Fouryear review of admissions to a South African regional hospital general surgery department

Background. There are limited published data describing surgical admissions at a regional hospital level in the South African (SA) context.Objectives. To retrospectively review data from an electronic discharge summary  database at a regional SA hospital from 2012 to 2016 to describe the burden of...

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Main Authors: J Pape, O Swart, R Duvenage
Format: Article
Language:English
Published: South African Medical Association 2019-02-01
Series:South African Medical Journal
Online Access:http://www.samj.org.za/index.php/samj/article/download/12536/8743
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author J Pape
O Swart
R Duvenage
author_facet J Pape
O Swart
R Duvenage
author_sort J Pape
collection DOAJ
description Background. There are limited published data describing surgical admissions at a regional hospital level in the South African (SA) context.Objectives. To retrospectively review data from an electronic discharge summary  database at a regional SA hospital from 2012 to 2016 to describe the burden of surgical disease by analysing characteristics of the patients admitted.Methods. All discharge summary records for the 4-year period were reviewed after extraction from a database created for the surgery department. Admissions were classified into 5 types: (i) elective surgery or investigations (ESI); (ii) trauma; (iii) burns; (iv) non-traumatic surgical emergencies (NTSE); and (v) unplanned readmission within 30 days. Other variables reviewed were demographic data, the International Statistical Classification of Diseases and Related Health Problems – Version 10 (ICD-10) diagnosis; area of origin; and outcome (death, tertiary referral, discharge). Data were subgrouped into 12-month periods to facilitate trend analysis.Results. Discharge summaries (N=9 805) over the 4-year study period were assessed and 9 799 were included in the analysis. All data were entered by the attending medical personnel. A total of 5 647 male patients (57.6%) and 4 152 female patients (42.4%) were admitted, with a mean age of 43.3 years (95% confidence interval (CI) 43.0 - 43.8) and a mean length of stay of 4.9 days (95% CI 4.7 - 5.1). Male patients comprised a larger proportion of trauma (83.7%) and burn (63.9%) admissions. The mean length of stay ranged from 3.5 days for elective patients to 9.1 days for burn patients. The most common diagnoses for emergency admissions were appendicitis, peripheral vascular disease and peptic ulcer disease. Common diagnoses for elective admissions were gallstone disease, inguinal hernia, anal fistulas/fissures, and ventral and incisional hernia. The most common cancer diagnoses were of the colorectum, oesophagus, breast and stomach. The overall mortality rate was 2.2%, and highest by subtype was burn patients (6.3%). Trend analysis showed a statistically significant increase in admission for NTSE (p=0.019), trauma (p<0.001) and 30-day readmission rates (p<0.001), with a decrease in admissions for ESI (p=0.001) over the 4 years.Conclusions. A precise understanding of the burden of disease profile is essential for national, provincial and district budgeting and resource allocation. Ongoing surveillance such as that performed in the study provides this critical information.
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spelling doaj.art-09cf0b1740704e8bbe03ef842652345e2024-01-02T04:03:46ZengSouth African Medical AssociationSouth African Medical Journal0256-95742078-51352019-02-01109212212610.7196/SAMJ.2019.v109i2.13433Fouryear review of admissions to a South African regional hospital general surgery departmentJ PapeO SwartR DuvenageBackground. There are limited published data describing surgical admissions at a regional hospital level in the South African (SA) context.Objectives. To retrospectively review data from an electronic discharge summary  database at a regional SA hospital from 2012 to 2016 to describe the burden of surgical disease by analysing characteristics of the patients admitted.Methods. All discharge summary records for the 4-year period were reviewed after extraction from a database created for the surgery department. Admissions were classified into 5 types: (i) elective surgery or investigations (ESI); (ii) trauma; (iii) burns; (iv) non-traumatic surgical emergencies (NTSE); and (v) unplanned readmission within 30 days. Other variables reviewed were demographic data, the International Statistical Classification of Diseases and Related Health Problems – Version 10 (ICD-10) diagnosis; area of origin; and outcome (death, tertiary referral, discharge). Data were subgrouped into 12-month periods to facilitate trend analysis.Results. Discharge summaries (N=9 805) over the 4-year study period were assessed and 9 799 were included in the analysis. All data were entered by the attending medical personnel. A total of 5 647 male patients (57.6%) and 4 152 female patients (42.4%) were admitted, with a mean age of 43.3 years (95% confidence interval (CI) 43.0 - 43.8) and a mean length of stay of 4.9 days (95% CI 4.7 - 5.1). Male patients comprised a larger proportion of trauma (83.7%) and burn (63.9%) admissions. The mean length of stay ranged from 3.5 days for elective patients to 9.1 days for burn patients. The most common diagnoses for emergency admissions were appendicitis, peripheral vascular disease and peptic ulcer disease. Common diagnoses for elective admissions were gallstone disease, inguinal hernia, anal fistulas/fissures, and ventral and incisional hernia. The most common cancer diagnoses were of the colorectum, oesophagus, breast and stomach. The overall mortality rate was 2.2%, and highest by subtype was burn patients (6.3%). Trend analysis showed a statistically significant increase in admission for NTSE (p=0.019), trauma (p<0.001) and 30-day readmission rates (p<0.001), with a decrease in admissions for ESI (p=0.001) over the 4 years.Conclusions. A precise understanding of the burden of disease profile is essential for national, provincial and district budgeting and resource allocation. Ongoing surveillance such as that performed in the study provides this critical information.http://www.samj.org.za/index.php/samj/article/download/12536/8743
spellingShingle J Pape
O Swart
R Duvenage
Fouryear review of admissions to a South African regional hospital general surgery department
South African Medical Journal
title Fouryear review of admissions to a South African regional hospital general surgery department
title_full Fouryear review of admissions to a South African regional hospital general surgery department
title_fullStr Fouryear review of admissions to a South African regional hospital general surgery department
title_full_unstemmed Fouryear review of admissions to a South African regional hospital general surgery department
title_short Fouryear review of admissions to a South African regional hospital general surgery department
title_sort fouryear review of admissions to a south african regional hospital general surgery department
url http://www.samj.org.za/index.php/samj/article/download/12536/8743
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AT oswart fouryearreviewofadmissionstoasouthafricanregionalhospitalgeneralsurgerydepartment
AT rduvenage fouryearreviewofadmissionstoasouthafricanregionalhospitalgeneralsurgerydepartment