Changes in surgical practice in 85 South African hospitals during COVID-19 hard lockdown

K M Chu, M Smith, E Steyn, P Goldberg, H Bougard, I Buccimazza


Background. In preparation for the COVID-19 pandemic, South Africa (SA) began a national lockdown on 27 March 2020, and many hospitals implemented measures to prepare for a potential COVID-19 surge.

Objectives. To report changes in SA hospital surgical practices in response to COVID-19 preparedness.

Methods. In this cross-sectional study, surgeons working in SA hospitals were recruited through surgical professional associations via an online survey. The main outcome measures were changes in hospital practice around surgical decision-making, operating theatres, surgical services and surgical trainees, and the potential long-term effect of these changes.

Results. A total of 133 surgeons from 85 hospitals representing public and private hospitals nationwide responded. In 59 hospitals (69.4%), surgeons were involved in the decision to de-escalate surgical care. Access was cancelled or reduced for non-cancer elective (n=84; 99.0%), cancer (n=24; 28.1%) and emergency operations (n=46; 54.1%), and 26 hospitals (30.6%) repurposed at least one operating room as a ventilated critical care bed. Routine postoperative visits were cancelled in 33 hospitals (36.5%) and conducted by telephone or video in 15 (16.6%), 74 hospitals (87.1%) cancelled or reduced new outpatient visits, 64 (75.3%) reallocated some surgical inpatient beds to COVID-19 cases, and 29 (34.1%) deployed some surgical staff (including trainees) to other hospital services such as COVID-19 testing, medical/COVID-19 wards, the emergency department and the intensive care unit.

Conclusions. Hospital surgical de-escalation in response to COVID-19 has greatly reduced access to surgical care in SA, which could result in a backlog of surgical needs and an excess of morbidity and mortality.

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

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

E Steyn, Division of Surgery, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

P Goldberg, Division of Surgery, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa

H Bougard, Department of Surgery, New Somerset Hospital, Cape Town, South Africa

I Buccimazza, Department of Surgery, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Durban, South Africa

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COVID-19; Health systems; Global surgery; Universal health coverage

Cite this article

South African Medical Journal 2020;110(9):916-919. DOI:10.7196/SAMJ.2020.v110i9.15014

Article History

Date submitted: 2020-07-28
Date published: 2020-07-28

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