Peri-operative SARS-CoV-2 infection increases postoperative mortality. The aim of this study was to determine the optimal duration of planned delay before surgery in patients who have had SARS-CoV-2 infection. This international, multicentre, prospective cohort study included patients undergoing elective or emergency surgery during October 2020. Surgical patients with pre-operative SARS-CoV-2 infection were compared with those without previous SARS-CoV-2 infection. The primary outcome measure was 30-day postoperative mortality. Logistic regression models were used to calculate adjusted 30-day mortality rates stratified by time from diagnosis of SARS-CoV-2 infection to surgery. Among 140,231 patients (116 countries), 3127 patients (2.2%) had a pre-operative SARS-CoV-2 diagnosis. Adjusted 30-day mortality in patients without SARS-CoV-2 infection was 1.5% (95%CI 1.4-1.5). In patients with a pre-operative SARS-CoV-2 diagnosis, mortality was increased in patients having surgery within 0-2 weeks, 3-4 weeks and 5-6 weeks of the diagnosis (odds ratio (95%CI) 4.1 (3.3-4.8), 3.9 (2.6-5.1) and 3.6 (2.0-5.2), respectively). Surgery performed ≥ 7 weeks after SARS-CoV-2 diagnosis was associated with a similar mortality risk to baseline (odds ratio (95%CI) 1.5 (0.9-2.1)). After a ≥ 7 week delay in undertaking surgery following SARS-CoV-2 infection, patients with ongoing symptoms had a higher mortality than patients whose symptoms had resolved or who had been asymptomatic (6.0% (95%CI 3.2-8.7) vs. 2.4% (95%CI 1.4-3.4) vs. 1.3% (95%CI 0.6-2.0), respectively). Where possible, surgery should be delayed for at least 7 weeks following SARS-CoV-2 infection. Patients with ongoing symptoms ≥ 7 weeks from diagnosis may benefit from further delay.

SARS-CoV-2 has been associated with an increased rate of venous thromboembolism in critically ill patients. Since surgical patients are already at higher risk of venous thromboembolism than general populations, this study aimed to determine if patients with peri-operative or prior SARS-CoV-2 were at further increased risk of venous thromboembolism. We conducted a planned sub-study and analysis from an international, multicentre, prospective cohort study of elective and emergency patients undergoing surgery during October 2020. Patients from all surgical specialties were included. The primary outcome measure was venous thromboembolism (pulmonary embolism or deep vein thrombosis) within 30 days of surgery. SARS-CoV-2 diagnosis was defined as peri-operative (7 days before to 30 days after surgery); recent (1-6 weeks before surgery); previous (≥7 weeks before surgery); or none. Information on prophylaxis regimens or pre-operative anti-coagulation for baseline comorbidities was not available. Postoperative venous thromboembolism rate was 0.5% (666/123,591) in patients without SARS-CoV-2; 2.2% (50/2317) in patients with peri-operative SARS-CoV-2; 1.6% (15/953) in patients with recent SARS-CoV-2; and 1.0% (11/1148) in patients with previous SARS-CoV-2. After adjustment for confounding factors, patients with peri-operative (adjusted odds ratio 1.5 (95%CI 1.1-2.0)) and recent SARS-CoV-2 (1.9 (95%CI 1.2-3.3)) remained at higher risk of venous thromboembolism, with a borderline finding in previous SARS-CoV-2 (1.7 (95%CI 0.9-3.0)). Overall, venous thromboembolism was independently associated with 30-day mortality ). In patients with SARS-CoV-2, mortality without venous thromboembolism was 7.4% (319/4342) and with venous thromboembolism was 40.8% (31/76). Patients undergoing surgery with peri-operative or recent SARS-CoV-2 appear to be at increased risk of postoperative venous thromboembolism compared with patients with no history of SARS-CoV-2 infection. Optimal venous thromboembolism prophylaxis and treatment are unknown in this cohort of patients, and these data should be interpreted accordingly.

Background Iron deficiency anaemia in pregnancy is common and is a major cause of maternal and neonatal morbidity worldwide. Serum ferritin is the current gold standard test for identifying iron depletion, with a cut-off value of 30 µg/L. Recent studies in low- and middle-income countries have identified mean cell haemoglobin concentration as a surrogate marker for the prediction of iron depletion. Methods We studied values from 786 antenatal blood results from 2018 in Oxford, UK, and correlated the red cell indices with serum ferritin measurements. Results Haemoglobin, mean cell volume, mean cell haemoglobin and mean cell haemoglobin concentration have low specificity and sensitivity for the identification of iron depletion. Conclusions We found that haemoglobin, mean cell volume, mean cell haemoglobin and mean cell haemoglobin concentration do not have sufficient predictive value in this population to be used as a screening test for non-anaemic iron depletion.

Background The benefits of robotic over laparoscopic surgery for Roux-en-Y gastric bypass (RYGB) are debatable, with current evidence suggesting no significant differences in short-term outcomes. This study compares short-term outcomes and excess weight loss (EWL) % difference between these two techniques. Methods A retrospective study of patients undergoing RYGB between January 2016 and November 2020 at a single centre. Demographic, peri-operative and EWL% data were analysed. Results 424 RYGB procedures were performed by three surgeons including 77 robotic (RRYGB) and 347 laparoscopic (LRYGB) operations. The first 8 RRYGB were excluded being early in the learning curve and the operative technique was modified afterwards. There were no statistically significant demographic differences. The median operative time was 179 (151 – 195) and 149 (123 -171) minutes in the RRYGB and LRYGB groups respectively (P < 0.001). There were no statistically significant differences between both groups in complications, length of stay, 30-day readmission and EWL% at 6 and 12 months. The EWL% at 2 years was 88.5 (+/-19.1) and 66.6 (+/-29.8) in the RRYGB and LRYGB groups respectively (P = 0.003). Conclusions RRYGB increases the operative time with no significant short-term outcome differences. The EWL% was higher at 2 years, probably due to a narrower hand-sewn gastro-jejunal anastomosis.