The impact of COVID-19 on a South African pediatric cardiac service: implications and insights into service capacity
Background and ObjectivesThe Western Cape public pediatric cardiac service is under-resourced. COVID-19 regulations are likely to have long-term effects on patient care but may provide insight into service capacity requirements. As such, we aimed to quantify the impact of COVID-19 regulations on thi...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2023-05-01
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| Series: | Frontiers in Public Health |
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| Online Access: | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1177365/full |
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| author | Thomas Aldersley Thomas Aldersley Andre Brooks Andre Brooks Andre Brooks Paul Human Paul Human John Lawrenson John Lawrenson John Lawrenson John Lawrenson George Comitis George Comitis Rik De Decker Rik De Decker Barend Fourie Barend Fourie Barend Fourie Rodgers Manganyi Rodgers Manganyi Rodgers Manganyi Harold Pribut Harold Pribut Shamiel Salie Shamiel Salie Lenise Swanson Lenise Swanson Liesl Zühlke Liesl Zühlke Liesl Zühlke |
| author_facet | Thomas Aldersley Thomas Aldersley Andre Brooks Andre Brooks Andre Brooks Paul Human Paul Human John Lawrenson John Lawrenson John Lawrenson John Lawrenson George Comitis George Comitis Rik De Decker Rik De Decker Barend Fourie Barend Fourie Barend Fourie Rodgers Manganyi Rodgers Manganyi Rodgers Manganyi Harold Pribut Harold Pribut Shamiel Salie Shamiel Salie Lenise Swanson Lenise Swanson Liesl Zühlke Liesl Zühlke Liesl Zühlke |
| author_sort | Thomas Aldersley |
| collection | DOAJ |
| description | Background and ObjectivesThe Western Cape public pediatric cardiac service is under-resourced. COVID-19 regulations are likely to have long-term effects on patient care but may provide insight into service capacity requirements. As such, we aimed to quantify the impact of COVID-19 regulations on this service.MethodsAn uncontrolled retrospective pre-post study of all presenting patients over two, one-year periods; the pre-COVID-19 period (01/03/2019–29/02/2020) and the peri-COVID-19 period (01/03/2020–28/02/2021).ResultsAdmissions decreased by 39% (624 to 378) and cardiac surgeries decreased by 29% (293 to 208) in the peri-COVID-19 period, with an increase in urgent cases (PR:5.99, 95%CI:3.58–10.02, p < 0.001). Age at surgery was lower in the peri-COVID-19 period, 7.2 (2.4–20.4) vs. 10.8 (4.8–49.2) months (p < 0.05), likewise, age at surgery for transposition of the great arteries (TGA) was lower peri-COVID-19, 15 (IQR:11.2–25.5) vs. 46 (IQR:11–62.5) days (p < 0.05). Length of stay 6 (IQR:2–14) vs. 3 days (IQR:1–9) (p < 0.001), complications (PR:1.21, 95%CI:1.01–1.43, p < 0.05), and age-adjusted delayed-sternal-closure rates (PR:3.20, 95%CI:1.09–9.33, p < 0.05) increased peri-COVID-19.ConclusionCardiac procedures were significantly reduced in the peri-COVID-19 period which will have implications on an overburdened service and ultimately, patient outcomes. COVID-19 restrictions on elective procedures freed capacity for urgent cases, demonstrated by the absolute increase in urgent cases and significant decrease in age at TGA-surgery. This facilitated intervention at the point of physiological need, albeit at the expense of elective procedures, and also revealed insights into capacity requirements of the Western Cape. These data emphasize the need for an informed strategy to increase capacity and reduce backlog whilst ensuring minimal morbidity and mortality.Graphical Abstract |
| first_indexed | 2024-04-09T13:30:06Z |
| format | Article |
| id | doaj.art-e31c5166a0d3432bb06b464911fa3b8f |
| institution | Directory Open Access Journal |
| issn | 2296-2565 |
| language | English |
| last_indexed | 2024-04-09T13:30:06Z |
| publishDate | 2023-05-01 |
| publisher | Frontiers Media S.A. |
| record_format | Article |
| series | Frontiers in Public Health |
| spelling | doaj.art-e31c5166a0d3432bb06b464911fa3b8f2023-05-10T04:27:05ZengFrontiers Media S.A.Frontiers in Public Health2296-25652023-05-011110.3389/fpubh.2023.11773651177365The impact of COVID-19 on a South African pediatric cardiac service: implications and insights into service capacityThomas Aldersley0Thomas Aldersley1Andre Brooks2Andre Brooks3Andre Brooks4Paul Human5Paul Human6John Lawrenson7John Lawrenson8John Lawrenson9John Lawrenson10George Comitis11George Comitis12Rik De Decker13Rik De Decker14Barend Fourie15Barend Fourie16Barend Fourie17Rodgers Manganyi18Rodgers Manganyi19Rodgers Manganyi20Harold Pribut21Harold Pribut22Shamiel Salie23Shamiel Salie24Lenise Swanson25Lenise Swanson26Liesl Zühlke27Liesl Zühlke28Liesl Zühlke29Department of Pediatrics and Child Health, Pediatric Cardiology, University of Cape Town, Cape Town, South AfricaRed Cross War Memorial Children’s Hospital, Cape Town, South AfricaRed Cross War Memorial Children’s Hospital, Cape Town, South AfricaChris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South AfricaGroote Schuur Hospital, Cape Town, South AfricaChris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South AfricaGroote Schuur Hospital, Cape Town, South AfricaDepartment of Pediatrics and Child Health, Pediatric Cardiology, University of Cape Town, Cape Town, South AfricaRed Cross War Memorial Children’s Hospital, Cape Town, South AfricaDivision of Pediatric Cardiology, Department of Pediatrics and Child Health, University of