Provision of an emergency theatre in tertiary hospitals is cost-effective: Audit and cost of cancelled planned elective general surgical operations at Pietersburg Hospital, Limpopo Province, South Africa

Background. Cancellations of planned elective surgical operations increase financial cost to the patient and the hospital.Objectives. To determine the rate and reasons for cancellations, estimate the cost incurred by such cancellations and recommend possible solutions.Methods. We did a prospective descriptive study of cancellations of elective general surgical operations over the 1-year period January -December 2014 in the main theatre at Pietersburg (PTB) Hospital, Limpopo Province, South Africa. All patients listed on the theatrebooking slate for elective general surgical operations before the cut-off time of 13h00 on the day before the anticipated operation were included. Epi Info version 7 was used to analyse the data and derive the descriptive statistics.Results. There were 537 booked patients (median age 47 years, range 1 - 94); a total of 298 operations were performed, and 239 were cancelled (cancellation rate 44.5%). Reasons for cancellation were as follows: theatre needed for an emergency n=154 (64.4%), theatre equipment failure and lack of consumables n=17 (7.1%), non-theatre equipment failure n=10 (4.2%), prolonged time of operations n=13 (5.4%), abnormal blood results n=8 (3.3%), patient comorbidity and poor general condition n=9 (3.8%), patients absent from the ward n=8 (3.3%), patients not starved n=2 (0.8%), patients’ condition improved significantly n=3 (1.3%), nurses’ strike n=5 (2.1%), rebooking of cases for senior surgeons or other specialty n=2 (0.8%), and other reasons n=8 (3.3%). The cost per inpatient per day was estimated at ZAR4 890 at PTB Hospital and ZAR2 100 at district hospitals, and the total cost per cancelled operation was ZAR25 860.Conclusions. Over the 1-year period 44.5% of elective operations at PTB Hospital were cancelled, 64.4% because the theatre was needed for an emergency operation. We recommend that a theatre dedicated to emergencies be opened at PTB Hospital. The cost incurred due to cancellations was about ZAR6 million for the hospital, with additional cost and emotional trauma for the patients

An audit of emergency admissions to the adult general surgery department at Pietersburg Hospital, Polokwane, Limpopo Province, South Africa, during an 8-month period in 2021

Background. Emergency general surgery represents illnesses of very diverse pathology, related only by their urgent nature. The burden of general surgery emergency admissions at Pietersburg Hospital in Polokwane, Limpopo Province, South Africa, is currently unknown. Objectives. To describe the demographic characteristics and clinical presentation of general surgical patients admitted to Pietersburg Hospital, as well as their surgical management, in order to plan future resource allocation. Methods. This was a retrospective descriptive audit of patients admitted to the adult general surgery department over the 8-month period April - November 2021. Results. A total of 893 surgical emergency patients treated during the study period were included in the analysis. Of these, 357 were trauma and 536 non-trauma emergency cases. The majority of the patients (61%) were managed non-operatively. Of the 39% who required surgical management, only 24% had their operation performed within the first 24 hours, with the remainder only operated on after a delay owing to unavailability of space in theatre and/or unavailability of an intensive care unit (ICU) bed. Conclusion. The lack of a dedicated surgical emergency theatre and the shortage of ICU beds are burning issues at Pietersburg Hospital and should be addressed as a matter of the greatest urgency

Audit of surgical procedures in regional and central hospitals in Limpopo Province, South Africa

Background. There is a paucity of data on the functioning and surgical procedures performed in rural hospitals in South Africa.Objective. To determine the category of procedures performed at regional and tertiary hospitals in Limpopo Province, South Africa. Method. We conducted a retrospective analysis of surgical procedures performed in the regional and tertiary hospitals in Limpopo Province during a 1-year period from 1 March 2019 to 29 February 2020.Results. A total of 24 263 surgical procedures were performed during the study period. More than half of all cases (50.4%; n=12 252) were operated on at the tertiary hospitals while regional hospitals performed the remaining 12 011 operations.Conclusion. There is a great necessity to alleviate the central hospitals from the bulk of surgical procedures

Safety and affordability of an elective Saturday list at Pietersburg Hospital, Limpopo, South Africa

Background. The backlog of patients waiting for operations continues to be a problem in many public hospitals in South Africa (SA), with elective surgery procedures being postponed for up to 2 years.Objective. To determine the rate of death in hospital or out of hospital within 30 days of an elective procedure performed on a Saturday, and to determine the cost incurred by paying staff members who perform these operations.Method. A prospective, observational descriptive cohort study of all patients undergoing inpatient general surgery operations during weekdays and weekends between 1 September 2015 and 31 August 2016 (1 year) at Pietersburg Hospital (PBH), Limpopo, SA. Microsoft Excel 2010 (Microsoft, USA) was used to analyse and derive descriptive statistics. The finance department at the hospital calculated the overtime pay for theatre staff who operated on Saturdays.Results. The study included 1 352 operations (607 elective and 745 emergency procedures). Saturday elective operations contributed 133/607 (22%), and the rate of death for these operations was 1.5%. The most common procedures performed on a Saturday were hernia repair and amputation. The cost for 8 hours of work on a Saturday was ZAR13 900, amounting to a total of ZAR333 600 for 24 Saturdays.Conclusion. Performing minor surgery on a Saturday had a mortality rate of 1.5%, and a theatre staff cost of ~ZAR2 317 per patient, excluding surgeons’ fees. If surgeons were to be paid the costs would be ZAR3 450 per patient

