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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.

Background Non‐attendance to scheduled medical appointments in outpatient clinics is a problem that affects patient health and health‐care systems. Objective Evaluate association of non‐attendance to scheduled appointments in outpatient clinics and Emergency Department (ED) visits, hospitalizations and mortality. Methods Retrospective cohort study of outpatients enrolled in 2015 to 2016 in the Hospital Italiano de Buenos Aires HMO with over five scheduled appointments. Individual non‐attendance proportion was obtained by dividing missed over scheduled appointment numbers in the 365 days prior to index date. Outcomes were evaluated with a Cox proportional‐hazards or Fine and Gray model for competing risks. We adjusted by several variables. Results Sixty‐five thousand two hundred sixty‐five adults were included. Mean age was 63.6 years (SD 18.16), 29.9% male. Outpatients had average 10.18 (SD 5.59) appointments. Non‐attendance the year before the index appointment had a median of 20%. A 10% increase in non‐attendance was significantly associated with ED visits (asHR 1.19; 95%CI 1.08‐1.32, P < .001) and all‐cause mortality (aHR 7.57; 95%CI 4.88‐11.73, P < .001). In the matched subcohort analysis we observed a crude significant association of non‐attendance with ED visits (P < .001) and all‐cause mortality (P < .001). Discussion Our findings show non‐attendance could be a marker of health events that lead to emergency department evaluations and/or death.

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