Theatre Logbooks Research Articles

EP349 - Use of Pre-operative Risk and Frailty Assessment in patients undergoing Emergency Laparotomy

Abstract Aims Formal preoperative assessment of risk of complications and death in all patients undergoing Emergency Laparotomy is recommended by NELA (National Emergency Laparotomy Audit) in the UK. In addition, frailty assessment in patients who are 65years or older and frail undergoing Emergency Laparotomy is also recommended. In a previous 2018 audit, we had recorded Preoperative Mortality Risk in 77% patients undergoing Emergency Laparotomy and Frailty was not part of our assessment in these patients. In this audit our aim was to evaluate documentation of preoperative frailty and risk assessment in patients undergoing Emergency Laparotomy from 2019 to 2023. Methods Details of all patients who underwent Emergency Laparotomy at a University Hospital under care of one surgical team between January 2019 and December 2023 were obtained from theatre logbooks. Patient notes were retrospectively reviewed to see if frailty assessment and preoperative risk assessment scores were recorded. This data was collected and analyzed using Microsoft Excel. Results During this period, sixty-seven patients were identified. The median age was sixty-seven with an age range from four to ninety-one. Of these 38 (57%) were females. A preoperative p-possum score was documented in 59 (88.1%), 39 (58.2%) patients were 65 years or older of these 26 (66.7%) had frailty assessment carried out. Conclusions Our data suggests that we have over time made progress in the use of Perioperative Risk assessment scores and incorporated frailty assessment in our perioperative practice in patient’s undergoing Emergency Laparotomy. However there remains room for improvement.

Surgical demands of patients attending an Oral and Maxillofacial Surgery clinic in a Nigerian Hospital

Objectives: Reports on most performed oral and maxillofacial surgical procedures (OMSPs) are scarce globally. This study aimed to determine the pattern of surgical demands of patients attending oral and maxillofacial surgery services at the University of Benin Teaching Hospital, Edo State, Nigeria. Materials and Methods: A retrospective study was conducted on patients managed in the Department of Oral and Maxillofacial Surgery from March 2011 to April 2021. Data were collected from theatre logbooks and case notes of patients who had surgery. The data collected were the age of patients, gender, employment status, educational status, residential distance to the hospital, and type of surgery performed. Descriptive statistics were done using the IBM Statistical Package for the Social Sciences statistics for Windows version 20 (Armonk, NY: IBM Corp) software. Results: A total number of 550 patients were seen in the ten-year study period. The age of the patients ranges between 2 and 97 years. The mean age was 23.5 ± 2.08 years. More than half (55.6%) of the patients were male. The highest (47.1%) number of patients that had OMSP had only primary education, followed by tertiary education (25.1%), secondary (17.8%), and no formal education (10.0%). Cleft lip and palate repairs were the most common surgical demands (34.5%), followed by mandibulectomy, open reduction, and fixation. The least surgical demands were neck dissections (0.36%), and none (0.0%) of the patients had cosmetic surgery. Conclusion: The most common surgical demand by patients was cleft lip and palate repairs, while neck dissection was the least common demand, respectively.

EGS P39 The first cycle of an audit assessing the quality of documentation of emergency laparoscopic appendicectomies at Birmingham Heartlands Hospital, a District General Hospital

