Browsing by Author "Gibbs, Matthew"

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    Anaemia in a South African colorectal ERAS programme – identifying the prevalence and predictors of preoperative anaemia and the effect on post-operative complications and length of stay
    (2023) Nieuwenhuis, Kathryn; Gibbs, Matthew; Louw, Vernon; Alphonsus; Warden, C; Boutall, A; Bannister, S
    Background: Anaemia is a widespread public health problem associated with increased mortality and morbidity. In a surgical population, the prevalence of preoperative anaemia often exceeds that of the general population. Elective colorectal patients often have multiple risk factors for preoperative anaemia. The fourth updated ERAS Society guidelines for optimal perioperative care in colorectal surgery include specific recommendations for screening and treatment of preoperative anaemia as well as utilising restrictive blood transfusion practice. Assessing the prevalence and predictors of anaemia and outcomes in this population may allow for improved preoperative assessment and treatment of colorectal patients in a resource limited setting. Objectives: The primary objective of this retrospective study was to determine the prevalence of anaemia in the colorectal surgical population who were part of the enhanced recovery after surgery (ERAS) programme at a tertiary level hospital in the Western Cape, South Africa. Secondary objectives were to determine independent risk factors of preoperative anaemia, and the effect of anaemia on post-operative complications and length of stay after elective colorectal surgery. Methods: We performed a secondary analysis of data collected for the colorectal surgical ERAS programme. Data of 260 patients was reviewed from the initiation of the database 01 September 2016 to 30 September 2019. Three regression analyses were performed as part of the secondary objective to determine the risk factors for preoperative anaemia and predictors for postoperative complications and length of hospital stay. Patients were defined as anaemic if their haemoglobin was less than 13.0 g/dL. Results: The prevalence of preoperative anaemia was 157/260 (60.3%). Female sex (odds ratio (OR) 2.44, 95% confidence interval (CI) 1.43 – 4.18; p=0.001) and the presence of malignancy (OR 2.42, CI 1.26- 4.67; p=0.008) showed a significant association with anaemia. Anaemia was not associated with increased risk of post-operative complications or length of hospital stay. Conclusion: South African colorectal surgical patients in an enhanced recovery after surgery programme have a higher prevalence of preoperative anaemia compared to the general surgical population. Predictors of preoperative anaemia in this population included female sex and the presence of malignancy. Long waiting lists for patients awaiting elective colorectal surgery allow time for evaluation and optimisation of patients at risk for anaemia preoperatively
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    Perioperative ultrasound among South African anaesthetists: a survey of current practice and availability
    (2023) Kathrada, Mohammad; Gibbs, Matthew; Swanevelder Justiaan
    Background: Point-of-care ultrasound (POCUS) is becoming part of the standard skill set of the modern-day anaesthetist. There is limited knowledge regarding the availability of ultrasound (US) and POCUS skills in South Africa. There may be barriers to adopting US in many institutions. Methods: An observational cohort questionnaire was distributed via an online REDCap survey. All doctors practising anaesthesia in South Africa were eligible. Recruitment was done via an email link that was sent to South African Society of Anaesthesiologists (SASA) members. Non-SASA members were recruited via departmental mailing lists or social media. Results: Of the 580 respondents, 478 were SASA members (response rate 22.9%, confidence interval 3.94) and 102 were non-SASA members. In total, 571 surveys were suitable for analysis, 397 (69.5%) respondents had more than five years anaesthesia experience, 558 (97.7%) of respondents worked in hospitals that have US machines available, and 76.7% had US readily available after hours. Respondents used US mostly for central venous catheter (CVC) insertions (77.9%), regional anaesthesia (82.3%), and cardiac and lung assessments (26.4% and 17.7%, respectively). It is used much less frequently for neuraxial anaesthesia (1.4%). Of the respondents, 382 (66.9%) had received US training, only 198 (34.7%) felt confident in their US skills, and 482 (84.4%) wish to have further US training. The two most significant barriers to US were lack of equipment and lack of training at postgraduate level. Conclusion: South African anaesthetists work at institutions where US equipment is generally available, and most practitioners want to incorporate US in their practice. However, anaesthetists feel insecure with respect to their skills and indicated that they wish to receive further training. Efforts should be made to formalise POCUS training in the Fellowship of the College of Anaesthetists (FCA) curriculum and make US training more accessible.
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    The impact of point-of-care transthoracic echocardiography on management of patients presenting for emergency surgery in a resource-limited setting
    (2022) Munsie, Robert David; Gibbs, Matthew
    Objective: In this study of patients presenting for non-cardiac, emergency surgery in a resource limited setting, we aimed to evaluate the impact of routine preoperative transthoracic echocardiography on perioperative management. Design: A prospective before- and after-study of adult patients presenting for emergency, non-cardiac, non-obstetric surgery. Setting: The study was performed at an academic hospital in Cape Town, South Africa. Participants: Consenting patients over 18 years of age presenting for emergency surgery enrolled via convenience sampling during working hours over a 10 day period. Interventions: Basic and advanced Focused Assessment Transthoracic Echocardiography (FATE) was performed to evaluate ventricular function, valvular pathology and fluid status. After completing an assessment and treatment plan, the FATE findings were disclosed to the treating anesthetist. A post FATE plan was subsequently completed. Measurements and Main Results: A total of 67 patients were scanned with a change in management detected in 55% of cases. Thirty-nine percent of these alterations were in response to fluid management strategies with 31% of patients scanned being assessed as hypovolemic. There was a statistically significant link between patient volume status and change in perioperative management (p=0.0003). The presence or absence of valvular pathology also led to a significant association with change in management (p=0.020), most commonly in relation to the decision to proceed with surgery or the use of additional monitoring. Conclusion: This observational study of adult patients presenting for emergency surgery in an upper middle-income country demonstrates that routine preoperative transthoracic echocardiography has an impact on perioperative anesthetic management.
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    Transfusion medicine knowledge amongst specialist trainees at Groote schuur Hospital -using the BEST-TEST
    (2023) Swart, Andries; Gibbs, Matthew
    Background: The primary aim was to assess transfusion medicine knowledge amongst specialist trainees at a South African tertiary hospital. Secondary aims included identifying shortcomings and describing differences in knowledge between subspecialty groups, comparing self-perceived knowledge against a known standard. Method: The Biomedical Excellence for Safer Transfusions test, or BEST test,1 was utilised to assess base knowledge amongst specialist trainees at a large tertiary hospital. It was administered as a secure online REDCap questionnaire sent to all eligible specialist trainees at Groote Schuur Hospital. Results: There were 104 responses of 241 eligible trainees, a response rate of 43.2%. The overall mean score for correct responses of the BEST test was 44.1% (median 40%), which is similar to studies using the BEST test in non-South African contexts. Most specialist trainees thought more transfusion training was needed (80.8% agreeing or strongly agreeing), and 70.2% rating it as very important. Self-perception of transfusion knowledge did not equate with the BEST test score. Compared to contexts outside Africa, respondents could better identify the risks of transfusion transmitted infections, but had difficulty with the administration of prophylactic platelets. The average scores for the BEST test did not markedly differ between specialties. Conclusion: Transfusion knowledge amongst specialist trainees in a large, tertiary hospital is deficient, and there is recognition amongst the specialist trainees that further training is required. However, the standard of transfusion knowledge in this institution is similar to other areas of the globe, which suggests that the global knowledge of transfusion medicine is inadequate.