Aortobifemoral bypass for aorto-iliac occlusive disease in the population of KwaZulu-Natal: an in-depth assessment.

Masters Degree. University of KwaZulu-Natal, Durban.Abstract available in PDF.Quality of scanned PDF has been compromised owing to poor condition of original document

Incidence And Risk Factors For Surgical Site Infection Following Laparotomy At A South African Quaternary Hospital

Published ArticleBackground: A published report of surgical site infection (SSI) incidence and risk factors following laparotomy in a South African (SA) setting is lacking. This information would have important implications for SSI clinical prediction rules in SA patients undergoing this common surgical procedure. This study sought to determine the incidence and associated risk factors for SSI following laparotomy in a SA setting. Methods: This was a retrospective chart review study of 439 patients who underwent laparotomy at a SA quaternary hospital over a 5-year period. Demographic information, comorbidities, medication use, and surgery-related variables were collected for each patient. The Centers for Disease Control definition of SSI was used in this study. The incidence of SSI was determined using conventional epidemiological methods. Logistic regression was used to identify risk factors for SSI. Results: The incidence of SSI was 16.6% (CI: 13.4-20.4%). Risk factors for SSI included infectious indication for surgery (Odds Ratio, OR: 3.32, CI: 1.16-9.47; p=0.003), preoperative non-steroidal anti-inflammatory use (OR: 2.82, CI: 1.33-5.95; p=0.007), preoperative hypoalbuminemia (OR: 2.47, CI: 1.12-5.42; p=0.025), Bogota bag use (OR: 2.23, CI: 1.05-4.74; p=0.036), and perioperative blood transfusion (OR: 2.51, CI: 1.33-4.75; p=0.004). Conclusion: The incidence of SSI in SA patients undergoing laparotomy is higher than that reported for mixed surgical populations. Several risk factors for SSI were identified. The prognostic relevance of these risk factors, and the reduction in SSI risk when these factors are addressed requires further investigation

Geospatial distribution of severe paediatric intussusception in KwaZulu-Natal province, South Africa

Introduction: intussusception in South African (SA) children is often severe. A proportion of cases require management at quaternary hospitals which are a scare resource in SA. A geospatial investigation of severe paediatric intussusception (SPI) in the KwaZulu-Natal (KZN) province of SA would assist with identifying regions which should be targeted for preventative interventions. This could reduce resource utilisation for this condition at quaternary hospitals. The objective of this study was to determine the geospatial distribution of SPI in KZN. Methods: this was a retrospective analysis of data for patients with SPI who were admitted to a quaternary hospital in KZN over an 11-year period. Data related to patient demographics, duration of hospitalization, surgical intervention, inpatient mortality and residential postal code were extracted from the electronic hospital admissions system. Each residential postal code was linked to a corresponding KZN district municipality. Descriptive statistical methods were used to determine the distribution of various characteristics in the study sample. Semi-quantitative geospatial analysis was used to determine the distribution of patients with SPI in each KZN district municipality. Results: the study sample consisted of 182 patients with SPI. Most patients were <1 year old (83.5%), male (51.1%) and black African (87.9%). All patients underwent surgical intervention. Inpatient mortality was 2.7%. The majority of patients in the study sample resided in the eThekwini and King Cetshwayo district municipalities (51.1% and 14.8%, respectively). Conclusion: preventative interventions for SPI should be considered for rollout in the eThekwini and King Cetshwayo district municipalities of KZN, SA