Abstract Background Laparoscopic appendicectomy is a common general surgical procedure. Poor documentation can a) result in misunderstandings between healthcare workers looking after patients and b) limit fair investigation of incidents. The Get It Right First Time (GIRFT) guidance was produced to advise on the information that should be available in patient records to reduce risk of both of the above. Aims and objectives To assess how well laparoscopic appendicectomies are documented in accordance with the GIRFT criteria. To then develop interventions to improve documentation and ultimately improve communication with other healthcare workers and allow defence of good medical practice. Methods Three people collected data on 100 laparoscopic appendicectomies that took place in 2022-2023 at Heartlands Hospital. Data was collected based on the 34 GIRFT recommendations and the sources were: electronic patient notes (adults); scanned patient notes (children); electronic operation notes (all); and theatre logbooks. It was then analysed and grouped into factors that were documented well (>75% of the cases), moderately well (>50% but £75%), poorly (>25% but £50%) or very poorly (£25%). Results Factors that that were documented well (23%) included use of a sterile bag for appendix removal (83%), details of closure (96%), and instructions for post-operative antibiotics (88%) and recovery (97%). Those documented moderately well (19%) included port location and size (70%) and achievement of haemostasis (62%). Those documented poorly (23%) included whether ports were inserted under direct vision (38%) and whether any residual appendix was left behind (39%). Those documented very poorly (36%) included sending a sample to histology and grade of doctors. Several of these were documented primarily in paper records that are not scanned - hence not readily accessible). Conclusions While there are several aspects of documentation which we are currently doing well, there is still much scope to improve documentation as a whole. The current format of the operation note itself limits the information which can be communicated. This in combination with the documentation of some important information on paper – which is largely inaccessible outside of theatre or once a patient has been discharged – produces unnecessary ambiguity. Discussion is ongoing with electronic records teams to alter the operation note format to improve documentation quality. These findings will be discussed at a departmental audit meeting to specify changes before re-auditing.

Surgical management and post-operative functional outcomes of patients with a penile fracture-a single centre experience over 10years.

Penile fractures are uncommon urological emergencies which occur when there has been a breach in the tunica albuginea of the corpora cavernosum that may be unilateral and bilateral and can extend to involve the urethra. To assess the management and outcomes of penile fractures in a single institution in Ireland. A retrospective review of the emergency theatre logbooks was performed between 2011 and 2021 to identify patients who had undergone an exploration for a suspected penile fracture. Seventeen patients were initially identified on review of theatre logbooks as having an exploration for a suspected penile fracture. Two patients were excluded from the study due to a lack of clinical notes being available. A further 4 patients on chart review were found to not have a penile fracture at exploration. Eleven patients had a confirmed penile fracture intra-operatively, four of whom had an associated urethral injury. Nine (9/11) patients had preserved normal erections post-operatively documented on follow-up; two, however, reported erectile dysfunction requiring phosphodiesterase inhibitors. Our study supports urgent surgical exploration for penile fractures to ensure good functional outcomes. This is a retrospective review of theatre logbooks to identify patients with a suspected penile fracture. The results of our cohort show a good outcome of erectile function following surgical repair of a penile fracture (9/11; 82%). Four patients (4/11; 36%) had a urethral injury diagnosed intra-operatively, one of whom required a formal urethroplasty.

The Pediatric Emergency Surgery Course: Impact on Provider Practice in Rural Uganda

PurposeThe Pediatric Emergency Surgery Course (PESC) trains rural Ugandan providers to recognize and manage critical pediatric surgical conditions. 45 providers took PESC between 2018 and 2019. We sought to assess the impact of the course at three regional hospitals: Fort Portal, Kabale, and Kiwoko. MethodsWe conducted a retrospective cohort study. Diagnosis, procedure, and patient outcome data were collected twelve months before and after PESC from admission and theater logbooks. We also assessed referrals from these institutions to Uganda's two pediatric surgery hubs: Mulago and Mbarara Hospitals. Wilcoxon rank-sum and Pearson's chi-squared tests compared pre- and post-PESC measures. Interrupted time-series-analysis assessed referral volume before and after PESC. Results1534 admissions and 2148 cases were documented across the three regional hospitals. Kiwoko made 539 referrals, while pediatric surgery hubs received 116 referrals. There was a statistically significant immediate increase in the number of referrals from Fort Portal, from 0.5 patients/month pre-PESC to 0.8 post-PESC (95 % CI 0.03–1.51). Moving averages of the combined number of pyloromyotomy, intussusception reductions, and hernia repairs at the rural hospitals also increased post-course. Neonatal time to referral and referred patient age were significantly lower after PESC delivery. ConclusionOur data suggest that PESC increased referrals to tertiary centers and operative volume of selected cases at rural hospitals and shortened time to presentation at sites receiving referrals. PESC is a locally-driven, validated, clinical education intervention that improves timely care of pediatric surgical emergencies and merits further support and dissemination. Type of StudyRetrospective Cohort Study. Level of EvidenceIII.

