Changes in Surgical Practice in 85 South African Hospitals during COVID-19 hard Lockdown

Background. In preparation for the COVID19 pandemic, South Africa (SA) began a national lockdown on 27 March 2020, and many hospitals implemented measures to prepare for a potential COVID19 surge. Objectives. To report changes in SA hospital surgical practices in response to COVID19 preparedness. Methods. In this crosssectional 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 decisionmaking, operating theatres, surgical services and surgical trainees, and the potential longterm 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 deescalate surgical care. Access was cancelled or reduced for noncancer 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 COVID19 cases, and 29 (34.1%) deployed some surgical staff (including trainees) to other hospital services such as COVID19 testing, medical/ COVID19 wards, the emergency department and the intensive care unit. Conclusions. Hospital surgical deescalation in response to COVID19 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.