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

Abstract

The COVID-19 pandemic reached South Africa (SA) in March 2020. A national lockdown began on 27 March 2020, andhealth facilities reduced non-essential activity, including many surgical services. to estimate the COVID-19 surgical backlog in Western Cape Province, SA, by comparing 2019 and 2020general surgery operative volume and proportion at six district and regional hospitals. to compare the operative volumeof appendicectomy, laparoscopic cholecystectomy, cancer and trauma between the 2 years. This was a retrospective study of general surgery operations from six SA government hospitals in the Western Cape. Data wereobtained from electronic operative databases or operative theatre logbooks from 1 April to 31 July 2019 and 1 April to 31 July 2020. Total general surgery operations decreased by 44% between 2019 (n=3 247) and 2020 (n=1 810) (p<0.001). Elective operationsdecreased by 74% (n=1 379 v. n=362; p<0.001), and one common elective procedure, laparoscopic cholecystectomy, decreased by 68%(p<0.001). Emergency operations decreased by 22% (n=1 868 v. n=1 448; p<0.001) and trauma operations by 42% (n=325 v. n=190;p<0.001). However, non-trauma emergency operations such as appendicectomy and cancer did not decrease. The surgical backlog forelective operations after 4 months from these six hospitals is 1 017 cases, which will take between 4 and 14 months to address if each hospitalcan do one additional operation per weekday. The COVID-19 pandemic has created large backlogs of elective operations that will need to be addressed urgently. Clear andstructured guidelines need to be developed in order to streamline the reintroduction of full surgical healthcare services as SA slowly recoversfrom this unprecedented pandemic.