The COVID-19 pandemic caused a paradigm shift in the management and risk-stratification of patients presenting for both elective and emergency surgery, write researchers at the College of Health Sciences, University of KwaZulu-Natal, Durban in a SA Medical Journal study.
The first confirmed South African case of COVID-19 was identified in March 2020 in Hilton, KZN. Subsequently there has been a national drive to try to minimise the spread of the virus and reduce its impact on South Africa’s healthcare system. This culminated in the declaration of a National State of Disaster and implementation of a forced public lockdown on 27 March.
On 25 March 2020, a directive was issued by hospital management at Grey’s Hospital, a tertiary hospital in Pietermaritzburg, KZN (in accordance with national guidelines) to suspend all elective surgery at the hospital from 30 March.
As part of the national guidelines on management of the pandemic, theatre complexes have had to target: (i) protection of patients and staff from exposure to the disease; (ii) facilitating redeployment of staff to manage an expected surge of COVID-19 patients; (iii) maximising hospital beds available for the predicted COVID-19 patient surge; and (iv) facilitating the redistribution of resources to contain the outbreak.
The study found that there was a statistically significant 30% decrease in all operations during the period analysed.
The researchers write that during the pre-lockdown phase, the mean number of cases done at the institution was ~700 per month. A 30% reduction translates into 210 cases not performed during each month of restrictive theatre policies imposed. Extrapolating from the study period to include the whole period up to the commencement of level 1 lockdown restrictions (1 October 2020 – 6 months in total) reveals a ‘total case deficit’ of 1 ,60 operations.
The researchers said the decline in elective surgery noted was due to the implementation of restrictive theatre policies.
They say that the primary and secondary outcomes showed the negative effects on service delivery of COVID-19 restrictive theatre policies.
The researchers said: “What our research does not show is the benefit obtained from implementing restrictions. It should be noted that where the public health response to the pandemic was delayed and inefficient, mortality rates among patients and healthcare workers were significant.”
Effect of COVID-19 pandemic decisions on tertiary-level surgical services in Pietermaritzburg, KwaZulu-Natal Province, South Africa
DJ Laäs, Z Farina, DG Bishop
Published in the SA Medical Journal on 14 December 2020
The COVID-19 pandemic has led to the implementation of restrictive policies on theatre procedures, with profound impacts on service delivery and theatre output.
To quantify these effects at a tertiary hospital in KwaZulu-Natal Province, South Africa.
A retrospective review of morbidity and mortality data was conducted. The effects on emergency and elective caseload, intensive care unit (ICU) admissions from theatre, theatre cancellations and regional techniques were noted.
Theatre caseload decreased by 30% from January to April 2020 (p=0.02), ICU admissions remained constant, and theatre cancellations were proportionally reduced, as were the absolute number of regional techniques.
The resulting theatre case deficit was 1 260 cases. It will take 315 days to clear this deficit if four additional surgeries are performed per day.
SA Medical Journal study (Open access)
See also MedicalBrief archives:COVID-19’s long-term impact on surgery in SA
Delays in cancer surgery caused by COVID-19 may cost UK thousands of lives — Institute of Cancer Research