‘Getting under our skin’: Introducing banked allograft skin to burn surgery in South Africa

Deceased donor skin possesses many of the properties of the ideal biological dressing, and a well-stocked skin bank has become a critically important asset for the modern burn surgeon. Without it, managing patients with extensive burns and wounds becomes far more challenging, and outcomes are significantly worse. With the recent establishment of such a bank in South Africa, the challenge facing the medical fraternity is to facilitate tissue donation so that allograft skin supply can match the enormous demand

Quantifying capacity for burn care in South Africa

The Lancet Commission on Global surgery has highlighted the fact that the vast majority of surgical care is delivered and consumed in high income countries (HIC’s) yet about two thirds of the burden of surgical disease is in low and middle income countries (LMIC) where resources are grossly inadequate. In light of this we set out to audit the current resources available to treat burns in South Africa to quantify the extent of the resource deficit which needs to be addressed if we wish to close the gap in outcomes between South Africa and the developed world. Data was collected for seven out of the nine provinces. There are a total of 17 burn units with 511 beds and 8140 admissions per year across the country.Although there are some deficits in the infrastructure and staffing available to treat burn injuries in South Africa, for example access to isolation, after hours cover, dedicated temperature controlled theatres, this is difficult to alter without government buy in and the current fiscal environment. It would appear that process of care (what you do with what you have) is lacking and needs more development for example establishment of a national registry to facilitate data collection and audit, as well as the introduction of outreach programs, protocols and improving theatre efficiency. Keywords: Quality improvement, Management capacit

The ASOS Surgical Risk Calculator: development and validation of a tool for identifying African surgical patients at risk of severe postoperative complications

Background: The African Surgical Outcomes Study (ASOS) showed that surgical patients in Africa have a mortality twice the global average. Existing risk assessment tools are not valid for use in this population because the pattern of risk for poor outcomes differs from high-income countries. The objective of this study was to derive and validate a simple, preoperative risk stratification tool to identify African surgical patients at risk for in-hospital postoperative mortality and severe complications. Methods: ASOS was a 7-day prospective cohort study of adult patients undergoing surgery in Africa. The ASOS Surgical Risk Calculator was constructed with a multivariable logistic regression model for the outcome of in-hospital mortality and severe postoperative complications. The following preoperative risk factors were entered into the model; age, sex, smoking status, ASA physical status, preoperative chronic comorbid conditions, indication for surgery, urgency, severity, and type of surgery. Results: The model was derived from 8799 patients from 168 African hospitals. The composite outcome of severe postoperative complications and death occurred in 423/8799 (4.8%) patients. The ASOS Surgical Risk Calculator includes the following risk factors: age, ASA physical status, indication for surgery, urgency, severity, and type of surgery. The model showed good discrimination with an area under the receiver operating characteristic curve of 0.805 and good calibration with c-statistic corrected for optimism of 0.784. Conclusions: This simple preoperative risk calculator could be used to identify high-risk surgical patients in African hospitals and facilitate increased postoperative surveillance. © 2018 British Journal of Anaesthesia. Published by Elsevier Ltd. All rights reserved.Medical Research Council of South Africa gran