The impact of COVID-19 on a South African pediatric cardiac service: implications and insights into service capacity

Thomas Aldersley; Andre Brooks; Paul Human; John Lawrenson; George Comitis; Rik De Decker; Barend Fourie; Rodgers Manganyi; Harold Pribut; Shamiel Salie; Lenise Swanson; Liesl Zühlke

doi:10.3389/fpubh.2023.1177365

The impact of COVID-19 on a South African pediatric cardiac service: implications and insights into service capacity

Front Public Health. 2023 May 10:11:1177365. doi: 10.3389/fpubh.2023.1177365. eCollection 2023.

Authors

Thomas Aldersley^{1

2}, Andre Brooks^{2

3

4}, Paul Human^{3

4}, John Lawrenson^{1

2

5

6}, George Comitis^{1

2}, Rik De Decker^{1

2}, Barend Fourie^{2

5

6}, Rodgers Manganyi^{2

3

4}, Harold Pribut^{1

2}, Shamiel Salie^{2

7}, Lenise Swanson^{1

2}, Liesl Zühlke^{1

2

8}

Affiliations

¹ Department of Pediatrics and Child Health, Pediatric Cardiology, University of Cape Town, Cape Town, South Africa.
² Red Cross War Memorial Children's Hospital, Cape Town, South Africa.
³ Chris Barnard Division of Cardiothoracic Surgery, University of Cape Town, Cape Town, South Africa.
⁴ Groote Schuur Hospital, Cape Town, South Africa.
⁵ Division of Pediatric Cardiology, Department of Pediatrics and Child Health, University of Stellenbosch, Cape Town, South Africa.
⁶ Tygerberg Hospital, Cape Town, South Africa.
⁷ Department of Pediatrics and Child Health, Pediatric Intensive and Critical Care Unit, University of Cape Town, Cape Town, South Africa.
⁸ South African Medical Research Council, Cape Town, South Africa.

Abstract

Background and objectives: The 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.

Methods: An 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).

Results: Admissions 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.

Conclusion: Cardiac 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.

Keywords: COVID-19; cardiac surgery; cardiothoracic surgery; congenital heart disease; pediatric cardiology; service capacity.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

COVID-19* / epidemiology
Child
Hospitalization
Humans
Retrospective Studies
South Africa / epidemiology
Transposition of Great Vessels*

Grants and funding

MR/S005242/1/MRC_/Medical Research Council/United Kingdom