Maternal complications and associated factors among mothers who underwent a cesarean section at Gebretsadik Shewa general hospital: an institution based cross-sectional study.

Cesarean sections have played a major role in lowering maternal morbidity and mortality rates, but are a major concern in developing countries. This study aims to assess the magnitude of maternal complication and its associated factors among women who underwent a cesarean section at Gebretsadik Shewa general hospital, Southwest Ethiopia. A hospital-based cross-sectional study was conducted in Gebretsadik Shewa general hospital. Data were extracted from 382 mothers' medical charts, retrieved from the labor and operations theatre log book registry using systematic random sampling technique. The extracted data was coded and entered into Epi Data version 3.0, and exported to Statistical Package for Social Sciences (SPSS) version 20 for analysis. Logistic regression analysis was conducted and significance and strength association was determined considering AOR with a 95% confidence level. A total of 382 mothers' charts were reviewed; however, 368 charts were eligible for data entry. The age of the participants ranges between 16 and 42 years with mean and standard deviation of 26.1 ± 4.8 years. Maternal complication rate was 30.4% [95% CI: 25.8- 35.1]. Surgical site infection (10.3%), anemia (6.5%) and intraoperative bleeding (4.6%) were the most common. Multivariable logistic regression analysis showed that no antenatal care follow up, medical illness during pregnancy, emergency cesarean section and not receiving a prophylactic antibiotic were statistically associated with maternal complications. The incidence of maternal complication following cesarean delivery was unduly high. Community based education about antenatal care follow up and its importance should be further strengthened for favorable maternal and fetal outcomes.

The Effect of Preoperative Imaging on the Negative Appendicectomy Rate.

Background Appendicitis is one of the most common causes of acute abdominal pain and appendicectomy is one of the most frequently performed surgical procedures. The proliferation of radiological imaging has reduced the number of patients who have a normal appendix removed, i.e., a negative appendicectomy. We aimed to assess the effect of preoperative imaging on the negative appendicectomy rate (NAR). Methodology All emergency appendicectomies performed at a district general hospital in the United Kingdom over two separate one-year periods were retrospectively analysed using emergency theatre log books. The timeframes were chosen based on the introduction of a diagnostic pathway to reduce the number of appendicectomies performed on patients later found not to have appendicitis or alternative abnormality, i.e., a negative appendicectomy. This pathway involved a greater emphasis placed on preoperative imaging (CT or ultrasound) for patients with suspected appendicitis. The study excluded any patients who were found to have an alternative pathology during surgery. Information technology databases were used to collect data on patient demographics, date of surgery, histology, and any preoperative imaging that was performed. All histological findings showing acutely inflamed appendices and those positive for malignancy were categorised as positive, whereas all other findings were categorised as negative. Results During our initial data collection period (April 2018 to April 2019), we collected data on 207 patients who underwent an appendicectomy. The NAR was 17%. During our subsequent data collection period (August 2020 to August 2021), we collected data on 184 patients. The NAR was 16%. In our adult population, the NAR decreased from 13% to 9%. Discussion At first glance, the NAR does not seem to have improved. On closer look, all patients over the age of 21 years in our re-audit underwent pr-operative CT, and there was a reduction in the NAR in these patients. The issue arises with younger patients, in whom justifying the radiation associated with a CT scan may be difficult. Although ultrasound does not carry the same radiation risk, previous audits at our trust have that shown its sensitivity and specificity for appendicitis is approximately 60%. We may have to explore alternative imaging modalities such as MRI in the paediatric population or accept the higher NAR.

Clinical characteristics, diagnosis, and outcomes of orbital biopsies in a single Irish centre

