common language?

COVID-19 has caused all sorts of tragedies and disrupted every aspect of normal life across the globe since it emerged in late 2019. Its easy transmission from person-to-person and its high rates of morbidity and mortality compared to most other viruses have caused well-documented disruption to medical and surgical services in many countries. One of the most difficult problems facing health services was that, as a new pathogen, there was no data on which to base decisions and strategies. The speed of the spread of the disease overwhelmed some health care services, even in wealthy and well-resourced countries like Spain, Italy and parts of the United States. Almost everywhere else services were reorganised quickly, and with a degree of (understandable) over-reaction or planning for worstcase scenarios. What data existed was anecdotal, and tended to be catastrophic in nature, feeding the responses of responsible politicians, health care service managers and health care professionals. In response to the need for better data, the National Institute for Health Research (NIHR) Global Surgery Unit at Birmingham University, United Kingdom, organised the COVIDSurg Collaborative to collect and analyse data from surgeons around the world. NIHR Global Surgery is one of the many successful research collaboratives based in the United Kingdom which have developed this method of involving multiple centres in parallel to collect large data sets quickly. Surgeons across Australia and New Zealand joined this project at the outset, and have continued to develop it throughout the pandemic. The Clinical Trials Network of Australia and New Zealand (CTANZ) is the RACS group that has coordinated this work. CTANZ is charged with developing networks among surgically oriented medical students, Trainees and Fellows of the college. In three years this group has developed rapidly, and is now coordinating student projects across Australia and New Zealand – including IMAGINE, RECON and COMPASS. More recently, CTANZ has rolled out registrar-based projects including the SUNRRISE randomised clinical trial, as well as Australian and New Zealand contributions to large scale international prospective audit projects, including COVIDSurg. The COVIDSurg project is collating the outcomes of surgery on SARS-CoV-2 infected patients, as well as the impact of the COVID-19 pandemic and the pandemic response on cancer surgery. This is the largest collaborative study ever conducted in surgery, with data now collected from more than 700 hospitals in 70 countries, including outcome data from over 24,000 patients. This project has already produced two papers in high impact journals (The Lancet and British Journal of Surgery (BJS)) with more to come. The papers produced have allowed the group to estimate the effect of COVID-19 service changes on cancellations and waiting times, and on the actual mortality rates that result from operating on people who are infected or become infected with SARS-CoV-2 soon after their surgery. The Cancellations paper 1 in the BJS achieved widespread coverage in the general media in Australia and raised awareness of the impact of the recent slowdown in elective activity, and the projected medium-term impact on services going forwards as we all try to catch up as the pandemic recedes. In Australia, the modelling suggested a backlog of up to 400,000 cases have been deferred and need to be rescheduled.

The Morbidity and Mortality paper in The Lancet 2 shows the impact that COVID-19 has on surgical outcomes. The shortterm outcomes for 1128 patients in 24 countries was reported, showing an overall mortality of 23.8 per cent. The cohort included 22.3 per cent ‘minor’ procedures, and 74 per cent of the procedures were emergency operations. This very high mortality in a large case series will inform decision-makers and surgeons globally about the risks of surgery in the COVID-19 era. The success of the data collection, rapid analysis and presentation of clinically and organisationally relevant results has powerfully demonstrated the validity of this collaborative approach to surgical research, and the ability of trainee collaboratives to pivot quickly and respond to the rapidly changing scenarios we are encountering across the COVID-19 pandemic. CTANZ will ensure not only that COVID-19-related research continues in this way, but also that the growth in specialty, registrar and student/junior trainee networks is maintained. For more information contact CTANZ@surgeons.org

Dr Peter Pockney FRACS Dr Daniel Cox Dr Philip Townend FRACS Professor David Watson FRACS

REFERENCES

1. COVIDSurg Collaborative. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans: https://doi.org/10.1002/bjs.11746 2. COVIDSurg collaborative, Mortality and pulmonary complications in patients undergoing surgery with perioperative SARS-CoV-2 infection: an international cohort study. The Lancet, Accepted ahead of print, May 2020

Name change for international medical graduates

The Board of Council and the Executive team have approved that international medical graduates on a specialist pathway should be renamed Specialist International Medical Graduates (SIMGs). The name change, including for the committee responsible for the governance of the program, will align the Royal Australasian College of Surgeons with the Medical Board of Australia and many other specialist medical colleges’ terminology. The term will be used for all SIMGs including those on a vocational pathway to registration in New Zealand.