Division of General Surgery, Groote Schuur Hospital, University of Cape Town, South Africa.
S Afr J Surg. 2022 Sep;60(3):154-159. doi: 10.17159/2078-5151/SAJS3783.
The COVID-19 pandemic has resulted in a massive backlog of elective cases. Delays in the provision of "elective" surgical care have dire consequences for the patient: progression of disease and comorbidities, higher complication rates, and lower overall survival. Delays in elective surgery also have significant consequences for the health system: added emotional strain on healthcare workers, a reduction in training opportunities, increased costs, and increased inequality in health-service provision. As the virus is likely to become endemic, the recovery of surgical services from the initial shock of the first three waves needs to be carefully planned, in order to mitigate the further loss of elective surgical services. This article presents a narrative review of the latest international guidelines and recommendations pertaining to surgical recovery strategies in the COVID-19 pandemic. To begin with, any recovery plan should be led by a local governance committee, who need to design and implement a number of strategies across the three phases of recovery. The preparation phase includes deciding on a system of case prioritisation, assessing and organising resources, and planning innovative ways to reorganise the service itself. The perioperative phase involves putting measures in place to reduce the risk of COVID-19 transmission. The post discharge phase includes the implementation of telemedicine for follow-up, as well as methods of service audit to enable continuous adjustment and improvement. Surgical service recovery presents many challenges; however, these also present a unique opportunity to reassess and improve the efficiency of surgical care delivery.
COVID-19 大流行导致大量择期手术积压。延迟提供“择期”手术护理会给患者带来严重后果：疾病和合并症的进展、更高的并发症发生率以及整体生存率降低。择期手术的延迟也会对医疗系统产生重大影响：增加医护人员的情绪压力、减少培训机会、增加成本以及提供医疗服务的不平等加剧。由于该病毒可能成为地方病，因此需要仔细规划从最初的前三波冲击中恢复手术服务，以减轻进一步损失择期手术服务的情况。本文对与 COVID-19 大流行期间手术恢复策略相关的最新国际指南和建议进行了叙述性综述。首先，任何恢复计划都应由当地治理委员会领导，该委员会需要在恢复的三个阶段设计和实施多项策略。准备阶段包括确定病例优先排序系统，评估和组织资源，并规划创新的服务重组方式。围手术期阶段涉及实施降低 COVID-19 传播风险的措施。出院后阶段包括实施远程医疗进行随访，以及服务审核方法，以实现持续调整和改进。手术服务恢复带来了许多挑战；然而，这也为重新评估和提高手术护理提供了独特的机会。
