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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Aims To investigate the impact of the COVID-19 pandemic on general surgical emergencies and access to theatre during the pandemic. Methods We retrospectively reviewed emergency theatre lists in three distinct time periods: October 2019 (pre-COVID-19 era), April 2020 (first peak) and October 2020 (regional second peak). We extracted and compared data from a prospectively maintained database to calculate patient waiting times. Statistical analysis was performed with SPSS software v21.0 to compare median waiting times between groups and significance was set to a p value of < 0.05. Results Conclusions Despite the initial major drop in general surgical procedures and waiting times, the decreased availability of theatre lists due to staff redeployment and sickness, the introduction of routine pre-operative COVID-19 testing have all resulted in a significant increase in waiting time for urgent (CEPOD 2A) cases during the second peak.

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Aims The COVID-19 pandemic brought significant changes on all aspects of health care. We aimed to conduct a retrospective review of the trends in general surgical and vascular procedures during the first peak following the cessation of all elective activity. Methods All general and vascular procedures performed during April 2020 were included in the study. Peri-operative data were extracted from electronic patient records. We looked into operation notes, COVID status and post-operative complications. Descriptive analysis was performed using Microsoft Excel software. Results Table 1 shows a breakdown of the 54 operations performed. There were 47 patients, with a male to female ratio at 1:1. Mean age was 46.9 years. There were 6 expedited cases but none elective. Mean duration of symptoms prior to presentation was 8.3 days. Laparoscopic work was kept to a minimum. A consultant was present for 63% of the cases. There were only 2 COVID positive patients, but the majority (74%) were not tested. 20% of patients suffered a complication requiring an intervention. 6/54 had an unplanned return to theatre and there were 5 deaths in total. Conclusion The number of procedures during the first peak was significantly reduced following the uncertainty around the novel coronavirus. In accordance with the initial intercollegiate guidance, patients were managed conservatively where possible. The high complication rate is indicative of the often-late presentation due to hospital fear following the outbreak of SARS-CoV-2.