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Benedict Rogers, Editor-in-Chief of the Annals of The Royal College of Surgeons of England The Shorter Oxford English Dictionary provides two definitions for the word ‘literature': 1. … that kind of written composition valued on account of its qualities of form or emotional effect. 2. An interesting, related paper by Faux et al considers the overall diagnostic value of FIT testing, not solely linked to colorectal cancer, and this hints at further benefits yet to be evaluated in this technology. Rajput et al review national bowel cancer audit dataset to assess the impact of the pandemic on management decisions, while Ghosh et al look at colorectal cancer care outcomes from a "mixed site” model.
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The joint editorial published on 6 September 2021, by Annals and 232 other international scientific journals, on climate change further brings this further into focus.2 Plastics products (including gloves, tubing & blood sample tubes) are among the greatest contributions to carbon emissions in the NHS, and the UK is committed to reducing the use of plastics within healthcare.1,3 Of note, it is estimated that there are nearly two million tons of plastic waste generated by the US healthcare industry.4 As the largest employer in Britain, the NHS is responsible for approximately 4-5% of the nation’s carbon emissions - equivalent to the entire carbon emission of Croatia.5 In April 2021, the Royal College of Surgeons of England launched the “Sustainability in Surgery Strategy” group to ‘embed financial, environmental and social sustainability with ethical purchasing’ into surgical practice.6 Prof Mahmood Bhutta is a key figure leading these changes and provides a thoughtful and insightful editorial to this edition of Annals. Call for emergency action to limit global temperature increases, restore biodiversity, and protect health. Health care’s response to climate change: a carbon footprint assessment of the NHS in England.
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PURPOSE: The COVID-19 pandemic has caused 1.4 million deaths globally and is associated with a 3-4 times increase in 30-day mortality after a fragility hip fracture with concurrent COVID-19 infection. Typically, death from COVID-19 infection occurs between 15 and 22 days after the onset of symptoms, but this period can extend up to 8 weeks. This study aimed to assess the impact of concurrent COVID-19 infection on 120-day mortality after a fragility hip fracture. METHODS: A multi-centre prospective study across 10 hospitals treating 8% of the annual burden of hip fractures in England between 1st March and 30th April, 2020 was performed. Patients whose surgical treatment was payable through the National Health Service Best Practice Tariff mechanism for "fragility hip fractures" were included in the study. Patients' 120-day mortality was assessed relative to their peri-operative COVID-19 status. Statistical analysis was performed using SPSS version 27. RESULTS: A total of 746 patients were included in this study, of which 87 (11.7%) were COVID-19 positive. Mortality rates at 30- and 120-day were significantly higher for COVID-19 positive patients relative to COVID-19 negative patients (p < 0.001). However, mortality rates between 31 and 120-day were not significantly different (p = 0.107), 16.1% and 9.4% respectively for COVID-19 positive and negative patients, odds ratio 1.855 (95% CI 0.865-3.978). CONCLUSION: Hip fracture patients with concurrent COVID-19 infection, provided that they are alive at day-31 after injury, have no significant difference in 120-day mortality. Despite the growing awareness and concern of "long-COVID" and its widespread prevalence, this does not appear to increase medium-term mortality rates after a hip fracture.