Breast cancer: Factors influencing late-stage presentation at the Mankweng Hospital breast cancer clinic, Polokwane, Limpopo Province, South Africa

Background. Female breast cancer remains the most common cancer in many parts of the world. According to GLOBOCAN (2021), female breast cancer has become the most commonly diagnosed cancer, surpassing lung cancer. Women in low- and middle-income countries are reported to seek medical help at an advanced stage of the disease, which negatively affects the prognosis, irrespective of the care available. Objectives. To determine factors influencing late-stage diagnosis of breast cancer in women at the specialist breast cancer clinic at Mankweng Hospital in Polokwane, Limpopo Province, South Africa. Methods. The study was conducted at the Mankweng breast cancer clinic in the rural province of Limpopo over the 18-month period July 2020 - December 2021 and applied a quasi-experimental design to determine the stage of breast cancer at the time of presentation to the clinic, and factors influencing late-stage presentation. Results. Of the study sample, 269 patients were female (98%) and 5 male (2%). The majority of the females (n=203; 75%) had late-stage cancer at presentation, only 66 (25%) being in the early stages. Conclusion. Most of the patients (76%) presented with late-stage disease. The main reason for the delay was lack of knowledge about breast cancer and its symptoms (not painful, not considered serious). Of concern is the higher proportion of educated patients presenting with late-stage disease compared with the group with a lower level of education

Provision of an emergency theatre in tertiary hospitals is cost-effective: Audit and cost of cancelled planned elective general surgical operations at Pietersburg Hospital, Limpopo Province, South Africa

Background. Cancellations of planned elective surgical operations increase financial cost to the patient and the hospital. Objectives. To determine the rate and reasons for cancellations, estimate the cost incurred by such cancellations and recommend possible solutions. Methods. We did a prospective descriptive study of cancellations of elective general surgical operations over the 1-year period January - December 2014 in the main theatre at Pietersburg (PTB) Hospital, Limpopo Province, South Africa. All patients listed on the theatre booking slate for elective general surgical operations before the cut-off time of 13h00 on the day before the anticipated operation were included. Epi Infoversion 7 was used to analyse the data and derive the descriptive statistics. Results. There were 537 booked patients (median age 47 years, range 1 - 94); a total of 298 operations were performed, and 239 were cancelled (cancellation rate 44.5%). Reasons for cancellation were as follows: theatre needed for an emergency n=154 (64.4%), theatre equipment failure and lack of consumables n=17 (7.1%), non-theatre equipment failure n=10 (4.2%), prolonged time of operations n=13 (5.4%), abnormal blood results n=8 (3.3%), patient comorbidity and poor general condition n=9 (3.8%), patients absent from the ward n=8 (3.3%), patients not starved n=2 (0.8%), patients’ condition improved significantly n=3 (1.3%), nurses’ strike n=5 (2.1%), rebooking of cases for senior surgeons or other specialty n=2 (0.8%), and other reasons n=8 (3.3%). The cost per inpatient per day was estimated at ZAR4 890 at PTB Hospital and ZAR2 100 at district hospitals, and the total cost per cancelled operation was ZAR25 860. Conclusions. Over the 1-year period 44.5% of elective operations at PTB Hospital were cancelled, 64.4% because the theatre was needed for an emergency operation. We recommend that a theatre dedicated to emergencies be opened at PTB Hospital. The cost incurred due to cancellations was about ZAR6 million for the hospital, with additional cost and emotional trauma for the patients

Audit of surgical specialty patients and beds at Pietersburg Hospital, Limpopo Province, South Africa in 2021

Background. While the absolute number of hospital beds is usually discussed, adequate utilisation of beds is a far better instrument to measure departmental efficiency. Objective.To measure the number of beds for each surgical specialty in Pietersburg Hospital as well as the average length of stay (LoS) to compare bed utilisation. Method. We conducted a 1-day descriptive cross-sectional audit of patients admitted to surgical wards on 21 April 2021 at Pietersburg Hospital.Results. There were huge discrepancies in the number of beds per surgical specialty as well as the LoS. Over one-third of surgical beds were occupied by patients waiting for either a computed tomography scan, surgical procedure, or transfer. Conclusion. There is a need to address the functioning of the surgical specialties with regards to the number of beds allocated as well as the ideal average length of sta

Profile of patients seen at Pietersburg and Mankweng breast cancer clinics in Limpopo

Background. Breast cancer is the most common cancer diagnosed among women worldwide. It is the most prevalent cancer and leading cause of death among South African (SA) women. The increasing incidence of breast cancer is a major health concern. Until now, the distribution of breast cancer demography, stage at first presentation, and histological characterisation have not been studied in Limpopo Province, SA.Objectives. To record the demographic profile of breast cancer patients, to report the stage at the time of presentation and to characterise the pattern of malignant disease in Limpopo, SA.Methods. We conducted a retrospective descriptive review of the records of patients managed at Pietersburg Hospital oncology and Mankweng Hospital breast cancer clinics during the period 1 March 2015 - 28 February 2017. Stata was used to analyse data.Results. A total of 248 patients with a mean age of 55 years were included for analysis, 7 males (3%) and 241 females (97%). Capricorn and Vhembe districts constituted 32% and 27% respectively. The majority (69%) of patients were diagnosed with disease stage III or IV. The most common histological type was invasive ductal cell carcinoma (IDC) (87%).Conclusions. More than one-third of patients were younger than 50 years. The majority (69%) had an advanced breast cancer (stage III or IV). We recommend provision of mammography services in regional hospital