All three grew out of the COVID-19 pandemic, when the questions were urgent and no registry could answer them. Two of them share a single dataset — which is the model CUBITUS now follows.
UKCoTS
Published 2023
50 UK centres
The impact of the COVID-19 pandemic on the mortality and morbidity of patients undergoing trauma surgery
Did operating through the first wave cost patients their lives? The collaborative collected outcomes for consecutive trauma surgery patients across 50 centres in April 2020, and compared them with the same month in 2019.
7.4% vs 3.7%
30-day mortality, 2020 against 2019 (p<0.001)
20.7% vs 26.4%
30-day complications — lower in 2020 (p<0.001)
57.5% vs 75.6%
Patients followed up within 30 days
Mortality roughly doubled while recorded complications fell — a pattern best explained by the collapse in follow-up rather than by safer surgery. The finding is a caution about reading pandemic-era outcome data at face value.
Imam M, Yiu ACF, Elgebaly A, Sobti A, Field RE, Jaffry Z, Ghaith H, Consigliere P, Narvani AA, Hassan R, Abdalla H, and the UKCoTS Collaborative. International Orthopaedics 2023;47(6):1397–1405.
COVID-19 risk nomogram
Conference abstract
2022
A nomogram for prediction of 30-day morbidity and mortality in COVID-19 patients undergoing orthopaedic and trauma surgery
Built from the same 50-centre dataset as UKCoTS. If you must operate during a pandemic wave, can you tell in advance which patient is at risk? The model combines preoperative COVID-19 status, sex, ASA grade, urgency and indication of surgery, tourniquet use, grade of operating surgeon, and comorbidities.
2,525
2020 patients with suspected SARS-CoV-2 infection
4,417
2019 comparison cases
Moderate
Predictive ability of the 2020 model; the 2019 model performed excellently
That gap between the two models is the result worth keeping. Established risk factors predicted outcome well in a normal year and much less well during the wave, which suggests pandemic-era risk was driven by something the usual preoperative variables do not capture.
Sobti A, Yiu A, Jaffry Z, Imam M. Orthopaedic Proceedings 2022;104-B(SUPP_1):32. Presented at the British Indian Orthopaedic Society Annual Scientific Meeting, Cardiff, 2–3 July 2021. Published as a conference abstract; the full analysis is not yet a peer-reviewed paper.
GlobalCOST
Published 2022
54 countries
Global impact of COVID-19 on surgeons and team members
The pandemic literature counted patients. This study counted the people operating on them — physical illness, mental health, salary, family time, and what support their institutions actually provided. An anonymous survey of everyone working in the operating theatre environment, not surgeons alone.
1,590
Complete responses from 54 countries, July to December 2020
32.0%
Reported becoming physically ill
OR 4.62
Odds of illness with reduced access to PPE (95% CI 2.82–7.56)
A drop in salary was associated with higher anxiety and depression; less time with family with higher depression. Only 36.0% had easy access to occupational health and 44.0% to mental health services, and fewer measures were available in countries with a low Human Development Index.
Jaffry Z, Raj S, Sallam A, Lyman S, Negida A, Yiu CFA, Sobti A, Bua N, Field RE, Abdalla H, Hammad R, Qazi N, Singh B, Brennan PA, Hussein A, Narvani A, Jones A, Imam MA, and the OrthoGlobe Collaborative. BMJ Open 2022;12(8):e059873.