Surgery of COVID-19-infected Patients in Africa: A Scoping Review

Franck Katembo Sikakulya1,2, Robinson Ssebuufu1, Jorge Soria1, Sonye Magugu Kiyaka1, Selamo Fabrice Molen1, and Patrick Kyamanywa1

1. Faculty of Medicine and Dentistry, Department of General Surgery, Kampala International University Western Campus, Bushenyi, Uganda

2. Faculty of Medicine, Université Catholique du Graben, Butembo, Democratic Republic of the Congo

Correspondence to: Dr. Franck Katembo Sikakulya; Email: frank.katembo@studwc.kiu.ac.ug  

 Received: 17 Mar 2021; Revised: 16 Jul 2021; Accepted: 26 Jul 2021; Available online: 4 Sep 2021

Abstract

Objective: The aim of this scoping review was to highlight the nature and scope of research and publications about surgery in COVID-19-infected patients in Africa in order to inform guidelines applicable in Africa. Methods: We considered peer-reviewed and gray literature from PubMed, Google Scholar, and Word Health Organization COVID-19 online databases published from February 1, 2020, to February 28, 2021, about surgery for/in COVID-19-infected patients. The review is reported using the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews. Results: Of 530 studies screened, only 11 (2.08%) were found eligible, including 4 cohort studies, 3 cross-sectional studies, 2 letters to the editor, 1 case series, and 1 review. The key emphasis areas by the eligible studies were vaccination, testing prior to surgery, clinical guidelines to reduce complications related to COVID-19 among infected patients, and protection of the surgical team. Conclusion: There is a dearth of studies on surgery in COVID-19-infected patients in Africa. There is an urgent need for more reports and publications from the African experiences so as to inform contextualized guidelines for surgical care in low-resource settings during the COVID-19 pandemic.

Keywords: Surgery, COVID-19 pandemic, Infected patients, Africa


Ann Afr Surg. 2021 ; 18(4): 200-207 
DOI: http://dx.doi.org/10.4314/aas.v18i4.3 
Conflicts of Interest: None
Funding: None
© 2021 Author. This work is licensed under the Creative Commons Attribution 4.0 International License 

Introduction

More than a year since the first cases were reported in Wuhan, China, on December 31, 2019, the world continues to battle with the highly infectious coronavirus pandemic and its new variants (1). As of July 13, 2021, more than 100 million cases were confirmed worldwide (more than 4 million cases were confirmed in Africa), of which some patients have undergone surgeries while infected with COVID-19 (2).

There is an increased demand on health systems especially regarding existing resources, including staff and supplies. Pandemic preparedness has become a priority in response to the many outbreaks and epidemics reported globally, including severe acute respiratory syndrome (SARS), Middle East respiratory syndrome, H1N1 swine flu, and Ebola (3), with publication of guidelines for prevention, control, and treatment. In high-income countries (HICs), such efforts have prioritized resource procurement and allocation, including vaccine procurement policies, distribution of medicaments, and emergency health response (4).

The presence of guidelines for the management of COVID-19-infected patients in HICs (5) has positively impacted the health systems (6); however, not much has been reported about COVID-19-infected patients undergoing surgery, special management considerations made, and recommendations in low-resource settings, particularly in Africa. Furthermore, despite the repeated Ebola outbreaks in Africa, very little has been published about surgery among infected patients (7).

 

Review objective 

The purpose of this scoping review was to highlight the nature and scope of research and publications about surgery in COVID-19-infected patients in Africa in order to inform guidelines applicable in low-resource settings like sub-Saharan Africa. The guiding question was: “What are the known guidelines, special considerations, and outcomes of surgery among COVID-19-infected patients in Africa?”

 

Methodology

This scoping review was conducted and is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-analysis extension for Scoping Reviews (8). We do not have a registered protocol.

 

Eligibility criteria 

We considered all peer-reviewed articles and gray literature on surgery among COVID-19-infected patients, published in English and French and those published in other languages but with a well-structured English abstract with no restrictions on country of origin or type of population included in the study. We targeted surgical studies reported in Africa and focused on guidelines, protocols, letters to the editors, case reports, and reviews of surgery in COVID-19-infected patients, prevention of nosocomial transmission, surgical case prioritization and scheduling, perioperative care and surgical team support and training, and outcome of surgery.