SURGICAL BURDEN OF DISEASE AT A REGIONAL HOSPITAL IN SOUTH AFRICA

• Published in: South African journal of surgery Vol. 55; no. 3; p. 68
• Main Authors: Swart, O, Pape, J, Duvenage, R
• Format: Journal Article
• Language: English
• Published: South Africa 01.09.2017
• ISSN: 0038-2361

There is limited published data describing the nature of surgical admissions at a regional level in the South African context. Worcester Hospital General Surgery has introduced an electronic online database to manage its surgical services. This study uses that database to evaluate the surgical burden of disease for the Cape Winelands East and Overberg districts of the Western Cape. Admissions data were prospectively captured from February 2012 to January 2016, then retrospectively reviewed and classified into 5 types: (1) elective surgery/investigations (ESI); (2) trauma; (3) burns; (4) non-traumatic surgical emergencies (NTSE); (5) unplanned readmission within 30 days. All data were entered by attending doctors. (Stellenbosch University HREC # N16/04/054). 9 799 discharge summaries were included for analysis. Mean age of was 43,4 years (95% CI 43,0-43,8 years) and mean length of stay was 4,9 days (95% CI 4,7-5,1 days). 57,6% (5 647) patients were male. NTSE (47,6%), ESI (38,6%) and trauma (11,9%) form the majority of admissions. Common NTSE diagnoses were appendicitis (23,8% of NTSE admissions), peripheral vascular disease (16,8%) and peptic ulcer disease (13,3%). Common ESI diagnoses were gallstone disease (23,1% of ESI diagnoses), inguinal hernia (21,8%), anal disease (10,2%), midline primary hernia (9,1%) and incisional hernia (8,6%). Most prevalent cancer diagnoses were colorectal (17,6% of cancer diagnoses), oesophagus (16,4%), breast (14,0%) and stomach (13,2%). Overall in hospital mortality rate was 2.2% - highest by subtype was burns patients (6,3%). Trend analysis show a statistically significant increase in admission for NTSE (p=0.019) and 30 day readmission rates (p < 0.001) with a decrease in admissions for ESI (p=0.001) over the four year period. A precise understanding of burden of disease profile is essential for national, provincial and district resource allocation. Ongoing surveillance such as is performed in this study provides this critical information.