Centre for Global Surgery, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
S Afr Med J. 2021 Mar 23;111(5):426-431. doi: 10.7196/SAMJ.2021.v111i5.15603.
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.
To develop a national framework for COVID-19 surgical prioritisation, including a set of recommendations and a risk calculatorfor operative care.
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.
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.
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.
自 COVID-19 大流行开始以来，南非（SA）的外科手术大幅减少。已经发布了关于 COVID-19 期间手术优先级的指南，但这些指南仅适用于高收入国家。迫切需要针对具体情况的指南和经过验证的工具，以在 COVID-19 大流行期间对手术病例进行优先级排序。2020 年 3 月，国家卫生部门要求南非国家外科产科麻醉计划工作组成立一个 COVID-19 手术优先级排序的国家框架。
制定 COVID-19 手术优先级排序的国家框架，包括一套建议和一个用于手术护理的风险计算器。
该手术优先级排序框架分三个阶段开发：（i）对 COVID-19 和手术护理的国际、国家和当地建议进行文献回顾；（ii）根据现有文献和 COVID-19 工作组的共识制定一套建议；（iii）开发和评估 COVID-19 手术风险计算器。
共确定了 30 份文件，其中包括对手术护理优先级排序的建议，用于制定术前 COVID-19 筛查和检测以及使用适当的个人防护设备的六项建议。来自南非八个省份的 99 名围手术期从业者评估了 COVID-19 手术风险计算器，该计算器具有较高的可接受性和与当前临床实践的高度一致性（81%）。
该 COVID-19 手术优先级排序的国家框架可以帮助医院团队在这场前所未有的大流行期间做出符合伦理、公平和个性化的决策，决定是否继续或延迟手术。
