Changes in surgical practice in 85 South African hospitals during COVID-19 hard lockdown

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

How long are Elderly Patients Followed up with Mammography after the Diagnosis of Breast Cancer? A Single-Centre Experience in a Developing Country

BACKGROUND:The effect of breast cancer on elderly South African (SA) patients is not well characterised. The lack of data with regard to disease burden; post-treatment surveillance and breast cancer relapse poses a challenge to providing optimum follow-up care to this group of patients. OBJECTIVES:To assess the effect of breast cancer and adherence to post-treatment surveillance programmes among the local elderly population attending the breast oncology clinics at Addington and Inkosi Albert Luthuli Central hospitals in Durban; KwaZulu-Natal; SA.METHODS: A retrospective review was undertaken of all patients aged =65 years diagnosed with breast cancer during 2007. Hospital records were reviewed for a period of 5 years to ascertain the stage of the disease; treatment received; adherence to post-treatment surveillance mammograms; incidence of new mammographic findings and recurrence; site of recurrence; mode of detection of recurrence; disease-free survival; and overall survival rates at 5 years.RESULTS:In our study; the incidence of breast cancer in the elderly population was 26.7%. A significant percentage of patients (56.3%) were diagnosed at an advanced stage of disease. Of the 46.9% who had received surveillance mammography; only 6.3% received their post-treatment surveillance mammograms on time; in accordance with international recommendations. New mammographic findings were detected in 26.7% of patients during the 5-year follow-up. During the follow-up period; 15.6% of the total number of study patients presented with disease recurrence. Eighty percent of cases of recurrence were detected clinically. The overall survival at 5 years was 65.6%. CONCLUSION:Our study highlights the significant number of elderly patients with advanced disease at diagnosis; poor compliance with internationally recommended annual post-treatment surveillance mammograms; and the relatively low overall 5-year survival rate compared with that of international studies