Browsing by Author "Chu, K. M."

Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Changes in surgical practice in 85 South African hospitals during COVID-19 hard lockdown
    (Health & Medical Publishing Group, 2020) Chu, K. M.; Smith, M.; Steyn, E.; Goldberg, P.; Bougard, H.; Buccimazza, I.
    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.
  • Thumbnail Image
    Item
    Establishing a South African national framework for COVID-19 surgical prioritisation
    (Health & Medical Publishing Group, 2021-03-23) Chu, K. M.; Owolabi, E. O.; Smith, M.; Hardcastle, T. C.; Maswime, S.; Geduld, H.; Gopalan, P. D.; Marco, J.; Mendelson, M.; Biccard, B. M.; Cairncross, L.
    Background. Since the start of the COVID-19 pandemic, surgical operations have been drastically reduced in South Africa (SA). Guidelines on surgical prioritisation during COVID-19 have been published, but are specific to high-income countries. There is a pressing need for context-specific guidelines and a validated tool for prioritising surgical cases during the COVID-19 pandemic. In March 2020, the South African National Surgical Obstetric Anaesthesia Plan Task Team was asked by the National Department of Health to establish a national framework for COVID-19 surgical prioritisation. Objectives. To develop a national framework for COVID-19 surgical prioritisation, including a set of recommendations and a risk calculator for operative care. Methods. The surgical prioritisation framework was developed in three stages: (i) a literature review of international, national and local recommendations on COVID-19 and surgical care was conducted; (ii) a set of recommendations was drawn up based on the available literature and through consensus of the COVID-19 Task Team; and (iii) a COVID-19 surgical risk calculator was developed and evaluated. Results. A total of 30 documents were identified from which recommendations around prioritisation of surgical care were used to draw up 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 high acceptability and a high level of concordance (81%) with current clinical practice. Conclusions. This national framework on COVID-19 surgical prioritisation can help hospital teams make ethical, equitable and personalised decisions whether to proceed with or delay surgical operations during this unprecedented epidemic.
  • Thumbnail Image
    Item
    Global surgery : a South African action plan
    (SAJS, 2020-11-30) Hardcastle, T. C.; Chu, K. M.
    ENGLISH ABSTRACT: Global surgery is the study, research, and practice of improving access for all people to quality and timely surgical care locally and transnationally. This relatively new academic field was kick started in 2015 with the launch of the Lancet Commission on Global Surgery1 and a World Health Assembly declaration that essential and emergency surgical care (EESC) is an essential component of universal health coverage.2 What does global surgery mean to the South African surgeon and how can it improve healthcare provision for surgical conditions within our region? Surgical care is an indispensable, cross-cutting health service that is necessary to improve health in diverse areas, such as cancer, injury, cardiovascular disease, infection, and maternal/child health. The high burden of trauma, noncommunicable diseases (including cancer), maternal and child-health challenges, and communicable diseases (HIV and TB in particular) are a quadruple threat to the health and well-being of South Africans.3 Poor access to highquality surgical, obstetric and anaesthesia care remains a major contributor to the global disease burden, accounting for large numbers of deaths worldwide.
  • Thumbnail Image
    Item
    Surgery as a component of universal healthcare : where is South Africa?
    (Health & Medical Publishing Group, 2019) Reddy, C. L.; Makasa, E. M.; Biccard, B.; Smith, M.; Steyn, E.; Fieggen, G.; Maswime, S.; Meara, J. G.; Chu, K. M.
    ENGLISH ABSTRACT: No abstract available