AimsTo review the distribution of histopathological diagnoses and visual outcome of orbital biopsy in an Irish tertiary referral centre over a 10-year period.MethodsThis was a retrospective, clinical-histopathological case series. Clinical records of all patients who underwent orbital biopsy between January 2008 and January 2018 in the Mater Misericordiae University Hospital were reviewed using data collected from theatre logbooks and hospital-based medical records.ResultsA total of 83 orbital biopsies in 77 patients were included for analysis in this study. The mean age was 55.7 ± 18.41 years. The mean follow-up period was 1.87 ± 2.097 years. The most common presenting symptoms and signs were pain (22.3%) and proptosis (27.6%). Most lesions were located in the extraconal space (65%), with incisional biopsy (65%) being the most common technique used to gain a sample for histopathological diagnosis. Histopathology analysis of the biopsies revealed malignant tumours (27, 32.5%), benign tumours (7, 8.4%), inflammation (26, 31.3%), and other diagnoses (23, 27%). Excluding patients who underwent exenteration procedures, no study patients suffered visual loss following orbital biopsy.ConclusionsOrbital biopsy serves as a safe diagnostic tool in managing orbital diseases. The breakdown of diagnosis in our patients is in line with international studies. No patients in our series suffered vision loss as a result of their orbital biopsy. This emphasises its use as a safe procedure in the diagnosis and management of patients with the orbital disease. Our data provides helpful guidance to clinicians when counselling patients for orbital biopsy.

994 The Evolving Role of Interventional Radiology in the Management of Diverticular Abscesses: A Review of Practice at University Hospital Waterford Over 10 Years

Abstract Background Historically, intra-abdominal sepsis was managed conservatively, or with operative intervention, which is associated with significant morbidity and mortality. Image-guided drainage of abscesses or collections provides a useful alternative and has become more common with the increasing prominence of Interventional Radiology, offering faster recovery, reduced length of hospital stay and cost of treatment. Modern procedural tools, techniques and expertise allow high levels of percutaneous drainage success. The scope of practice has widened to include targets which previously wouldn't have been amenable to drainage. Aim To quantify the use and benefit of IR drainage for complicated diverticulitis at University Hospital Waterford over the past ten years. The size and location of collections drained throughout the ten years was observed. Length of hospital stay for each mode of management (conservative, percutaneous drainage and surgical) was used as an endpoint to assess morbidity. Method Using NIMIS, all CT abdomen/pelvis reports containing the words “abscess” or “collection”, and “diverticul” over the past 10 years was compiled. These patients were categorised by their management, into groups of conservatives, percutaneous drainage, surgical intervention, or a combination of these. NIMIS was used to determine who underwent IR drainage. T-pro, theatre logbooks and patient notes were used to determine who had surgical management, and iPMS was used to assess length of hospital stay. Results IR drainage has become more common year-on-year in UHW and was shown to be more effective for all abscess sizes as compared with conservative management, as outlined in the table shown

SP7.10 Improving Our Preop Fasting Practice

Abstract Aims Preoperative fasting has always been a tussle between patient and surgery staff. Keeping patient nil by mouth unnecessarily not only increases the anxiety, thirst, hunger, postoperative insulin resistance but can also lead to serious hypoglycemic events in diabetic patients. The objective of our study to standardize the habits of pre-operative fasting according to AABGI guidelines and make sure to curtail the fasting period to the required minimum to 2 hours for liquids. Method This retrospective study included all inpatients who had any vascular surgery done under general anaesthesia from Sep 2020 to Nov 2020 in Birmingham Heartland Hospital. As per departmental practices every patient is fasted from 0300. Anaesthesia induction time was noted for every patient from theatre logbook to calculate the fasting interval. After data analysis meetings were done with the ward sister, anaesthetic & vascular surgery consultants to draw an action plan. Results Data collected from a total of 50 patients showed that average fasting period was 11 hrs 2 mins with longest fasting interval was 14 hrs 55 mins. Blanket allowance of clear fluids till 7 am, late dinner and communication of theatre list priority to the ward resulted in achieving an average fasting period of 2 hrs 53 minutes. Conclusions Identification of this simple but crucial problem is the first step towards compliance with the standard. These unassuming butchallenging implementations can significantly affect patient satisfaction and help achieve recommended fasting intervals. Pre-op fasting can easily be optimized by good communication between staff. As further evidence arises, structured peri-operative care can progress.

