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

  • Surgery in Low and Middle Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

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.

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Funding

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Authors and Affiliations

  1. Department of Surgery, Pietermaritzburg Metropolitan Hospitals Complex, Grey’s Hospital, 201 Townbush Road, Private Bag X9001, Pietermaritzburg, 3200, South Africa

    Vincent Ehlers, C. Kohler, Natasha Di Rago & Damian Clarke

  2. Department of Surgery, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa

    Vincent Ehlers, C. Kohler, Natasha Di Rago & Damian Clarke

  3. South African Global Surgery Society, Johannesburg, South Africa

    C. Kohler

  4. Epidemiology Unit, KZN Department of Health, Natalia 330 Langalibalele (Longmarket) Street Pietermaritzburg 3201, P/Bag X9051, Pietermaritzburg, 3200, South Africa

    Aida Tefera & Elizabeth Lutge

  5. School of Nursing and Public Health, University of KwaZulu-Natal, Mazisi Kunene Road, Glenwood, Durban, 4041, South Africa

    Elizabeth Lutge

  6. Department of Surgery, University of the Witwatersrand, Johannesburg, South Africa

    Damian Clarke

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  1. Vincent Ehlers
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  2. C. Kohler
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Correspondence to Damian Clarke.

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Ehlers, V., Kohler, C., Di Rago, N. et al. Soft Tissue Sepsis Places a Massive Burden on Regional and Tertiary Surgical Services in KZN Province South Africa. World J Surg 44, 2526–2532 (2020). https://doi.org/10.1007/s00268-020-05510-5

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  • DOI: https://doi.org/10.1007/s00268-020-05510-5

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