Estimating the surgical backlog from the COVID-19 lockdown in South Africa: A retrospective analysis of six government hospitals

Background. The COVID-19 pandemic reached South Africa (SA) in March 2020. A national lockdown began on 27 March 2020, and health facilities reduced non-essential activity, including many surgical services.Objectives. Primary objective: to estimate the COVID-19 surgical backlog in Western Cape Province, SA, by comparing 2019 and 2020 general surgery operative volume and proportion at six district and regional hospitals. Secondary objective: to compare the operative volume of appendicectomy, laparoscopic cholecystectomy, cancer and trauma between the 2 years.Methods. This was a retrospective study of general surgery operations from six SA government hospitals in the Western Cape. Data were obtained from electronic operative databases or operative theatre logbooks from 1 April to 31 July 2019 and 1 April to 31 July 2020.Results. Total general surgery operations decreased by 44% between 2019 (n=3 247) and 2020 (n=1 810) (p<0.001). Elective operations decreased by 74% (n=1 379 v. n=362; p<0.001), and one common elective procedure, laparoscopic cholecystectomy, decreased by 68% (p<0.001). Emergency operations decreased by 22% (n=1 868 v. n=1 448; p<0.001) and trauma operations by 42% (n=325 v. n=190; p<0.001). However, non-trauma emergency operations such as appendicectomy and cancer did not decrease. The surgical backlog for elective operations after 4 months from these six hospitals is 1 017 cases, which will take between 4 and 14 months to address if each hospital can do one additional operation per weekday.Conclusions. The COVID-19 pandemic has created large backlogs of elective operations that will need to be addressed urgently. Clear and structured guidelines need to be developed in order to streamline the reintroduction of full surgical healthcare services as SA slowly recovers from this unprecedented pandemic