Dr Anton Van Heerden says blanket restrictions on elective surgery are having a devastating impact on public health.
The pandemic and our response to it has impacted all facets of life. In particular, sweeping bans on elective surgery have had a devastating impact on community health, as has cataract surgery. As we know, it is a fast and very effective way to reverse blindness.
The most recent ban on elective surgery was called due to a rapidly escalating COVID crisis in Victoria. The objective was to avoid hospitalizations, ICU (day surgery) admissions and to redeploy day surgery staff to specific COVID facilities. A “Code Brown” was called by the Victorian government in anticipation of this crisis.
Fortunately, the expected number of hospitalizations never materialized. Meanwhile, public and private surgery facilities have remained idle, staff idle, and the degree of public health pathology has rapidly increased due to the cumulative number of elective surgery bans over the past two years.
Cataract surgery is performed as day surgery in most cases. It is extremely rare for patients to need an overnight stay in hospital, and patients almost never need to be admitted to intensive care. Staff trained in ophthalmology have specific eye care skills and should be retrained for use in COVID facilities and would therefore likely be the last medical staff called in to fill a gap in COVID response facilities. Closing all cataract surgery structures therefore does nothing to the COVID response.
The unnecessary and arbitrary nature of the ban – and the government’s ignorance – was evidenced by the knee-jerk reaction to restart IVF surgery in response to an emotional social media post and media pressure. That doesn’t take away from the plight of patients undergoing fertility treatments, but why should a procedure with a relatively low success rate be given preference over patients with crippling arthritis, prostate cancer, or visual impairment? ?
The latest available national data shows that wait times for ophthalmic procedures increased by 6.5 weeks in 2020-2021 from pre-pandemic levels and more than doubled to 172 days for eye surgery. cataract. It will probably be much worse now with the last shutdown, not included in the reference period.
But the backlog of patients requiring cataract surgery since the start of the pandemic will be impossible to know. Public hospital waiting lists are not an indication of the real problem as these lists only reflect the number of patients who have had an appointment at the public hospital and are waiting for surgery. Outpatient clinics have also been mostly suspended during this time, so the true backlog of patients in the community requiring surgery will be significantly underestimated.
The number of patients with advanced disease and blinding cataracts will also be unknown. A small sample of patients I saw in a recent public hospital clinic had blinding cataracts. These patients had their clinical appointments delayed and rescheduled repeatedly.
They were desperate for cataract surgery, however, they were considered Category 2A and therefore unable to have surgery during the indefinite restriction period. Closing the private system was even more absurd. These facilities depend on income from surgeries. And since staff were generally not assigned to the COVID-19 response, they had little to do as their facilities were idle.
Did the Victorian government’s reliance on private hospitals to manage their load of COVID patients influence its decision-making? One can only suspect that private hospitals lobbied the government to ban competing day surgery facilities from operating while their facilities were filled with COVID patients.
Future waves of COVID are coming. There will be new variants and surges in hospitalizations. The government knows this and should plan accordingly. Recently built quarantine facilities that are no longer part of the COVID response are just a small example of government-run facilities that could be used to manage future COVID patients rather than relying on private hospitals to support the charged.
Blanket restrictions on elective surgery are unnecessary, have a devastating impact on public health, and should not be an excuse for poor government public health planning.
ABOUT THE AUTHOR :
Name: Dr. Anton van Heerden
Qualifications: MBChB (Stell); FRANZCO; FCOphth(SA); MRCO Phth (London)
Company: Royal Victorian Eye and Ear Hospital (RVEEH), Armadale Eye Clinic and Mornington Peninsula Eye Clinic
Position: Head of surgical ophthalmology department (RVEEH) and director of private clinic
Location: Melbourne
Years of profession: 14
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