408 Blood Parameters as an Early Indicator of Complications Following Oesophagogastric Resection

Abstract Aim Oesophageal and gastric cancers are the eighth and fifth most prevalent cancers with a high degree of morbidity and mortality. Oesophagogastric resections are associated with a high degree of complications postoperatively. Complications following resection are associated with poorer hospital recovery, recurrence of cancer, readmission to hospital and increased mortality. A study was carried out to examine if there was an association between post-operative bloods and the development of complications. Method Data was collected from theatre logbooks, Integrated Clinical Environment (ICE) and clinical portal. Patients undergoing oesophagogastric resection for gastric and oesophageal cancer between October 2010 and November 2014 were included. Complications were organised using the Clavien Dindo classification. Data was analysed using the Student’ T test and Chi-Squared test. A P-value of 0.05 was classed as being statiscally significant. Results 94 patients met the inclusion criteria for this study. 55 patients (58.5%) underwent Oesophagectomy, 18 (19.1%) total gastrectomy and 21 (22.3%) partial gastrectomy. A significant association was seen between development of complications and higher Day 5 White Cell count (WCC) (p = 0.048), lower Day 2–5 Albumin (Day 2 Albumin p = 0.038) and higher Day 2–5 C Reactive Protein (CRP) (Day 2 CRP p<0.001). Conclusions This study suggests Albumin, CRP and WCC may be used to predict postoperative complications in patients undergoing oesophagogastric resections for malignancy. Changes in the blood parameters present as early as day 2 postoperatively and can highlight patients who require closer monitoring, allowing earlier re-intervention if required.

EVALUATION OF MODIFIED ALVARDO SYSTEM IN ACUTE APPENDICITIS IN TRIBAL POPULATION OF GUJARAT

Clinical scoring systems, such as the Alvarado and modied Alvarado scoring systems, were developed with the goal of reducing the negative appendectomy rate to 5%–10%. The Raja Isteri Pengiran Anak Saleha Appendicitis (RIPASA) scoring system was established in 2008 specically for Asian populations. The aim of this study was to compare the modied Alvarado with the RIPASA scoring system.This study included 180 patients who underwent appendectomies and were documented as having “acute appendicitis” or “abdominal pain” in the operating theatre logbook (unit B).The sensitivity, specicity, positive predictive value (PPV), negative predictive value (NPV), diagnostic accuracy, predicted negative appendectomy and receiver operating characteristic (ROC) curve of the modied Alvarado and RIPASA scoring systems were derived using SPSS statistical software.A total of 136 patients were included in this study according to our criteria. The cut-off threshold point of the modied Alvarado score was set at 7.0, which yielded a sensitivity of 82.8% and a specicity of 56%. The PPVwas 89.3% and the NPVwas 42.4%. The cut-off threshold point of the RIPASAscore was set at 7.5, which yielded a 94.5% sensitivity and an 88% specicity. The PPV was 97.2% and the NPV was 78.5%. The predicted negative appendectomy rates were 10.7% and 2.2% for the modied Alvarado and RIPASA scoring systems, respectively. The negative appendectomy rate decreased signicantly, from 18.4% to 10.7% for the modied Alvarado, and to 2.2% for the RIPASA scoring system, which was a signicant difference (P<0.001) for both scoring systems.Based on the results of this study, the RIPASA score is a simple scoring system with better sensitivity and specicity than the modied Alvarado scoring system in Asian populations. It consists of 14 clinical parameters that can be obtained from a good patient history, clinical examination and laboratory investigations.

A Nationwide Enumeration of the Surgical Workforce, its Production and Disparities in Operative Productivity in Liberia

BackgroundAny health care system that strives to deliver good health and well-being to its population relies on a trained workforce. The aim of this study was to enumerate surgical provider density, describe operative productivity and assess the association between key surgical system characteristics and surgical provider productivity in Liberia.MethodsA nationwide survey of operation theatre logbooks, available human resources and facility infrastructure was conducted in 2018. Surgical providers were counted, and their productivity was calculated based on operative numbers and full-time equivalent positions.ResultsA total of 286 surgical providers were counted, of whom 67 were accredited specialists. This translated into a national density of 1.6 specialist providers per 100,000 population. Non-specialist physicians performed 58.3 percent (3607 of 6188) of all operations. Overall, surgical providers performed a median of 1.0 (IQR 0.5–2.7) operation per week, and there were large disparities in operative productivity within the workforce. Most operations (5483 of 6188) were categorized as essential, and each surgical provider performed a median of 2.0 (IQR 1.0–5.0) different types of essential procedures. Surgical providers who performed 7–14 different types of essential procedures were more than eight times as productive as providers who performed 0–1 essential procedure (operative productivity ratio = 8.66, 95% CI 6.27–11.97, P < 0.001).ConclusionThe Liberian health care system struggles with an alarming combination of few surgical providers and low provider productivity. Disaggregated data can provide a high-resolution picture of local challenges that can lead to local solutions.

