Estimating the surgical backlog from the COVID-19 lockdown in South Africa: A retrospective analysis of six government hospitals

Chu, Kathryn; Bougard, Heather; Strauss, Clara; Bertels, Léonard; Victor, Audêncio; Walt, L Van der; Goliath, A; Duvenage, Riaan

doi:10.7196/samj.2021.v111i7.15686

Cited by 15 publications

(22 citation statements)

References 12 publications

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“…Fourteen studies reporting findings from 19 SSA countries were included in this narrative synthesis (Table 1) [2,[20][21][22][23][24][25][26][27][28][29][30][31][32]. Details of article screening and selection are provided in Figure 1.…”

Section: Resultsmentioning

confidence: 99%

“…Studies were conducted largely in the first wave of the pandemic (i.e. between March and July 2020) [2,20,22,24,25,[27][28][29][30][31]. Geographically, the majority of the included studies were from South Africa (n = 7) [2, 22-24, 28, 29, 31], Kenya (n = 5) [20-22, 25, 31] and Nigeria (n = 5) [22,26,[30][31][32].…”

Section: Resultsmentioning

confidence: 99%

“…health facilities, oncology workforce, access to cancer medicine and other clinical supplies, etc. ), resource allocation and research/outreach programmes [2,20,[29][30][31][32][21][22][23][24][25][26][27][28]. It provides an up-to-date evidence base for informing and supporting COVID-19 responsive policies and practices in the region.…”

Section: Discussionmentioning

confidence: 99%

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Cancer service delivery and the impact of the COVID-19 pandemic in sub-Saharan Africa: a scoping review

Ezenwankwo¹,

Nnaji²,

Moodley³

2022

ecancer

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Background:The impact of the Coronavirus Disease 2019 (COVID-19) pandemic on health systems is widely reported worldwide. However, what remains unclear is the relative extent of the pandemic's effects on cancer management in sub-Saharan Africa (SSA). This review provides an up-to-date synthesis of the literature to inform post-pandemic policy and practice efforts in the region.Methods: Sources searched for published research include MEDLINE, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, African Index Medicus, African Wide Information and Web of Science. Using predefined criteria, the retrieved citations were screened for primary research describing the direct and indirect impacts of the COVID-19 pandemic on the cancer care and service delivery landscape in SSA since March 2020. Evidence was summarised using narrative synthesis.Results: Fourteen studies reporting findings from 19 SSA countries were included in this review. Studies were conducted mostly in the first wave of the pandemic (between March and July 2020) (10/14). The most commonly reported impact on cancer treatment (including surgery) were cancellations, delays and modifications (11/14). Half (7/14) of the studies reported on the impact of the pandemic on cancer care resource availability and service restructuring. Other notable impacts included temporary suspension, total cancellations or alterations in cancer screening (3/14) and diagnostic (3/14) services or programmes. Disruptions in cancer research and outreach activities were also reported (3/14). The availability and maintenance of cancer healthcare depended on multiple factors like availability of clinical supplies, existing oncology workforce, adequate supply of personal protective equipment and local pandemic mitigation measures. Notably, no studies reported on the impact of the pandemic on psychosocial support programmes, physiotherapy and other rehabilitation care for cancer patients. Conclusion:Changes in cancer care and service delivery due to the COVID-19 pandemic varied considerably across countries in SSA. This review underscores the need for urgent actions to mitigate current setbacks while recommending evidence-based and contextualised approaches to revitalising cancer care in the post-pandemic era.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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Cancer service delivery and the impact of the COVID-19 pandemic in sub-Saharan Africa: a scoping review

Ezenwankwo¹,

Nnaji²,

Moodley³

2022

ecancer

View full text Add to dashboard Cite

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“… [32] Some of these include patient factors, bed availability in light of emergency admissions, and the repercussions of surgery postponement where there is substantial pressure of surgical backlogs: this especially in the era of the COVID-19 pandemic. [33] The parties involved around decision making were not mentioned in the studies included in this review, but it should be a multidisciplinary discussion among anaesthetists, surgeons and intensivists to maximise the strength of the verdict.…”

Section: Discussionmentioning

confidence: 99%

Risk factors associated with unplanned ICU admissions following paediatric surgery: A systematic review

