Emergency and essential surgical healthcare services during COVID-19 in low- and middle-income countries: A perspective

Abstract

The COVID-19 pandemic resulted in significant changes in health care systems worldwide, with low-and middleincome countries (LMIC) sustaining important repercussions. Specifically, alongside cancellation and postponements of non-essential surgical services, emergency and essential surgical care delivery may become affected due to the shift of human and material resources towards fighting the pandemic. For surgeries that do get carried through, new difficulties arise in protecting surgical personnel from contracting SARS-CoV-2. This scarcity in LMIC surgical ecosystems may result in higher morbidity and mortality, in addition to the COVID-19 toll. This paper aims to explore the potential consequences of COVID-19 on the emergency and essential surgical care in LMICs, to offer recommendations to mitigate damages and to reflect on preparedness for future crises. Reducing the devastating consequences of the COVID-19 pandemic on LMIC emergency and essential surgical services can be achieved through empowering communities with accurate information and knowledge on prevention, optimizing surgical material resources, providing quality training of health care personnel to treat SARS-CoV-2, and ensuring adequate personal protection equipment for workers on the frontline. While LMIC health systems are under larger strain, the experience from previous outbreaks may aid in order to innovate and adapt to the current pandemic. Protecting LMIC surgical ecosystems will be a pivotal process in ensuring that previous health system strengthening efforts are preserved, comprehensive care for populations worldwide are ensured, and to allow for future developments beyond the pandemic.

Postoperative mortality among surgical patients with COVID-19: A systematic review and meta-analysis

“…Surgery during the COVID-19 outbreak is challenging to the patient, health care workers, and non-COVID-19 patients [34,35,38,[44][45][46][47] particularly for low and middle-income countries where the limping health care systems were broken with low testing capacity, sub-optimal postoperative care, lack of anesthesia machine lters and limited personal protective equipment [48][49][50][51].…”

Understanding the Effect of COVID-19 Pandemic on Emergency Surgical Care Delivery in India: A Multicenter Cross-Sectional Study

“…None of the studies have documented the effect on emergency surgeries other than those for sub specialties. [1,6,10,12] Similar 70% drop in surgical admissions and 50% drop in major surgeries was documented in the Ebola pandemic from Sierra Leone. [15] We found a 54% reduction in emergency surgeries and a 91% reduction in the elective surgeries.…”

“…In reality, the pandemic and reduction in services affected not just the elective but many emergency surgeries as well. [1][2][3][4] Some of these emergency surgeries are categorized as 'essential surgeries' by the World Bank in 'Disease Control Priorities-3'(DCP3), indicating these need to be performed to avert l.5 million deaths, globally per year. [5] Among these emergency surgeries, caesarean births, exploratory laparotomy and fracture xation surgeries are considered bellwether procedures which indicate the capacity of healthcare system to perform essential and emergency surgeries.…”

Understanding the Effect of COVID-19 Pandemic on Emergency Surgical Care Delivery in India: A Multicenter Cross-Sectional Study

“…In reality, the pandemic and reduction in services affected not just the elective but many emergency surgeries as well. [1][2][3][4] Some of these emergency surgeries are categorized as 'essential surgeries' by the World Bank in 'Disease Control Priorities-3'(DCP3), indicating these need to be performed to avert l.5 million deaths, globally per year. [5] Among these emergency surgeries, caesarean births, exploratory laparotomy and fracture fixation surgeries are considered bellwether procedures which indicate the capacity of healthcare system to perform essential and emergency surgeries.…”