Soft Tissue Sepsis Places a Massive Burden on Regional and Tertiary Surgical Services in KZN Province South Africa

Ehlers, Vincent; Kohler, Charles; Rago, Natasha Di; Tefera, Aida; Lutge, Elizabeth; Clarke, Damian

doi:10.1007/s00268-020-05510-5

Cited by 4 publications

(2 citation statements)

References 20 publications

(40 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…This suggests that district hospitals are not providing the expected level of surgical care and that this workload is being transferred to higher levels of care. 13,14…”

Section: Discussionmentioning

confidence: 99%

The surgical burden of breast disease in KwaZulu-Natal province

Ehlers¹,

Kohler²,

Lutge

et al. 2021

S. Afr. j. surg.

View full text Add to dashboard Cite

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

show abstract

“…This suggests that district hospitals are not providing the expected level of surgical care and that this workload is being transferred to higher levels of care. 13,14…”

Section: Discussionmentioning

confidence: 99%

The surgical burden of breast disease in KwaZulu-Natal province

Ehlers¹,

Kohler²,

Lutge

et al. 2021

S. Afr. j. surg.

View full text Add to dashboard Cite

show abstract

“…Surgery provides immediate and transformative treatment for many health conditions and will remain a key therapeutic strategy in all countries 1 2. While surgery is performed in every community, wealthy and poor, rural and urban and in all regions with an estimated 234 million major surgical procedures performed annually,3 4 it is also a major source of avoidable morbidity and mortality worldwide 5 6. Recent studies have revealed a global surge in surgical procedures and indicated that expanding access to surgeries in low and middle-income countries (LMICs) has the potential to avert 1.4 million fatalities and reduce the burden of 77.2 million disability-adjusted life years each year 7.…”

Section: Introductionmentioning

confidence: 99%

Evaluating the uptake and effect of Surgical Safety Checklist implementation in a rural hospital, Neno District, Malawi

Kapira,

Aron,

Mphande

et al. 2023

BMJ Open Qual

View full text Add to dashboard Cite

BackgroundThe WHO introduced the Surgical Safety Checklist (SSC) in 2008, which has been proven to enhance collaboration and patient safety before, during and after surgical procedures. However, the impact of using SSC has not been assessed in a rural setting in Malawi. We aimed to evaluate the uptake of SSC in Neno District, Malawi.MethodsWe conducted a cross-sectional hospital-based retrospective chart review of 468 surgical cases from July 2021 to March 2022 in two hospitals in Neno District. We collected data using Excel and used R software for analysis. We used descriptive statistics to characterise the surgeries. We used χ2test and Wilcoxon signed-rank test to test the association between SSC use and independent variables. We fitted logistic regression to assess predictors of SSC use and complications.ResultsOf 468 surgical cases, 92% (n=431) were done as emergency procedures. The median age was 23 years (IQR: 19–29) and 94% (n=439) were female. Overall, 38% of surgeries (n=176) used the SSC and of these, 98% were in emergency procedures. We found an association between the use of SSC and the age of the client (p=0.018), type of procedure, name of the procedure, healthcare worker cadre, time procedure performed and complications (p<0.001). However, no association was observed between SSC use and outcome (p>0.05). The odds of using SSC were higher in emergency surgeries, surgeries performed at night; however, they were lower among temporary employees and anaesthetists with a diploma (p<0.001). The odds of experiencing complications were 1.71 times greater when using SSC compared with surgeries without SSC (p=0.029).ConclusionsThe use of an SSC in a rural area was promising, despite its fluctuating use and this needs programme improvement. Further studies are highly recommended to understand the fluctuation in the use of the SSC.

show abstract

Down-regulation of lncRNA SNHG5 relieves sepsis-induced acute kidney injury by regulating the miR-374a-3p/TLR4/NF-κB pathway

Wei

Shang

et al. 2021

The Journal of Biochemistry

View full text Add to dashboard Cite

Sepsis is an acute systemic infectious disease engendered by infectious factors, which can cause the dysfunction of multiple organs, including acute kidney injury (AKI). Recently, more and more researchers are focusing on long non-coding RNA (lncRNA) that is closely associated with the development and progression of various diseases; however, the role and mechanism of lncRNA in sepsis-induced acute kidney injury is not fully understood. Here, we found a significant increase in the expression of lncRNA small nuclear RNA host gene 5 (SNHG5) in the serum of patients with sepsis than healthy controls. Similar results were obtained from mouse model of sepsis. Further investigations revealed that knockdown of SNHG5 improves the viability and reduces the rate of apoptosis and the generation of inflammatory cytokines in HK-2 and TCMK-1 cells treated with lipopolysaccharide (LPS). Mechanistically, we showed that SNHG5 can combine with microRNA-374a-3p (miR-374a-3p) which inhibits nuclear factor-κB (NF-κB) activity by targeting TLR4. In conclusion, our results demonstrate that SNHG5 may regulate sepsis-induced AKI via the miR-374a-3p/TLR4/NF-κB pathway, therefore providing a new insight into the treatment of this disease.

show abstract

Soft Tissue Sepsis Places a Massive Burden on Regional and Tertiary Surgical Services in KZN Province South Africa

Cited by 4 publications

References 20 publications

The surgical burden of breast disease in KwaZulu-Natal province

The surgical burden of breast disease in KwaZulu-Natal province

Evaluating the uptake and effect of Surgical Safety Checklist implementation in a rural hospital, Neno District, Malawi

Down-regulation of lncRNA SNHG5 relieves sepsis-induced acute kidney injury by regulating the miR-374a-3p/TLR4/NF-κB pathway

Contact Info

Product

Resources

About