Starting A Peripheral Nerve Surgery Unit in an Area of Limited Resources - Our Experience

Dedicated peripheral nerve surgery centers are few in developing countries where majority of affected patients either remain untreated or are simply palliated with just physiotherapy. In this chapter, we review our experience with surgery for peripheral nerve lesions and peripheral nerve injuries over a 5-year period. A total of 68 procedures were carried out for 58 patients with various peripheral nerve lesions and injuries. Among the 19 surgeries for adult brachial plexus injuries, 10 were for pan-brachial plexus injury, 2 procedures for lower brachial plexus injuries, and 7 procedures for upper brachial plexus injury, while 11 repair surgeries were done for pediatric brachial plexus injuries. The remaining 38 surgeries included 21 peripheral nerve sheath tumor excisions, 5 ablative procedures for chronic neuralgia, 8 procedures for non-carpal tunnel peripheral nerve entrapments, and 4 adults with upper or lower limb isolated nerve injury repairs. The patients were followed up between 6 months and 2 years post-surgery for functional outcome assessment. Overall, as many as 57.5% of the patients had significant neurologic improvement noticed at 2 years of follow-up. Despite its challenges, optimal outcomes following surgery are still possible for patients with nerve injuries, entrapments, and nerve tumors in developing countrie

An audit of surgical site infection following open prostatectomy in a Nigerian Teaching Hospital

Background: Surgical site infections (SSI) are a potential cause of morbidity and increased cost of care after operations such as open prostatectomy.Objective: To audit the occurrence of SSI after open prostatectomy at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, NigeriaMethods: A review of all patients who underwent open prostatectomy over a ten-year period (July 2005 to June 2015). Data analysis was done using the statistical package for social sciences version 21. Association between variables was determined using Chi-square or Fisher’s exact test as appropriate. A p-value < 0.05 was considered statistically significant.Results: A total of 247 open prostatectomy surgeries were reviewed, with the patients’ ages ranging from 43 – 91 years and a mean age of 67.0 ± 8.8 years. Elective procedures were 98.8% while the remaining 1.2% were emergency cases. There were 24 (9.8%) surgical site infections. The duration of admission of the patients with SSI ranged from 6 – 15 days with a mean of 9.5 ± 3.2 days, as against 4 – 9 days (mean of 5.0 ± 2.1days) for those without SSI. All the patients with SSI were successfully managed with no resultant mortality. Risk factors identified for SSI were emergency surgery (p=0.001), obesity (p<0.0001), diabetesmellitus (p=0.008), smoking (p<0.0001), pre-operative catheterization (p<0.0001), excessive haemorrhage (p<0.0001) and post-operative suprapubic bladder drainage (p<0.0001).Conclusion: SSI is a recognized complication of open prostatectomy. Identified risk factors for its occurrence from this audit are emergency operation, obesity, diabetes mellitus, smoking, pre-operative catheterization, excessive haemorrhage and post-operativesuprapubic bladder drainage. Age, approach to prostatectomy (retropubic vs transvesical), incision type (lower midline vs pfannenstiel), level of the surgeon, catheter type and modality of irrigation were however not significant risk factors for post-prostatectomy SSI in this study.Keywords: Surgical site infection, risk factors, open prostatectomy

An audit of surgical site infection following open prostatectomy in a Nigerian Teaching Hospital

