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The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1–84·9), which varied between HIC (88·5 [89·0–88·0]), MIC (81·8 [82·5–81·1]), and LIC (66·8 [64·9–68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0–4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1–5·5]; p<0·0001), MIC (2·8 [2·0–3·7]; p<0·0001), and LIC (3·8 [1·3–6·7%]; p<0·0001) settings. The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs. National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic.

We report a case of an avulsion of part of the fibular head during a primary total knee replacement for osteoarthritis. Post‐operatively the patient developed a foot‐drop. However, there was no clinically demonstrable instability of the knee. The patient was managed conservatively, the foot‐drop recovered completely and the knee remained clinically stable. We observed that excessive hyperextension and/or a varus strain on the knee during pressurisation while cementing could have led to the injury. We advise caution while using this manoeuvre for pressurisation. This is the first injury of its kind reported in the literature.

[...]with the girls' under-19 title in the Smt Krishna Khaitan All India Junior Ranking badminton tournament, she has clearly sent the message that she is all set for the big league (seniors). [...]I had seen them playing on television only.

[...]those medicines affected me badly and led to dehydration. [...]I continued with a strong willpower,\" added Tidke.

Asked if he is expecting to play a bigger role this season, he said, \"I would like to but ultimately that is left to the coach to decide.

\"Hyderabad: Though Maharashtra team lost their chances of ending the 72-year Ranji Trophy title drought, Maharashtra Cricket Association (MCA) president Ajay Shirke was happy with the team's performance.

[...]Maharashtra's hopes of getting an outright win was shattered as Karnataka attained the 157-run target quite comfortably. p_ashish@dnaindia.net Scorecard Maharashtra (1st innings): 305 Karnataka (1st innings): 515 Maharashtra (2nd innings, o/n 272/6): R Motwani c Gautam b Mithun 21, S Mundhe c Gautam b Gopal 42, A Sanklecha c Nair b Mithun 14, A Darekar c Uthappa b Gopal 13, S Fallah not out 2 Extras (B6, LB4, W11, NB3) 24 Total (all out, 91.2 overs) 366 Fall of wickets: 6-268 (Jadhav, 65.4 ov), 7-307 (Motwani, 78.5 ov), 8-338 (Sanklecha, 84.5 ov), 9-362 (Darekar, 89.4 ov) Bowling: R Vinay Kumar 29-1-116-4, A Mithun 22-1-77-2, S Aravind 21-0-67-0, R Uthappa 2-0-15-0, M Pandey 2-0-14-0, S Gopal 13.2-1-47-4, Amit Verma 2-0-20-0 Karnataka (2nd innings): R Uthappa c Khurana b Darekar 36, KL Rahul c Khurana b Mundhe 29, A Verma c&b Khurana 38, M Pandey not out 28, K Nair not out 20 Extras (B1, LB2, NB3) 6 Total (for 3 wkts; 40.5 overs) 157 Fall of wickets: 1-65 (Uthappa, 15.2 ov), 2-87 (Rahul, 22.3 ov), 3-120 (Amit Verma, 29.3 ov) Bowling: S Fallah 11-2-28-0, A Sanklecha 3-2-7-0, A Darekar 10-0-46-1, C Khurana 8.5-0-53-1, S Mundhe 8-1-20-1 Credit:Ashish Phadnis

Earlier, Maharashtra, who were struggling to find their foot for the past two days, finally managed to control proceedings for the first time. \"\"scoreboard Maharashtra (1st innings): 305 Karnataka (O/N 474/7): S Gopal c Motwani b Sanklecha 10, R Vinay Kumar run out (Khadiwale/Motwani) 28, A Mithun c Motwani b Mundhe 16, S Aravind not out 0; Extras (B9, LB4, W3, NB9) 25; Total (all out, 171.1 overs) 515; FoW: 8-475 (Gopal, 160.5 ov), 9-513 (Mithun, 169.3 ov), 10-515 (Vinay Kumar, 171.1 ov); Bowling: S Fallah 37-8-93-3, A Sanklecha 30-7-83-1, A Darekar 28.5-4-108-0, S Mundhe 31.1-5-90-3, C Khurana 39.1-10-110-2, S Atitkar 5-0-18-0 Maharashtra (2nd innings): H Khadiwale c Satish b Vinay Kumar 9, V Zol c Gautam b Vinay Kumar 31, A Bawne st Gautam b Gopal 61, K Jadhav c Uthappa b Vinay Kumar 112, S Atitkar c Verma b Gopal 0, C Khurana c Uthappa b Vinay Kumar 37, R Motwani batting 3, S Mundhe batting 3; Extras (B2, LB4, W10) 16; Total (6 wickets, 68 overs) 272 ; FoW: 1-18 (Khadiwale, 2.5 ov), 2-54 (Zol, 15.1 ov), 3-172 (Bawne, 41.4 ov), 4-174 (Atitkar, 43.3 ov), 5-262 (Khurana, 63.5 ov), 6-268 (Jadhav, 65.4 ov); Bowling: R Vinay Kumar 21-1-84-4, A Mithun 16-1-47-0, S Aravind 15-0-49-0, R Uthappa 2-0-15-0, M Pandey 2-0-14-0, S Gopal 10-0-37-2, A Verma 2-0-20-0\" Credit:Ashish Phadnis

Hyderabad: Karnataka strengthened their grip on the match with a crucial 169-run first innings lead at the Rajiv Gandhi international cricket stadium here.

Hyderabad: Though the boards of South Africa, Pakistan, Sri Lanka and Bangladesh have opposed the much-talked about Big Three draft, BCCI secretary Sanjay Patel said they were not worried about individual boards as a majority of the ICC members have given their approval.