Where are the paediatric patients with testicular torsion during the COVID-19 pandemic?

IntroductionThe Irish people were put on lockdown in mid-March 2020 due to concern of the spread of coronavirus. With these societal changes came a notable reduction in emergency department attendance. Our aim was to analyse emergency urological procedures performed during the COVID-19 era versus the previous year.MethodsA retrospective review of theatre logbooks was undertaken comparing numbers of emergency urological procedures performed between 1 March 2020 and 31 May 2020 (i.e. the COVID-19 era) with the corresponding 3-month period in 2019.ResultsA total of 173 cases were analysed between the two time periods. Similar overall numbers of cases were performed in 2019 (n = 90) and 2020 (n = 83). In particular, similar patient case numbers are also noted in both scrotal explorations (13 vs 9) and ureteric stone surgeries (69 vs 70). However, orchidectomies for testicular cancers were reduced by 63% (3/8). On further analysis of the scrotal exploration group, only 3 were performed in the period after lockdown regulations were instated.ConclusionWhilst patients with ureteric colic continue to present, those with acute testis pain requiring exploration attended less frequently, raising the possibility of undiagnosed testicular torsion in the community.

1256 Orthopaedics and The COVID19 Pandemic: Was Achilles Just A “Weekend Warrior”?

Abstract Background The COVID19 pandemic has affected the types of trauma being operated on by Orthopaedic surgeons. Lifting of restrictions pertaining to sports saw a sudden return to play for many people after a period of inactivity. Achilles tendon ruptures are associated with these episodic athletes. In our institution, we appeared to have a large number of these injuries within a short space of time. We hypothesised that Phase 3 of “Lockdown”, where all sports were allowed to return, led to increased Achilles tendon rupture rates vs. the same period in 2019 due to a prolonged period of inactivity. Method Data from electronic theatre logbooks of all operations performed in the trauma theatre from 27th March 2020 (Lockdown begins) to 31st July 2020 and 27th March 2019 to 31st July 2019 was collected. Results 772 cases were performed in 2019. There were 17 Achilles tendon ruptures in that period (2.2%). 14 of these occurred after Phase 3. 555 cases were performed in 2020. There were 13 Achilles tendon ruptures in that period (2%). 11 of these occurred after Phase 3. Conclusions Overall, there was a greater number and greater rate of Achilles tendon ruptures in 2019 vs. the equivalent “Lockdown” period in 2020. 8 of the 11 occurring after Phase 3 in 2020 occurred in the month of July. This led the authors to believe they were occurring more frequently. In conclusion, the COVID19 pandemic restrictions and subsequent return to play after inactivity does not increase the rate of Achilles tendon rupture.

Category 1 cesarean section decision to delivery interval: the causes of delay and impact on neonatal outcomes

