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

Abstract

Since the start of the COVID-19 pandemic, surgical operations have been drastically reduced in South Africa (SA). Guidelineson surgical prioritisation during COVID-19 have been published, but are specific to high-income countries. There is a pressing need forcontext-specific guidelines and a validated tool for prioritising surgical cases during the COVID-19 pandemic. In March 2020, the SouthAfrican National Surgical Obstetric Anaesthesia Plan Task Team was asked by the National Department of Health to establish a nationalframework for COVID-19 surgical prioritisation. To develop a national framework for COVID-19 surgical prioritisation, including a set of recommendations and a risk calculatorfor operative care. The surgical prioritisation framework was developed in three stages: (i) a literature review of international, national and localrecommendations on COVID-19 and surgical care was conducted; (ii) a set of recommendations was drawn up based on the availableliterature and through consensus of the COVID-19 Task Team; and (iii) a COVID-19 surgical risk calculator was developed and evaluated. A total of 30 documents were identified from which recommendations around prioritisation of surgical care were used to drawup 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 highacceptability and a high level of concordance (81%) with current clinical practice. This national framework on COVID-19 surgical prioritisation can help hospital teams make ethical, equitable andpersonalised decisions whether to proceed with or delay surgical operations during this unprecedented epidemic.