The Burden of Disease and Pathology at a Rapidly Expanding Tertiary Paediatric Surgical Unit in South Africa.
Journal
World journal of surgery
ISSN: 1432-2323
Titre abrégé: World J Surg
Pays: United States
ID NLM: 7704052
Informations de publication
Date de publication:
08 2021
08 2021
Historique:
accepted:
10
04
2021
pubmed:
6
5
2021
medline:
17
8
2021
entrez:
5
5
2021
Statut:
ppublish
Résumé
The precise burden of paediatric surgical care in South Africa is unknown. In the absence of epidemiological data, hospital-based study is a first step to gauge the burden and profile of paediatric surgical disease. We aim to describe the profile of pathology, pattern of referrals, and complications of paediatric surgical care at Chris Hani Baragwanath Academic Hospital (CHBAH). A 1-year retrospective record review for the period 3/1/2019 to 1/1/2020 was conducted by evaluation of the morbidity and mortality databases of the Department of Paediatric Surgery (DPS). Number of admissions, consultations, complications, and surgeries performed were analysed and classified. A total of 11,932 unique patient encounters occurred. Emergencies (79%, 1841/2329) accounted for the majority of admissions. Trauma accounted for 49% (896/1841) of emergency admissions. Elective surgery constituted 52% (1202/2316) and emergency surgery 48% (1114/2316) of all procedures performed. The emergency department (55%, 1271/2329), outpatients department (19%, 447/2329), and peripheral hospitals (16%, 378/2329) were the source of the majority of admissions. A complication rate of 9% (208/2316) was observed. The high-volume subspecialist environment at CHBAH presents the ideal environment for delivery of specialist paediatric surgical services and training. Injury prevention, optimal use of existing resources, and additional physical, human and financial resources are required to meet the existing and predicted future burden of paediatric surgical disease.
Sections du résumé
BACKGROUND
The precise burden of paediatric surgical care in South Africa is unknown. In the absence of epidemiological data, hospital-based study is a first step to gauge the burden and profile of paediatric surgical disease. We aim to describe the profile of pathology, pattern of referrals, and complications of paediatric surgical care at Chris Hani Baragwanath Academic Hospital (CHBAH).
METHODS
A 1-year retrospective record review for the period 3/1/2019 to 1/1/2020 was conducted by evaluation of the morbidity and mortality databases of the Department of Paediatric Surgery (DPS). Number of admissions, consultations, complications, and surgeries performed were analysed and classified.
RESULTS
A total of 11,932 unique patient encounters occurred. Emergencies (79%, 1841/2329) accounted for the majority of admissions. Trauma accounted for 49% (896/1841) of emergency admissions. Elective surgery constituted 52% (1202/2316) and emergency surgery 48% (1114/2316) of all procedures performed. The emergency department (55%, 1271/2329), outpatients department (19%, 447/2329), and peripheral hospitals (16%, 378/2329) were the source of the majority of admissions. A complication rate of 9% (208/2316) was observed.
CONCLUSION
The high-volume subspecialist environment at CHBAH presents the ideal environment for delivery of specialist paediatric surgical services and training. Injury prevention, optimal use of existing resources, and additional physical, human and financial resources are required to meet the existing and predicted future burden of paediatric surgical disease.
Identifiants
pubmed: 33950352
doi: 10.1007/s00268-021-06144-x
pii: 10.1007/s00268-021-06144-x
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2378-2385Références
Meara JG, Leather AJM, Hagander L et al (2015) Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet 386(9993):569–624. https://doi.org/10.1016/S0140-6736(15)60160-X
doi: 10.1016/S0140-6736(15)60160-X
Mars. Paediatric surgery education in sub-Saharan Africa. In: Pediatric Surgery: A Comprehensive Text for Africa. Seattle: Global Help; 2010:783–786.
Dell A, Numanoglu A, Arnold M, Rode H (2018) Pediatric surgeon density in South Africa. J Pediatr Surg 53(10):2065–2071. https://doi.org/10.1016/j.jpedsurg.2017.11.067
doi: 10.1016/j.jpedsurg.2017.11.067
pubmed: 29366506
Beasley SW (2013) The challenges facing training in pediatric surgery worldwide. Front Pediatr. https://doi.org/10.3389/fped.2013.00024
doi: 10.3389/fped.2013.00024
pubmed: 24400270
pmcid: 3864197
Thanni LOA, Shonubi AMO, Akiode O (2005) A retrospective audit of paediatric surgical admission in a sub-urban tertiary hospital. West Afr J Med 24(1):10–12. https://doi.org/10.4314/wajm.v24i1.28154
doi: 10.4314/wajm.v24i1.28154
pubmed: 15909702
https://www.chrishanibaragwanathhospital.co.za . Accessed 18/01/2021.
