12, P = 0·329; obese: OR 0·84, 0·66 to 1·06, P = 0·147).ConclusionOverweight and obese patients undergoing surgery for gastrointestinal malignancy are at increased risk of major postoperative complications compared with those of normal weight.