The Burden of Emergency Abdominal Surgery Heavily Outweighs Elective Procedures in KwaZulu-Natal Province, South Africa.

BACKGROUND: South Africa is a middle-income country with major discrepancies in wealth and access to care. There is a significant burden of surgical disease and limited access to quality health care for a large proportion of the population. This article quantifies the burden of abdominal surgery over a 6-month period in KwaZulu-Natal (KZN) province and quantifies the emergency to elective (Ee) ratio for these operations. METHODS: This study describes the abdominal operations conducted at all regional and tertiary hospitals in the public health sector of KZN province for the period of 1 July to December 31, 2015. Operations performed were tabulated in a spreadsheet and categorized as elective, emergency, and trauma. They were further subdivided by anatomical region and by specific predetermined procedures. Uncertain criteria were clarified using a modified Delphi discussion. The Ee ratio was determined using the recently described technique. RESULTS: Between June, 1st and December 31, 2015, of 13,282 operations, there were 4580 (34.5%) elective operations, 7777 (58.6%) emergency operations, and 925 (6.9%) trauma-related operations. A total of 5630 abdominal operations were performed of which 2949 were emergency procedures. There were 660 trauma-related abdominal procedures and 2021 elective procedures. There was a heavy weighting toward emergency surgeries with an Ee ratio of 145 for abdominal surgery. The previous sub-Saharan African ratio was estimated to be 62.6. CONCLUSIONS: An overview of abdominal surgery in KZN reveals a high ratio of emergency to elective surgery. This suggests that the current primary health care program is failing to detect and treat acute surgical disease timeously.

Soft Tissue Sepsis Places a Massive Burden on Regional and Tertiary Surgical Services in KZN Province South Africa.

BACKGROUND: Frequently, surgical intervention is needed to treat soft tissue sepsis (STS). Ideally, most STS should be managed at the lowest level of surgical care close to the patient's home and a well-functioning surgical service will be able to deliver this safely and effectively. This study interrogates the burden of STS in the province of KwaZulu-Natal and reviews at which level in the health system the operative management of STS is being dealt with. METHODS: This study describes the operations for soft tissue sepsis conducted at all regional and tertiary hospitals in KwaZulu-Natal province for the period of 1 July to 31 December 2015. All procedures for soft tissue sepsis were identified for closer review. RESULTS: Between 1 June and 31 December 2015, a total 6302 soft tissue-related procedures were performed in the regional and tertiary hospitals of KZN. The breakdown by anatomical region was as follows, 618 (9.8%) head and neck surgeries, 895 (14.2%) chest and back, 277 (4.4%) abdominal wall, 818 (13%) pelvis/perineal/buttock and 3070 (48.7%) extremity-related surgeries. There were a further 815 (12.9%) soft tissue-related procedures where the anatomical region was unspecified. Of the soft tissue procedures, 3943 (62.6%) were for the management of soft tissue sepsis. The anatomical regions involved included 316 (8%) head and neck, 485 (12.3%) chest and back, 194 (4.9%) abdominal wall, 589 (14.9%) pelvic, perineal and buttock, 2054 (52.1%) extremity and 365 unspecified operations. Peri-anal sepsis contributed 315 (8%), breast sepsis contributed to 372 (9.4%) of all soft tissue sepsis and amputations of extremities 658 (16.7%) of septic soft tissue procedures. CONCLUSION: There is a significant burden of soft tissue sepsis requiring surgical treatment each month at regional and tertiary hospitals in KZN. This is made up of breast sepsis, peri-anal sepsis and diabetic foot sepsis. This burden is being managed at an inappropriate level of care.