Objectives: The introduction of cesarean section categorization and recommendations on decision to delivery interval was a major step forward towards standardizing clinical response to obstetric emergencies. The recommended decision to delivery interval (DDI) for category 1 cesarean sections is 30 minutes, however there is a balance to be struck to ensure that reducing fetal hypoxic risk is not at the expense of increasing maternal and fetal morbidity. The aim of the study was to review category 1 cesarean sections, focusing on reasons for delays and neonatal outcomes. Design: The study was conducted as a quality improvement initiative to review the performance of the institution in managing women delivered as category 1 cesarean section between January 2020 and August 2020. Methods: The data was extracted from the operating theatre log book and patient electronic records (Cerner system) and analyzed using SPSS statistics package. Results: There were 577 cases of category 1 Cesarean section undertaken during the study period. The recommended DDI of 30 minutes was achieved in 385/577 (67%) of cases but was exceeded in 192/577 (33%) of cases. The most common indication of category 1 cesarean section was fetal distress (58%). It was noted that significantly more women (88.8%) in the &lt;30-minute group had the decision taken in the labor ward, which is in close proximity to the obstetric theatre. Significantly more women in the &lt;30-minute group had epidural or general anesthesia. Significant delays in the preparation time, transfer time, anesthesia time and delivery time were noted in the &gt;30-minute group. The neonates in the &lt;30-minute group had significantly lower pH and base excess measurements at birth however fewer were admitted to the neonatal intensive care unit. Conclusion: This study has demonstrated that only two thirds of category 1 cesarean deliveries are performed within the 30-minute recommendation. The delays were evident at every stage of the process of performing the cesarean. There are some factors which are not modifiable such as non labor ward transfers. Continued monitoring of category 1 cesarean outcomes is recommended.

Estimating the surgical backlog from the COVID-19 lockdown in South Africa: A retrospective analysis of six government hospitals.

The COVID-19 pandemic reached South Africa (SA) in March 2020. A national lockdown began on 27 March 2020, andhealth facilities reduced non-essential activity, including many surgical services. to estimate the COVID-19 surgical backlog in Western Cape Province, SA, by comparing 2019 and 2020general surgery operative volume and proportion at six district and regional hospitals. to compare the operative volumeof appendicectomy, laparoscopic cholecystectomy, cancer and trauma between the 2 years. This was a retrospective study of general surgery operations from six SA government hospitals in the Western Cape. Data wereobtained from electronic operative databases or operative theatre logbooks from 1 April to 31 July 2019 and 1 April to 31 July 2020. Total general surgery operations decreased by 44% between 2019 (n=3 247) and 2020 (n=1 810) (p&lt;0.001). Elective operationsdecreased by 74% (n=1 379 v. n=362; p&lt;0.001), and one common elective procedure, laparoscopic cholecystectomy, decreased by 68%(p&lt;0.001). Emergency operations decreased by 22% (n=1 868 v. n=1 448; p&lt;0.001) and trauma operations by 42% (n=325 v. n=190;p&lt;0.001). However, non-trauma emergency operations such as appendicectomy and cancer did not decrease. The surgical backlog forelective operations after 4 months from these six hospitals is 1 017 cases, which will take between 4 and 14 months to address if each hospitalcan do one additional operation per weekday. The COVID-19 pandemic has created large backlogs of elective operations that will need to be addressed urgently. Clear andstructured guidelines need to be developed in order to streamline the reintroduction of full surgical healthcare services as SA slowly recoversfrom this unprecedented pandemic.

Early application of human amniotic membrane in paediatric scald burns decreases the need for surgical intervention

Paediatric burns are a major health concern, and treatment of choice for less extensive intermediate-depth scald burns is debatable. In a developing country like India where the incidence and complications are high, the need for an easy and cost-effective treatment is highly necessary. The study aimed to retrospectively analyse the need for interventions in paediatric scald burns in a single tertiary referral centre over 4 years, comparing early application amniotic membrane vs wet collagen and paraffin gauze dressings. All paediatric scald burn patients admitted to the Department of Plastic and Reconstructive Surgery between Jan 2015 and Dec 2018 were identified. Demographics were collected from hospital records and operation theatre logbook. Acute scald burns in patients younger than 15 years were analysed according to dressing applied to find the need for intervention, days of hospitalisation, antibiotics usage and rate of infection. A total of 71 paediatric scald burn patients were analysed between 2015 and 2018. Thirty-six were treated with early application of human amniotic membrane and the remaining 35 were treated with wet collagen and paraffin gauze dressings. Patients treated with human amniotic membrane had lower in-hospital stay (p 0.000) and underwent less frequent dressing change (p 0.046), and none of them needed grafting (p 0.000). Our study results suggest that early application of human amniotic membrane can significantly reduce the need for surgical intervention and should be the preferred method of treatment in less extensive paediatric scald burns. Level of evidence: Level III, therapeutic study.

