The South African COVID-19 Surgical Outcomes Study - A patient-centred research project piloting digital health at team (micro) level

Based on estimates by the COVIDSurg Collaborative,[1] large numbers of elective surgical procedures are cancelled during the disruption caused by the pandemic. It would take a median of 45 weeks to address if a country increases the usual surgical volume by 20% after the pandemic. It is crucial to assess the impact of surgical procedures on outcome during the pandemic to appropriately plan the safe return to surgical activity after the epidemic.
The COVID-19 pandemic has forced healthcare providers to ‘shift from patient-centred ethics to public health ethics’.[2,3] This has had particular implications with regards to pre-operative testing for COVID-19, and scheduling of surgery. Weighing the risk of surgery and potential complications during the COVID-19 pandemic, against the benefit of undergoing a surgical procedure to improve quality of life,[4,5] remains difficult. Unfortunately, patients may delay seeking care due to fear of the implications of admission to a hospital during the pandemic.[6] A patient-centred research[7] project to determine the effect of the pandemic may provide guidance on how to safely return to surgical activity that are again more focussed on individualized care. By using a secure digital platform with a workflow tailored to the data requirements of the surgical team, clinical audit on a micro- or team level is possible. Team outcomes can also be benchmarked to national de-identified data, by team members.[8]
Virtual and online communication has become a global standard of living for people with access to the necessary technology. Patient engagement using an electronic patient-centric platform for perioperative data capture has the potential to contribute significantly to data on surgery in South Africa during the COVID-19 pandemic. Patient-reported outcomes are seen as ‘central to the management of COVID-19’.[9] There is also the opportunity to record outcomes that are currently accepted as the standard for understanding recovery after surgery, from a South African patient perspective.[10]
Study design - Prospective observational cohort study
Primary objective - To describe the relationship between patient comorbidities, surgical characteristics and postoperative morbidity/mortality in surgical patients during and after the SARS-CoV-2 pandemic in South Africa.
Secondary objectives - To determine the incidence of 30-day mortality in adult surgical patients with perioperative SARS-CoV-2 infection in South Africa.
- To describe the relationship between postoperative pulmonary complications and postoperative mortality.
- To compare quality of recovery and functional recovery after surgery in patients with and without SARS-CoV-2 infection.
Inclusion criteria - Patients 18 years and older, capable of consenting to participation, presenting for a surgical procedure with a participating clinical team during the period February 2021 to December 2021.
Follow up - In case of clinician participation in data collection, follow up will be limited to postoperative in-hospital outcomes, censored at 30 days.
Data collection from patients will be on postoperative outcomes & COVID-19 infection at 7 days and 30 days, and health-related quality of life at 6 months.

1. CovidSurg Collaborative, Nepogodiev D, Bhangu A. Elective surgery cancellations due to the COVID-19 pandemic: global predictive modelling to inform surgical recovery plans. Br J Surg. 2020. doi:10.1002/bjs.11746
2. Zakrison TL, Martin M, Seamon M, et al. COVID-19, Ethics and Equity—What Is Our Role as Surgeons? Ann Surg. 2020;Publish Ah. doi:10.1097/sla.0000000000003969
3. Angelos P. Surgeons, Ethics, and COVID-19: Early Lessons Learned. J Am Coll Surg. 2020;230(6):1119-1120. doi:10.1016/j.jamcollsurg.2020.03.028
4. Moonesinghe SR, Jackson AIR, Boney O, et al. Systematic review and consensus definitions for the Standardised Endpoints in Perioperative Medicine initiative: patient-centred outcomes. Br J Anaesth. 2019;123(5):664-670. doi:10.1016/j.bja.2019.07.020
5. Herdman M, Gudex C, Lloyd A, et al. Development and preliminary testing of the new five-level version of EQ-5D (EQ-5D-5L). Qual Life Res. 2011;20(10):1727-1736. doi:10.1007/s11136-011-9903-x
6. Wong LE, Hawkins JE, Langness S, Murrell KL, Iris P, Sammann A. Where Are All the Patients? Addressing Covid-19 Fear to Encourage Sick Patients to Seek Emergency Care. NEJM Catal. 2020;(Figure 1):1-12. doi:https://catalyst.nejm.org/doi/abs/10.1056/CAT.20.0193
7. de Wit M, Cooper C, Reginster J-Y, Working Group W. Practical guidance for patient-centred health research. Lancet. 2019;393:1095-1096. doi:10.1016/S0140­6736(19)30472­6
8. Safe Surgery South Africa NPC. The Perioperative Shared Health Record. www.safesurgerysa.co.za.
9. Aiyegbusi OL, Calvert MJ. Patient-reported outcomes: central to the management of COVID-19. Lancet (London, England). 2020;6736(20):31724. doi:10.1016/S0140-6736(20)31724-4
10. Myles PS. More than just morbidity and mortality – quality of recovery and long-term functional recovery after surgery. Anaesthesia. 2020;75(S1):e143-e150. doi:10.1111/anae.14786