Research

Establishing a South African national framework for COVID-19 surgical prioritisation

K M Chu, E O Owolabi, M Smith, T C Hardcastle, S Maswime, H Geduld, P D Gopalan, J Marco, M Mendelson, B M Biccard, L Cairncross, on behalf of the South African National Surgical Obstetric Anaesthesia Plan Task Team

Abstract


Background. Since the start of the COVID-19 pandemic, surgical operations have been drastically reduced in South Africa (SA). Guidelines on surgical prioritisation during COVID-19 have been published, but are specific to high-income countries. There is a pressing need for context-specific guidelines and a validated tool for prioritising surgical cases during the COVID-19 pandemic. In March 2020, the South African National Surgical Obstetric Anaesthesia Plan Task Team was asked by the National Department of Health to establish a national framework for COVID-19 surgical prioritisation.
Objectives. To develop a national framework for COVID-19 surgical prioritisation, including a set of recommendations and a risk calculator
for operative care.
Methods. The surgical prioritisation framework was developed in three stages: (i) a literature review of international, national and local recommendations on COVID-19 and surgical care was conducted; (ii) a set of recommendations was drawn up based on the available literature and through consensus of the COVID-19 Task Team; and (iii) a COVID-19 surgical risk calculator was developed and evaluated.
Results. A total of 30 documents were identified from which recommendations around prioritisation of surgical care were used to draw up six recommendations for preoperative COVID-19 screening and testing as well as the use of appropriate personal protective equipment. Ninety-nine perioperative practitioners from eight SA provinces evaluated the COVID-19 surgical risk calculator, which had high acceptability and a high level of concordance (81%) with current clinical practice.
Conclusions. This national framework on COVID-19 surgical prioritisation can help hospital teams make ethical, equitable and personalised decisions whether to proceed with or delay surgical operations during this unprecedented epidemic.


Authors' affiliations

K M Chu, Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

E O Owolabi, Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

M Smith, Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand and Chris Hani Baragwanath Academic Hospital, Johannesburg, South Africa

T C Hardcastle, Department of Surgery, School of Clinical Medicine, University of KwaZulu-Natal and Inkosi Albert Luthuli Central Hospital, Durban, South Africa

S Maswime, Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa

H Geduld, Division of Emergency Medicine, Department of Family and Emergency Medicine, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

P D Gopalan, Discipline of Anaesthesiology and Critical Care, School of Clinical Medicine, University of KwaZulu-Natal, Durban, South Africa

J Marco, Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

M Mendelson, Division of Infectious Diseases and HIV Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

B M Biccard, Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital and Faculty of Health Sciences, University of Cape Town, South Africa

L Cairncross, Global Surgery Division, Department of Surgery, Faculty of Health Sciences, University of Cape Town, South Africa

on behalf of the South African National Surgical Obstetric Anaesthesia Plan Task Team,

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Keywords

COVID-19; Surgery; South Africa; Health systems

Cite this article

South African Medical Journal 0;0(0):.

Article History

Date submitted: 2021-03-23
Date published: 2021-03-23

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