Background Frequently, surgical intervention is needed to treat soft tissue sepsis (STS). Ideally, most STS should be managed at the lowest level of surgical care close to the patient's home and a well‐functioning surgical service will be able to deliver this safely and effectively. This study interrogates the burden of STS in the province of KwaZulu‐Natal and reviews at which level in the health system the operative management of STS is being dealt with. Methods This study describes the operations for soft tissue sepsis conducted at all regional and tertiary hospitals in KwaZulu‐Natal province for the period of 1 July to 31 December 2015. All procedures for soft tissue sepsis were identified for closer review. Results Between 1 June and 31 December 2015, a total 6302 soft tissue‐related procedures were performed in the regional and tertiary hospitals of KZN. The breakdown by anatomical region was as follows, 618 (9.8%) head and neck surgeries, 895 (14.2%) chest and back, 277 (4.4%) abdominal wall, 818 (13%) pelvis/perineal/buttock and 3070 (48.7%) extremity‐related surgeries. There were a further 815 (12.9%) soft tissue‐related procedures where the anatomical region was unspecified. Of the soft tissue procedures, 3943 (62.6%) were for the management of soft tissue sepsis. The anatomical regions involved included 316 (8%) head and neck, 485 (12.3%) chest and back, 194 (4.9%) abdominal wall, 589 (14.9%) pelvic, perineal and buttock, 2054 (52.1%) extremity and 365 unspecified operations. Peri‐anal sepsis contributed 315 (8%), breast sepsis contributed to 372 (9.4%) of all soft tissue sepsis and amputations of extremities 658 (16.7%) of septic soft tissue procedures. Conclusion There is a significant burden of soft tissue sepsis requiring surgical treatment each month at regional and tertiary hospitals in KZN. This is made up of breast sepsis, peri‐anal sepsis and diabetic foot sepsis. This burden is being managed at an inappropriate level of care.
BACKGROUND: The current surgical workload assessments in KwaZulu-Natal (KZN) are inadequate to inform strategies to improve surgical services. Breast diseases have a well-defined spectrum and surgical treatment options, analysis of which could guide health policy in the field. This project aimed to quantify and analyse the operative workload for breast pathology in KZN METHOD: A retrospective review of breast-related operations conducted at public sector hospitals in KwaZulu-Natal province between 1 July and 31 December 2015 was undertaken. Data was collected from theatre operative registers and manually categorised as follows: sepsis, benign pathology, malignant pathology, and by hospital, according to geographic location, and complexity of care to determine factors to improve the service for breast care in the province RESULTS: In the 6-month study period, 13 282 general surgical procedures were performed of which 776 (5.8%) were breast-related operations. There were 372 (47.9%) operations for breast sepsis, 140 (18%) for benign breast lesions, 17 (2.2%) for cosmetic indications and 27 (3.5%) for diagnostic procedures. There were 223 (28.7%) procedures for non-benign disease: 21 (2.6%) wide local excisions (WLE), 203 (26.2%) mastectomies of which 161 (72.2%) mastectomies had an axillary lymph node dissection and 26 (11.7%) were performed as onco-plastic procedures. Hospitals in the Durban and Pietermaritzburg metropolitan areas performed 75% of the breast-related procedures. The majority (69.6%) of sepsis-related procedures were performed at secondary/regional facilities, while 58.3% of non-benign breast surgeries were performed at tertiary and quaternary centres CONCLUSION: Breast sepsis accounts for almost 50% of the surgery and is mainly dealt with at hospitals above district level. One-third of breast surgery in KZN province is for non-benign disease. There is a paucity of breast-conserving surgery. Elucidation of these observations can guide improvement in the provincial breast care service Keywords: breast surgery, breast pathology, breast cancer, general surgery
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