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All NOF patients beyond 24-hour window over the COVID Lockdown period From April 2020 to July 2020 were identified and causes of delay to theatre were stratified. Manual Data collection over a time period of April 2020 to July 2020, when lockdown was introduced. All patients with NOF who had surgery within 24 hours were excluded. Cases not within 24 hours were included. A total of 70 patients were included in the study. Cause for Delay beyond 24 hours included No list space 30, Medically unfit 20, Anticoagulation 18, COVID related 2 needing ventilatory support. Causes of medical Delay include chest infection (not COVID related), High anaesthetic risk, Cardiac, Anaemia, Electrolyte imbalance. Covid19 accounted for 2 % of operative delays of NOF patients. Other causes include medical optimization, theatre efficiency and use of anticoagulation. However, our study proved there is a vital requirement for robust protocols and pathways in the management of NOF especially during a global pandemic. This is important for the reduction of overall Morbidity and Mortality. Local Strategies should be put in place to address these with the importance of a MDT approach including the Anaesthetic and Orthogeriatic team.

Introduction COVID-19 have delayed treatments for cancer; hence we performed a systematic review on the oncological effects of active surveillance (AS), delayed intervention (DI) and sequencing of cytoreductive nephrectomy (CN) and target therapy (TT) on localised and metastatic renal cell carcinoma (RCC). PROSPERO: CRD42020190882 Method Both randomised controlled trials and observational studies related to the study were included in this review after a comprehensive search and screening. Results A total of 2065 potential eligible records were identified. 23 studies were included for quantitative analysis. In meta-analysis, no significant difference was found between the patients who underwent AS/DI and PN/RN for overall survival (OS) (HR 1.36, 95% CI 0.99-1.87, p = 0.06), while cancer-specific survival is significantly worsened (CSS) (HR 1.67, 95% CI 1.23-2.27, p Conclusions Based on low quality evidence, AS and DI is no inferior to immediate surgical intervention in well selected T1a patient’s OS but not CSS. Upfront TT followed by deferred CN improves OS and progression free survival.

Introduction Covid-19 has changed surgical practice. Infection risk and hospital pressures means appropriate patient ambulation is paramount. Uncomplicated diverticulitis can be managed as an outpatient. Clinical differentiation of uncomplicated and complicated diverticulitis remains challenging. This study aims to develop a diagnostic algorithm to differentiate complicated from uncomplicated disease prior to imaging. Method A single-centre retrospective review of 177 patients referred as diverticulitis between Sept-Dec 2018, was performed. Data collected included clinical presentation, biochemistry and imaging. Complicated diverticulitis was defined as occlusion, perforation, abscess formation, fistula and/or bleeding. Inferential parametric analysis was performed to ensure predictive value. Results Of 177 patients referred, 71 received a consultant diagnosis of diverticulitis. 60 were confirmed and differentiated on CT scan. LIF/lower abdominal pain (P 75. Conclusions Once diverticulitis diagnosis is made based on pain localisation and change in bowel habit, complicated disease can be predicted by symptom duration (< 4 days), presence of fever and a CRP > 75. Plans to assess these findings prospectively in a Surgical Admissions Unit are currently in development.

Introduction Effective pain management is a pivotal component of day-surgical pathways. Intra-operative regional infiltration of long-acting local anaesthetic (LA) has been shown to be efficacious in reducing post-operative pain after general anaesthesia, yet few studies have explored the optimal timing of its use. Method Patients undergoing day-case breast/general surgical operations under a single consultant surgeon were randomised to receive LA infiltration (Levobupivicaine) before the initial incision, or during wound closure. All patients were given a propofol-based general anaesthetic. Primary outcomes were intra-operative/post-operative fentanyl requirements, and numerical pain scores (at 1 and 3 hours post-operatively). The study ran from October 2019 but was suspended during the COVID-19 pandemic. Non-parametric statistical tests were used. Results 25 patients were randomised. Those receiving pre-incisional LA had lower fentanyl requirements intra-operatively (mean; 150mcg vs 186mcg, p 0.4). Conclusions Pre-incisional infiltration of LA led to a significantly reduced requirement for intra-operative fentanyl, and significantly lower pain scores at 1 hour post-operatively. Larger studies should interrogate this effect at individual procedure level and assess for differences in rates of chronic pain.