Big backlogs for Cape surgeries

Backlogs of more than 1,000 elective surgical operations were built up by just six public hospitals in the Western Cape during the first four months of the Covid-19 lockdown, suggesting a potentially devastating national picture of deferred care, according to a study published in the SA Medical Journal.

Backlogs of more than 1,000 elective surgical operations were built up by just six public hospitals in the Western Cape during the first four months of Covid-19 lockdown, suggesting a potentially devastating national picture of deferred care, according to a study published in the SA Medical Journal.

Both government and private hospitals cut non-emergency services when the national lockdown began on March 27 2020, to prepare for the expected surge in Covid-19 admissions.

A modelling study that considered the impact of the first 12 weeks of the lockdown estimated the national backlog of surgical procedures could run to 150,000 cases, but to date there has been little primary research on the subject in SA.

The researchers examined electronic records from New Somerset, Worcester, Karl Bremer, Mitchells Plain, Khayelitsha and Eerste River hospitals. They found elective procedures fell by 75% and general surgical operations decreased by more than 40% during the first four months of the pandemic. The backlog for elective procedures alone at the end of this period stood at 1,017 cases, which the researchers estimated would take between four and 14 months to catch up with if each hospital managed its current workload and squeeze in one extra operation a day.

“Elective surgery in the government sector was already limited pre-Covid. We are concerned because elective conditions continue to occur, and therefore access is even more limited postpandemic.

“Even when surgical care returns to normal levels (which it now is), there is no capacity to increase it to address the backlog without finding creative solutions,” said the study’s lead author, Kathryn Chu, director of the Centre for Global Surgery at Stellenbosch University.

Trauma-related surgery fell 42%, which Chu attributed to the restrictions on movement and alcohol bans.

However, nontrauma emergency surgical operations remained unchanged, an important finding that signals lifethreatening illnesses are still being treated, she said.

Chu said it was difficult to gauge how the backlogs were affecting waiting lists at hospitals, as each surgical condition has different waiting times, which varies between hospitals.

“Even if two hospitals had 10 people waiting, one might address it in one week and another in 10 weeks, depending on the theatre time, number of surgeons, equipment, beds, etc. Some hospitals have waiting lists of patients and others have given up accepting any more patients until they plan on doing extra lists,” she said.

Most hospitals are operating at full surgical capacity, and many are trying to accommodate extra lists for “urgent electives” such as cancer patients.

The backlog is so large it will be difficult for individual hospitals to tackle alone, she said.

“Shared waiting lists between hospitals, even public and private, could be a more efficient way of addressing certain surgical conditions, by pooling surgeons and anaesthetists and seeing where theatre time is available. As we move towards NHI [national health insurance], this is the way we must be thinking,” Chu said.

MODELLING STUDY ESTIMATES THE NATIONAL BACKLOG OF SURGICAL PROCEDURES COULD RUN TO 150,000 CASES

EVEN WHEN SURGICAL CARE RETURNS TO NORMAL, NO CAPACITY EXISTS TO INCREASE IT TO ADDRESS THE BACKLOG