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.

INTRODUCTION Right iliac fossa pain is a common presenting complaint to general surgery. The differential diagnosis is wide, particularly in the elderly. Computed tomography (CT) is often used in the 'older' population, as they have a higher prevalence of acute colonic diverticulitis and colonic neoplasia, both of which should be identified prior to surgery. There is, however, no published evidence to support this practice. METHODS We retrospectively reviewed the records of all patients aged over 50 years who presented with right iliac fossa (RIF) pain to a district general hospital. We determined whether tenderness was predominantly right-or left-sided and whether systemic inflammatory response syndrome (SIRS) was present on admission. The use of imaging modalities, their results and, if performed, operative findings were recorded. RESULTS Of 3160 patients identified, 89 met the inclusion criteria. Diagnoses included appendicitis (27%), neoplasia (15%), non-specific abdominal pain (15%) and acute colonic diverticulitis (10%). CT was performed in 82% of patients, with a sensitivity of 97% based on operative findings. Six patients underwent surgery without a scan, two of whom required a change in the planned procedure due to unexpected findings. CONCLUSIONS Unless contraindicated, CT scanning should be mandatory in patients aged over 50 years presenting with signs of peritonism in the RIF or lower abdomen.

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