Stellenbosch, Cape Town, South AfricaTygerberg Hospital, Cape Town, South AfricaDepartment of Pediatrics and Child Health, Pediatric Cardiology, University of Cape Town, Cape Town, South AfricaRed Cross War Memorial Children’s Hospital, Cape Town, South AfricaDepartment of Pediatrics and Child Health, Pediatric Cardiology, University of Cape Town, Cape Town, South AfricaRed Cross War Memorial Children’s Hospital, Cape Town, South AfricaRed Cross War Memorial Children’s Hospital, Cape Town, South AfricaDivision of Pediatric Cardiology, Department of Pediatrics and Child Health, University of Stellenbosch, Cape Town, South AfricaTygerberg Hospital, Cape Town, South AfricaRed Cross War Memorial Children’s Hospital, Cape Town, South AfricaChris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South AfricaGroote Schuur Hospital, Cape Town, South AfricaDepartment of Pediatrics and Child Health, Pediatric Cardiology, University of Cape Town, Cape Town, South AfricaRed Cross War Memorial Children’s Hospital, Cape Town, South AfricaRed Cross War Memorial Children’s Hospital, Cape Town, South AfricaDepartment of Pediatrics and Child Health, Pediatric Intensive and Critical Care Unit, University of Cape Town, Cape Town, South AfricaDepartment of Pediatrics and Child Health, Pediatric Cardiology, University of Cape Town, Cape Town, South AfricaRed Cross War Memorial Children’s Hospital, Cape Town, South AfricaDepartment of Pediatrics and Child Health, Pediatric Cardiology, University of Cape Town, Cape Town, South AfricaRed Cross War Memorial Children’s Hospital, Cape Town, South AfricaSouth African Medical Research Council, Cape Town, South AfricaBackground and ObjectivesThe Western Cape public pediatric cardiac service is under-resourced. COVID-19 regulations are likely to have long-term effects on patient care but may provide insight into service capacity requirements. As such, we aimed to quantify the impact of COVID-19 regulations on this service.MethodsAn uncontrolled retrospective pre-post study of all presenting patients over two, one-year periods; the pre-COVID-19 period (01/03/2019–29/02/2020) and the peri-COVID-19 period (01/03/2020–28/02/2021).ResultsAdmissions decreased by 39% (624 to 378) and cardiac surgeries decreased by 29% (293 to 208) in the peri-COVID-19 period, with an increase in urgent cases (PR:5.99, 95%CI:3.58–10.02, p < 0.001). Age at surgery was lower in the peri-COVID-19 period, 7.2 (2.4–20.4) vs. 10.8 (4.8–49.2) months (p < 0.05), likewise, age at surgery for transposition of the great arteries (TGA) was lower peri-COVID-19, 15 (IQR:11.2–25.5) vs. 46 (IQR:11–62.5) days (p < 0.05). Length of stay 6 (IQR:2–14) vs. 3 days (IQR:1–9) (p < 0.001), complications (PR:1.21, 95%CI:1.01–1.43, p < 0.05), and age-adjusted delayed-sternal-closure rates (PR:3.20, 95%CI:1.09–9.33, p < 0.05) increased peri-COVID-19.ConclusionCardiac procedures were significantly reduced in the peri-COVID-19 period which will have implications on an overburdened service and ultimately, patient outcomes. COVID-19 restrictions on elective procedures freed capacity for urgent cases, demonstrated by the absolute increase in urgent cases and significant decrease in age at TGA-surgery. This facilitated intervention at the point of physiological need, albeit at the expense of elective procedures, and also revealed insights into capacity requirements of the Western Cape. These data emphasize the need for an informed strategy to increase capacity and reduce backlog whilst ensuring minimal morbidity and mortality.Graphical Abstracthttps://www.frontiersin.org/articles/10.3389/fpubh.2023.1177365/fullCOVID-19pediatric cardiologycardiothoracic surgerycardiac surgerycongenital heart diseaseservice capacity |
| spellingShingle | Thomas Aldersley Thomas Aldersley Andre Brooks Andre Brooks Andre Brooks Paul Human Paul Human John Lawrenson John Lawrenson John Lawrenson John Lawrenson George Comitis George Comitis Rik De Decker Rik De Decker Barend Fourie Barend Fourie Barend Fourie Rodgers Manganyi Rodgers Manganyi Rodgers Manganyi Harold Pribut Harold Pribut Shamiel Salie Shamiel Salie Lenise Swanson Lenise Swanson Liesl Zühlke Liesl Zühlke Liesl Zühlke The impact of COVID-19 on a South African pediatric cardiac service: implications and insights into service capacity Frontiers in Public Health COVID-19 pediatric cardiology cardiothoracic surgery cardiac surgery congenital heart disease service capacity |
| title | The impact of COVID-19 on a South African pediatric cardiac service: implications and insights into service capacity |
| title_full | The impact of COVID-19 on a South African pediatric cardiac service: implications and insights into service capacity |
| title_fullStr | The impact of COVID-19 on a South African pediatric cardiac service: implications and insights into service capacity |
| title_full_unstemmed | The impact of COVID-19 on a South African pediatric cardiac service: implications and insights into service capacity |
| title_short | The impact of COVID-19 on a South African pediatric cardiac service: implications and insights into service capacity |
| title_sort | impact of covid 19 on a south african pediatric cardiac service implications and insights into service capacity |
| topic | COVID-19 pediatric cardiology cardiothoracic surgery cardiac surgery congenital heart disease service capacity |
| url | https://www.frontiersin.org/articles/10.3389/fpubh.2023.1177365/full |
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