Abstract
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.
Similar content being viewed by others
References
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
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
Beasley SW (2013) The challenges facing training in pediatric surgery worldwide. Front Pediatr. https://doi.org/10.3389/fped.2013.00024
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
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
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
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
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
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
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
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
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
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
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
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
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
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
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
Pappas S, Davidson N, Woodard J, Davis J, Welton JM (2015) Risk-adjusted staffing to improve patient value. Nurs Econ 33(2):73–78
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
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
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that they have no conflict of interest. No funding was received for this work.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Zanini, A., Maistry, N., Brisighelli, G. et al. The Burden of Disease and Pathology at a Rapidly Expanding Tertiary Paediatric Surgical Unit in South Africa. World J Surg 45, 2378–2385 (2021). https://doi.org/10.1007/s00268-021-06144-x
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00268-021-06144-x