Clavien PA, Barkun J, de Oliveira ML et al (2009) The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg 250(2):187–196. https://doi.org/10.1097/SLA.0b013e3181b13ca2
doi: 10.1097/SLA.0b013e3181b13ca2
pubmed: 19638912
pmcid: 19638912
Herbert HK, van As AB, Bachani AM et al (2012) Patterns of pediatric injury in South Africa: an analysis of hospital data between 1997 and 2006. J Trauma Acute Care Surg 73(1):168–174. https://doi.org/10.1097/TA.0b013e31824d67c3
doi: 10.1097/TA.0b013e31824d67c3
pubmed: 22710788
Norman R, Matzopoulos R, Groenewald P, Bradshaw D (2007) The high burden of injuries in South Africa. Bull World Health Organ 85(9):695–702. https://doi.org/10.2471/blt.06.037184
doi: 10.2471/blt.06.037184
pubmed: 18026626
pmcid: 2636399
Patel N, Khofi-Phiri I, Mathiva LR, Grieve A, Loveland J, Nethathe GD (2017) Trauma related admissions to the PICU at Chris Hani Baragwanath Academic Hospital Johannesburg. Pediatr Surg Int 33(9):1013–1018. https://doi.org/10.1007/s00383-017-4125-0
doi: 10.1007/s00383-017-4125-0
pubmed: 28668993
McKiernan PJ, Baker AJ, Kelly DA (2000) The frequency and outcome of biliary atresia in the UK and Ireland. The Lancet 355(9197):25–29. https://doi.org/10.1016/S0140-6736(99)03492-3
doi: 10.1016/S0140-6736(99)03492-3
McKiernan P, Baker AJ, Lloyd C, Mieli-Vergani G, Kelly DA (2009) British paediatric surveillance unit study of biliary atresia: outcome at 13 years. J Pediatr Gastroenterol Nutr 48(1):78–81. https://doi.org/10.1097/MPG.0b013e31817d80de
doi: 10.1097/MPG.0b013e31817d80de
pubmed: 19172128
Langer JC, To T (2004) Does pediatric surgical specialty training affect outcome after ramstedt pyloromyotomy? A Popul-Based Study Pediatrics 113(5):1342–1347. https://doi.org/10.1542/peds.113.5.1342
doi: 10.1542/peds.113.5.1342
pubmed: 15121951
Kim Y, Jung K, Ryu Y-J, Moon S-B (2016) Pediatric appendectomy: the outcome differences between pediatric surgeons and general surgeons. Surg Today 46(10):1181–1186. https://doi.org/10.1007/s00595-016-1343-3
doi: 10.1007/s00595-016-1343-3
pubmed: 27142973
Boo YJ, Lee EH, Lee JS (2017) Comparison of surgical outcomes among infants in neonatal intensive care units treated by pediatric surgeons versus general surgeons: the need for pediatric surgery specialists. J Pediatr Surg 52(11):1715–1717. https://doi.org/10.1016/j.jpedsurg.2017.01.055
doi: 10.1016/j.jpedsurg.2017.01.055
pubmed: 28189454
Rice-Townsend S, Hall M, Jenkins KJ, Roberson DW, Rangel SJ (2010) Analysis of adverse events in pediatric surgery using criteria validated from the adult population: justifying the need for pediatric-focused outcome measures. J Pediatr Surg 45(6):1126–1136. https://doi.org/10.1016/j.jpedsurg.2010.02.075
doi: 10.1016/j.jpedsurg.2010.02.075
pubmed: 20620307
Sethi MVA, Zimmer J, Ure B, Lacher M (2016) Prospective assessment of complications on a daily basis is essential to determine morbidity and mortality in routine pediatric surgery. J Pediatr Surg 51(4):630–633. https://doi.org/10.1016/j.jpedsurg.2015.10.052
doi: 10.1016/j.jpedsurg.2015.10.052
pubmed: 26628204
Mattioli G, Avanzini S, Pini-Prato A et al (2009) Risk management in pediatric surgery. Pediatr Surg Int 25(8):683–690. https://doi.org/10.1007/s00383-009-2407-x
doi: 10.1007/s00383-009-2407-x
pubmed: 19562352
Thompson H, Jones C, Pardy C et al (2020) Application of the Clavien-Dindo classification to a pediatric surgical network. J Pediatr Surg 55(2):312–315. https://doi.org/10.1016/j.jpedsurg.2019.10.032
doi: 10.1016/j.jpedsurg.2019.10.032
pubmed: 31727385
Cimiotti JP, Aiken LH, Sloane DM, Wu ES (2012) Nurse staffing, burnout, and health care-associated infection. Am J Infect Control 40(6):486–490. https://doi.org/10.1016/j.ajic.2012.02.029
doi: 10.1016/j.ajic.2012.02.029
pubmed: 22854376
pmcid: 3509207
Pappas S, Davidson N, Woodard J, Davis J, Welton JM (2015) Risk-adjusted staffing to improve patient value. Nurs Econ 33(2):73–78
pubmed: 26281277
Rolle U (2017) Centralization of pediatric surgery: european perspective. Eur J Pediatr Surg Off J Austrian Assoc Pediatr Surg Al Z Kinderchir 27(5):387. https://doi.org/10.1055/s-0037-1606837
doi: 10.1055/s-0037-1606837
Schmedding A, Rolle U (2017) Decentralized rather than centralized pediatric surgery care in Germany. Eur J Pediatr Surg Off J Austrian Assoc Pediatr Surg Al Z Kinderchir 27(5):399–406. https://doi.org/10.1055/s-0037-1607026
doi: 10.1055/s-0037-1607026