Comparative Analysis of Kidney Stone Composition in Patients from Ghana and South Africa: Case Study of Kidney Stones from Accra and Cape Town

Background: Kidney stone disease, also termed nephrolithiasis is associated with significant morbidities such as severe colicky flank pain, haematuria, urinary tract infection and kidney failure. Kidney stone disease was perceived as uncommon in developing countries; however, the global prevalence has been rising over the past two decades due to lifestyle changes. There is very limited literature on kidney stone composition in Africa, including Ghana and South Africa. It was based on this evidence that this study was undertaken. Aim: The primary aim of this study was to describe and compare the composition of kidney stone in patients receiving treatment at the Korle-Bu Teaching Hospital (KBTH), Accra (Ghana) and Groote Schuur Hospital (GSH), Cape Town (South Africa). Methods: The study was a retrospective folder review of patients treated for nephrolithiasis at the Korle-Bu Teaching Hospital in Accra (Ghana) and Groote Schuur Hospital in Cape Town (South Africa). Patients who were treated for kidney stone disease between 1st June 2016 and 31st May 2018 were recruited, and their folder numbers were retrieved from theatre logbooks. A total of hundred and sixty-three (n = 163) folders (n = 30 KBTH; n = 133 GSH) were subsequently retrieved from the two facilities’ records department. Demographic data and kidney stone analysis results were analyzed using the R statistical software. Results: The age of KBTH patients ranged from 24 to 75 years and age of 45 years, while that of GSH ranged 19 to 77 years and median age 48 years respectively. Males were the majority stone formers for both hospitals [56.7% KBTH; 59.4% GSH]. There was no statistical difference in gender (p = 0.9447) and age (p = 0.2612) between the two groups. Calcium oxalate (86.7%) and uric acid (90.0%) were the commonest components of the kidney stones analyzed from the KBTH. Calcium oxalate (66.2%) and carbonate apatite (40.6%) were the most common components stones from GSH. Brushite (3.0%), cystine (3.8%) and struvite (19.6%) stones were only found in GSH patients. All kidney stones from the KBTH were mixed stones. Pure kidney stones were only found among the GSH dataset constituting 48.9%, also female patients from GSH formed more mixed stones than their male counterparts (M:F = 40.5%:66.67%) and infection kidney stones were also predominantly found among female patients. Conclusion: The findings indicate that the two facilities’ participants are not different in terms of gender and age. However, the composition of stones was found to be different between participants from both hospitals. This suggests that kidney stone composition may be influenced by patients’ geographical location and or cultural background.

Orthopaedic Surgical Task-Shifting and Its Impact on Time-to-Surgery in Western Uganda

Background: High rates of orthopaedic injury in Uganda place large burdens on its few orthopaedic surgeons. Although “task-shifting” of procedures to other providers is practiced, its specific role in orthopaedic surgical care is not well documented. The current study assessed the prevalence of orthopaedic task-shifting, and its impact on time-to-surgery, at the Mbarara Regional Referral Hospital (MRRH) in Western Uganda. Methods: A retrospective cohort study was conducted. All orthopaedic cases recorded in the MRRH operating theatre logbook were analyzed (October 2018 to July 2019). Surgical indication, type of procedure, and operator were recorded. Permanent hospital records, when available, were used to verify logbook data and identify the initial date of hospital admission for each patient. Results: There were 203 patients who received orthopaedic surgery during the study period, with 159 having hospital admission dates. The single orthopaedist at MRRH performed the majority of orthopaedic procedures (61.6% of cases). Significant task-shifting was seen, both to other physicians (33% of cases) and orthopedic clinical officers (5.4%). The orthopaedist performed most hardware implantation procedures (80.8%), while other practitioners performed the majority of trauma cases, particularly conservative fracture management (92.7%). Overall, the average time from admission to surgery was longer for orthopaedists (11.2 days) than for other providers (4.2 days, p<0.001). Conclusions: The current study demonstrates high utilization of orthopaedic task-shifting, and its associated decreased time-to-surgery, at MRRH. This reinforces the role of task-shifting in resource-limited settings. Furthermore, it highlights the importance of continued training of non-orthopaedic providers in foundational orthopaedic surgical principles.