As South Africa continues to focus on ploughing health, financial and human resources into the national response against the Covid-19 coronavirus, there is collateral damage in hospitals.
The pandemic has disrupted routine hospital services globally, and a new study estimates that 146 000 elective surgeries in this country could be cancelled as a result of the crisis – leading to patients facing a lengthy wait for their health issues to be resolved.
Worldwide, the CovidSurg Collaborative, a research network of 5 000 surgeons from 120 countries, has projected that based on a 12-week period of peak distribution to hospital services due to Covid-19, 28.4 million elective surgeries will be cancelled or postponed this year.
The modelling study, published in the British Journal of Surgery this week, shows that each additional week of disruption to hospital services will result in a further 2.4 million cancellations.
Led by researchers from the University of Birmingham, UK and the University of Cape Town (UCT), they collected detailed information from surgeons in 359 hospitals across 71 countries on plans for the cancellation of elective surgery.
This data was then statistically modelled to estimate the total number of cancelled surgeries across 190 countries.
The researchers projected that worldwide 72.3% of planned surgeries will be cancelled during the peak period of Covid-19 related disruption.
Most cancelled surgeries will be for non-cancer conditions. Orthopaedic procedures will be cancelled most frequently, with 6.3 million orthopaedic surgeries cancelled worldwide over a 12-week period. It is also projected that globally 2.3 million cancer surgeries will be cancelled or postponed.
In South Africa, more than 146 000 operations will be cancelled, including 12 000 cancer procedures. These cancellations will create a backlog that will need to be cleared after the Covid-19 disruption ends.
Professor Bruce Biccard, second chairperson in the department of anaesthesia and perioperative medicine at UCT, said: “Each additional week of disruption to hospital services results in an additional 12 000 surgeries being cancelled. Following the surge in the epidemic, we are going to need a continuous assessment of the situation, so that we can plan a safe resumption of elective surgery at the earliest opportunity.
DURING THE COVID-19 PANDEMIC ELECTIVE SURGERIES HAVE BEEN CANCELLED TO REDUCE THE RISK OF PATIENTS BEING EXPOSED TO THE VIRUS IN HOSPITAL
Aneel Bhangu, consultant surgeon and senior lecturer at the National Institute for Health Research
“Clearing the backlog of elective surgeries created by Covid-19 is going to result in a significant additional cost for the national health department. Government will have to ensure that the department is provided with additional funding and resources to ramp up elective surgeries to clear the backlog.”
Aneel Bhangu, consultant surgeon and senior lecturer at the National Institute for Health Research unit on global surgery at the University of Birmingham, said: “During the Covid-19 pandemic elective surgeries have been cancelled to reduce the risk of patients being exposed to the virus in hospital, and to support the wider hospital response, for example by converting operating theatres into intensive care units.
“Although essential, cancellations place a heavy burden on patients and society. Patients’ conditions may deteriorate, worsening their quality of life as they wait for rescheduled surgery. In some cases, for example cancer, delayed surgeries may lead to a number of unnecessary deaths.
A study in Wuhan, China’s COVID-19 epicentre suggests that having surgery during the coronavirus incubation period is likely to complicate or prolong your hospital stay. Researchers behind the first study of the effects of surgery on COVID-19 progression said that surgery might accelerate and worsen the disease.
Researchers from Renmin Hospital at Wuhan University and the University of Hong Kong found that 34 surgical patients who were later treated for COVID-19 complications had a 21% mortality rate, versus 2% for nonsurgical COVID-19 patients. Surgical patients also developed symptoms within two days of surgery compared to between five and eight days for the others.
“Surgery may not only cause immediate impairment of immune function but also induce an early systemic inflammatory response,” said lead researcher Shaoqing Lei.
The Times reports that says many hospitals in South Africa have postponed elective surgery, but authorities showed mixed reactions to the Chinese study. Mark van der Heever, spokesperson for the Western Cape Health Department, said the study sample was small and the patients involved had serious cancer procedures and even kidney transplants. “It is not relevant to our population or to any routine elective surgery,” he said.
However, “the department issued a public notice informing clients that … elective surgery will be cancelled”.
Netcare group medical director Anchen Laubscher said the hospital group is postponing all elective surgery, “provided that this will not result in the patient’s outcome or quality of life being significantly altered”.
Background: The outbreak of 2019 novel coronavirus disease (COVID-19) in Wuhan, China, has spread rapidly worldwide. In the early stage, we encountered a small but meaningful number of patients who were unintentionally scheduled for elective surgeries during the incubation period of COVID-19. We intended to describe their clinical characteristics and outcomes.
Methods: We retrospectively analyzed the clinical data of 34 patients underwent elective surgeries during the incubation period of COVID-19 at Renmin Hospital, Zhongnan Hospital, Tongji Hospital and Central Hospital in Wuhan, from January 1 to February 5, 2020.
Findings: Of the 34 operative patients, the median age was 55 years (IQR, 43–63), and 20 (58·8%) patients were women. All patients developed COVID-19 pneumonia shortly after surgery with abnormal findings on chest computed tomographic scans. Common symptoms included fever (31 [91·2%]), fatigue (25 [73·5%]) and dry cough (18 [52·9%]). 15 (44·1%) patients required admission to intensive care unit (ICU) during disease progression, and 7 patients (20·5%) died after admission to ICU. Compared with non-ICU patients, ICU patients were older, were more likely to have underlying comorbidities, underwent more difficult surgeries, as well as more severe laboratory abnormalities (eg, hyperleukocytemia, lymphopenia). The most common complications in non-survivors included ARDS, shock, arrhythmia and acute cardiac injury.
Interpretation: In this retrospective cohort study of 34 operative patients with confirmed COVID-19, 15 (44·1%) patients needed ICU care, and the mortality rate was 20·5%.
Funding: National Natural Science Foundation of China.
Shaoqing Lei, Fang Jiang, Wating Su, Chang Chen, Jingli Chen, Wei Mei, Li-Ying Zhan, Yifan Jia, Liangqing Zhang, Danyong Liu, Zhong-Yuan Xia, Zhengyuan XiaFull report in The TimeseClinical Medicine abstract