Pape J, Swart O, Duvenage R
Department of Surgery, Worcester Hospital and Ukwanda Centre for Rural Health, Stellenbosch University, Cape Town, South Africa.
S Afr Med J. 2019 Jan 31;109(2):122-126. doi: 10.7196/SAMJ.2019.v109i2.13433.
There are limited published data describing surgical admissions at a regional hospital level in the South African (SA) context.
To retrospectively review data from an electronic discharge summary database at a regional SA hospital from 2012 to 2016 to describe the burden of surgical disease by analysing characteristics of the patients admitted.
All discharge summary records for the 4-year period were reviewed after extraction from a database created for the surgery department. Admissions were classified into 5 types: (i) elective surgery or investigations (ESI); (ii) trauma; (iii) burns; (iv) non-traumatic surgical emergencies (NTSE); and (v) unplanned readmission within 30 days. Other variables reviewed were demographic data, the International Statistical Classification of Diseases and Related Health Problems - Version 10 (ICD-10) diagnosis; area of origin; and outcome (death, tertiary referral, discharge). Data were subgrouped into 12-month periods to facilitate trend analysis.
Discharge summaries (N=9 805) over the 4-year study period were assessed and 9 799 were included in the analysis. All data were entered by the attending medical personnel. A total of 5 647 male patients (57.6%) and 4 152 female patients (42.4%) were admitted, with a mean age of 43.3 years (95% confidence interval (CI) 43.0 - 43.8) and a mean length of stay of 4.9 days (95% CI 4.7 - 5.1). Male patients comprised a larger proportion of trauma (83.7%) and burn (63.9%) admissions. The mean length of stay ranged from 3.5 days for elective patients to 9.1 days for burn patients. The most common diagnoses for emergency admissions were appendicitis, peripheral vascular disease and peptic ulcer disease. Common diagnoses for elective admissions were gallstone disease, inguinal hernia, anal fistulas/fissures, and ventral and incisional hernia. The most common cancer diagnoses were of the colorectum, oesophagus, breast and stomach. The overall mortality rate was 2.2%, and highest by subtype was burn patients (6.3%). Trend analysis showed a statistically significant increase in admission for NTSE (p=0.019), trauma (p<0.001) and 30-day readmission rates (p<0.001), with a decrease in admissions for ESI (p=0.001) over the 4 years.
A precise understanding of the burden of disease profile is essential for national, provincial and district budgeting and resource allocation. Ongoing surveillance such as that performed in the study provides this critical information.
在南非背景下，关于地区医院层面外科住院情况的已发表数据有限。
回顾性分析南非一家地区医院2012年至2016年电子出院小结数据库中的数据，通过分析入院患者的特征来描述外科疾病负担。
从为外科创建的数据库中提取的4年期间所有出院小结记录进行了审查。入院分为5种类型：（i）择期手术或检查（ESI）；（ii）创伤；（iii）烧伤；（iv）非创伤性外科急症（NTSE）；（v）30天内非计划再入院。审查的其他变量包括人口统计学数据、国际疾病和相关健康问题统计分类第10版（ICD-10）诊断；来源地区；以及结局（死亡、三级转诊、出院）。数据按12个月时间段分组以方便趋势分析。
对4年研究期间的出院小结（N=9805）进行了评估，9799份纳入分析。所有数据均由主治医务人员录入。共收治男性患者5647例（57.6%），女性患者4152例（42.4%），平均年龄43.3岁（95%置信区间（CI）43.0 - 43.8），平均住院时间4.9天（95%CI 4.7 - 5.1）。男性患者在创伤（83.7%）和烧伤（63.9%）入院患者中占比更大。平均住院时间从择期患者的3.5天到烧伤患者的9.1天不等。急诊入院最常见的诊断为阑尾炎、外周血管疾病和消化性溃疡病。择期入院常见诊断为胆结石病、腹股沟疝、肛瘘/肛裂以及腹侧和切口疝。最常见的癌症诊断为结直肠癌、食管癌、乳腺癌和胃癌。总体死亡率为2.2%按亚型最高的是烧伤患者（6.3%）。趋势分析显示，4年期间NTSE入院（p=0.019）、创伤（p<0.001）和30天再入院率（p<0.001）有统计学显著增加，而ESI入院有所下降（p=0.001）。
准确了解疾病负担概况对于国家、省和地区的预算编制和资源分配至关重要。本研究中进行的持续监测提供了这一关键信息。