Background: Surgical site infections (SSI) are a potential cause of morbidity and increased cost of care after operations such as open prostatectomy. Objective: To audit the occurrence of SSI after open prostatectomy at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Nigeria Methods: A review of all patients who underwent open prostatectomy over a ten-year period (July 2005 to June 2015). Data analysis was done using the statistical package for social sciences version 21. Association between variables was determined using Chi-square or Fisher\u2019s exact test as appropriate. A p-value < 0.05 was considered statistically significant. Results: A total of 247 open prostatectomy surgeries were reviewed, with the patients\u2019 ages ranging from 43 \u2013 91 years and a mean age of 67.0 \ub1 8.8 years. Elective procedures were 98.8% while the remaining 1.2% were emergency cases. There were 24 (9.8%) surgical site infections. The duration of admission of the patients with SSI ranged from 6 \u2013 15 days with a mean of 9.5 \ub1 3.2 days, as against 4 \u2013 9 days (mean of 5.0 \ub1 2.1days) for those without SSI. All the patients with SSI were successfully managed with no resultant mortality. Risk factors identified for SSI were emergency surgery (p=0.001), obesity (p<0.0001), diabetes mellitus (p=0.008), smoking (p<0.0001), pre-operative catheterization (p<0.0001), excessive haemorrhage (p<0.0001) and post-operative suprapubic bladder drainage (p<0.0001). Conclusion: SSI is a recognized complication of open prostatectomy. Identified risk factors for its occurrence from this audit are emergency operation, obesity, diabetes mellitus, smoking, pre-operative catheterization, excessive haemorrhage and post-operative suprapubic bladder drainage. Age, approach to prostatectomy (retropubic vs transvesical), incision type (lower midlinevs pfannenstiel), level of the surgeon, catheter type and modality of irrigation were however not significant risk factors for post-prostatectomy SSI in this study. DOI: https://dx.doi.org/10.4314/ahs.v19i2.30 Cite as: Salako AA, Badmus TA, Onyia CU, David RA, Adejare IE, Lawal AO, Onyeze CI, Ndegbu CU. An audit of surgical site infection following open prostatectomy in a Nigerian Teaching Hospital. Afri Health Sci.2019;19(2): 2068-2072. https://dx.doi.org/10.4314/ahs.v19i2.3

Review of adult head injury admissions into the intensive care unit of a tertiary hospital in Nigeria

Background: Head injury is frequently associated with death and disability and imposes considerable demands on health services. Outcome after head injury is closely related to prompt management, including prevention of secondary brain injury and intensive care unit (ICU) management. This study aimed at determining the aetiological spectrum, injury characteristics, ICU admission patterns, and treatment outcomes of adult head-injured patients at a sub-Saharan tertiary hospital.Methods: A retrospective study on adult head-injured patients admitted to the ICU of a sub-Saharan tertiary hospital between July 2000 and June 2010.Results: A total of 198 head-injured adult patients were managed in the ICU during the study period. This included 128 males and 70 females with a male-to-female ratio of 1.8:1. The most common mode of injury was road traffic accident. All the patients admitted to ICU had either moderate or severe head injury, with 73.7% having severe head injury. About 26.3% of the patients had associated cervical spine injuries and 50% had various musculoskeletal and soft tissue injuries. Cranial computed tomography findings included brain contusions and intracranial haematomas. Mean duration of ICU stay was 18 days (range 24 hours-42 days), with 89.9% discharged out of ICU care. The overall mortality was 10.1%, although only 36.9% had satisfactory outcomes, as determined by the Glasgow Outcome Scale. Outcome had statistically significant (P < 0.05) relationship with severity of head injury and surgical intervention.Conclusions: Head injury management in the ICU requires an approach to ensure prevention of secondary brain injury; appropriate and early neuroimaging to diagnose lesions that would benefit from timely surgical intervention; as well as management of fluid, electrolyte and haematological derangements.Keywords: head injury; admissions; IC

Paediatric day-case neurosurgery in a resource challenged setting: Pattern and practice

Background: It has been generally observed that children achieve better convalescence in the home environment especially if discharged same day after surgery. This is probably due to the fact that children generally tend to feel more at ease in the home environment than in the hospital setting. Only few tertiary health institutions provide routine day-case surgery for paediatric neurosurgical patients in our sub-region. Objective: To review the pattern and practice of paediatric neurosurgical day-cases at our hospital. Patients and Methods: A prospective study of all paediatric day-case neurosurgeries carried out between June 2011 and June 2014. Results: A total of 53 patients (34 males and 19 females) with age ranging from 2 days to 14 years were seen. Majority of the patients (77.4%) presented with congenital lesions, and the most common procedure carried out was spina bifida repair (32%) followed by ventriculoperitoneal shunt insertion (26.4%) for hydrocephalus. Sixty-eight percentage belonged to the American Society of Anesthesiologists physical status class 2, whereas the rest (32%) belonged to class 1. General anaesthesia was employed in 83% of cases. Parenteral paracetamol was used for intra-operative analgesia for most of the patients. Two patients had post-operative nausea and vomiting and were successfully managed. There was no case of emergency re-operation, unplanned admission, cancellation or mortality. Conclusion: Paediatric day-case neurosurgery is feasible in our environment. With careful patient selection and adequate pre-operative preparation, good outcome can be achieved