Essa

Mogane

Moodley

et al. 2022

South Afr J Crit Care

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Background. Unplanned admissions to the intensive care unit (ICU) have important implications in the general management of patients. Research in this area has been conducted in the adult and non-surgical population. To date, there is no systematic review addressing risk factors in the paediatric surgical population.Objective. To synthesise the information from studies that explore the risk factors associated with unplanned ICU admissions following surgery in children through a systematic review process. Method. We conducted a systematic review of published literature (PROSPERO registration CRD42020163766), adhering to the Preferred Reporting of Observational Studies and Meta-Analysis (PRISMA) statement. The Population, Exposure, Comparator, Outcome (PECO) strategy used was based on: population – paediatric population, exposure – risk factors, comparator – other, and outcome – unplanned ICU admission. Data that reported on unplanned ICU admissions following paediatric surgery were extracted and analysed. Quality of the studies was assessed using the Newcastle-Ottawa Scale. Results. Seven studies were included in the data synthesis. Four studies were of good quality with the Newcastle-Ottawa Scale score ≥7 points. The pooled prevalence (95% confidence interval) estimate of unplanned ICU stay was 2.69% (0.05 - 8.6%) and ranged between 0.06% and 8.3%. Significant risk factors included abnormal sleep studies and the presence of comorbidities in adenotonsillectomy surgery. In the general surgical population, younger age, comorbidities and general anaesthesia were significant. Abdominal surgery and ear, nose and throat (ENT) surgery resulted in a higher risk of unplanned ICU admission. Owing to the heterogeneity of the data, a meta-analysis with risk prediction could not be performed. Conclusion. Significant patient, surgical and anaesthetic risk factors associated with unplanned ICU admission in children following surgery are described in this systematic review. A combination of these factors may direct planning toward anticipation of the need for a higher level of postoperative care. Further work to develop a predictive score for unplanned ICU stay is desirable.

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“…The surgical backlog in these hospitals would take from 4 to 14 months to clear if each hospital performed one additional operation per weekday. 2 A tertiary academic centre in the KwaZulu-Natal province reported a deficit of 1 260 cases in the first wave, which would take them 315 days to clear if four additional cases were done per weekday. 3 There is no data on the cumulative impact of the second and third waves on elective surgery backlogs, but an estimate from our centre, another tertiary academic hospital in the Western Cape province, is that 1 500 lists were lost, resulting in the cancellation of around 8 000 elective operations.…”

Section: The Elective Surgery Backlogmentioning

confidence: 99%

Strategies for recovery of a surgical service in the COVID-19 era

Nel

2022

S. Afr. j. surg.

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The COVID-19 pandemic has resulted in a massive backlog of elective cases. Delays in the provision of "elective" surgical care have dire consequences for the patient: progression of disease and comorbidities, higher complication rates, and lower overall survival. Delays in elective surgery also have significant consequences for the health system: added emotional strain on healthcare workers, a reduction in training opportunities, increased costs, and increased inequality in health-service provision. As the virus is likely to become endemic, the recovery of surgical services from the initial shock of the first three waves needs to be carefully planned, in order to mitigate the further loss of elective surgical services. This article presents a narrative review of the latest international guidelines and recommendations pertaining to surgical recovery strategies in the COVID-19 pandemic. To begin with, any recovery plan should be led by a local governance committee, who need to design and implement a number of strategies across the three phases of recovery. The preparation phase includes deciding on a system of case prioritisation, assessing and organising resources, and planning innovative ways to reorganise the service itself. The perioperative phase involves putting measures in place to reduce the risk of COVID-19 transmission. The post discharge phase includes the implementation of telemedicine for follow-up, as well as methods of service audit to enable continuous adjustment and improvement. Surgical service recovery presents many challenges; however, these also present a unique opportunity to reassess and improve the efficiency of surgical care delivery.

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Estimating the surgical backlog from the COVID-19 lockdown in South Africa: A retrospective analysis of six government hospitals

Cited by 15 publications

References 12 publications

Cancer service delivery and the impact of the COVID-19 pandemic in sub-Saharan Africa: a scoping review

Cancer service delivery and the impact of the COVID-19 pandemic in sub-Saharan Africa: a scoping review

Risk factors associated with unplanned ICU admissions following paediatric surgery: A systematic review

Strategies for recovery of a surgical service in the COVID-19 era

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