The Burden of Disease and Pathology at a Rapidly Expanding Tertiary Paediatric Surgical Unit in South Africa

Abstract

Background The precise burden of paediatric surgical care in South Africa is unknown. In the absence of epidemiological data, hospital‐based study is a first step to gauge the burden and profile of paediatric surgical disease. We aim to describe the profile of pathology, pattern of referrals, and complications of paediatric surgical care at Chris Hani Baragwanath Academic Hospital (CHBAH). Methods A 1‐year retrospective record review for the period 3/1/2019 to 1/1/2020 was conducted by evaluation of the morbidity and mortality databases of the Department of Paediatric Surgery (DPS). Number of admissions, consultations, complications, and surgeries performed were analysed and classified. Results A total of 11,932 unique patient encounters occurred. Emergencies (79%, 1841/2329) accounted for the majority of admissions. Trauma accounted for 49% (896/1841) of emergency admissions. Elective surgery constituted 52% (1202/2316) and emergency surgery 48% (1114/2316) of all procedures performed. The emergency department (55%, 1271/2329), outpatients department (19%, 447/2329), and peripheral hospitals (16%, 378/2329) were the source of the majority of admissions. A complication rate of 9% (208/2316) was observed. Conclusion The high‐volume subspecialist environment at CHBAH presents the ideal environment for delivery of specialist paediatric surgical services and training. Injury prevention, optimal use of existing resources, and additional physical, human and financial resources are required to meet the existing and predicted future burden of paediatric surgical disease.

An audit of trauma laparotomy in children and adolescents highlights the role of damage control surgery and the need for a trauma systems approach to injury in this vulnerable population

“…Of the three patients who died intraoperatively, the median time from injury to admission was 05:39:50 (03:00:07-08:19:32) and the median age was eight years old (3)(4)(5)(6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18). The physiology of the non-survivors is tabulated in Table III.…”

“…In addition, poverty in itself appears to be a risk factor for sustaining trauma. [1][2][3][4][5][6][7][8] In most countries, the incidence of intentional trauma in children is relatively low and this means that most of the trauma in these countries is non-intentional and blunt in nature. Blunt abdominal trauma is increasingly managed non-operatively, and this means that the need for laparotomy in children following abdominal trauma is decreasing.…”

“…This burden of trauma is especially egregious as a major component of it is secondary to interpersonal violence. [1][2][3][4][5][6][7][8] Children in South Africa are at risk of sustaining both intentional and non-intentional trauma. Intentional trauma can be blunt in nature due to blunt assault or penetrating due to either a stab wound or a gunshot wound.…”

“…South Africa has a high rate of penetrating trauma compared to many other countries in the world. [1][2][3][4][5][6][7][8] This impacts on children and there is a high incidence of penetrating injury in children and adolescents in South Africa. Subsequently, the rate of laparotomy in children in South Africa is higher than international norms.…”

Globalization in Pediatric Surgical Training: The Benefit of an International Fellowship in a Low-to-Middle–Income Country Academic Hospital

“…It offers care to a broad spectrum of pediatric surgical patients from neonates to adolescents and has subspecialist units covering the full spectrum of pediatric surgery. 7 Apart from local South African trainees, the department also has a well-established program for international fellowships, both pre-and postqualification. 8 There are few published studies evaluating the benefits of such international collaborations on the global surgical community.…”