Browsing by Author "Nejthardt, Marcin"

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    Open Access
    A study of the prevalence of preoperative anaemia and iron deficiency in adult elective surgical patients in hospitals in the western cape province, South Africa. “A multicentre prospective observational study of the prevalence of preoperative anaemia and iron deficiency in adult elective surgical patients in hospitals in western cape province, South Africa.”
    (2021) Conradie, Willem Stephanus; Roodt, Francois; Biccard, Bruce; Nejthardt, Marcin
    Background. Preoperative anaemia has been shown to be an independent risk factor for postoperative morbidity and mortality. Iron deficiency is the leading cause of anaemia globally. There are limited data describing the burden of perioperative anaemia and the relative contribution of iron deficiency in South Africa (SA). Objectives. To determine the prevalence and severity of preoperative anaemia in adults presenting for elective surgery in Western Cape Province, SA, and to investigate the contribution of iron deficiency as a cause of the anaemia. For this purpose, an investigative protocol from a recent consensus statement on the management of perioperative anaemia was applied. Methods. We performed a prospective, observational study in adult patients presenting for elective non-cardiac, non-obstetric surgery over a 5-day period at six Western Cape government-funded hospitals. The World Health Organization patient classification was applied, and patients with anaemia were investigated for iron deficiency. Results. The prevalence of preoperative anaemia was 28% (105/375; 95% confidence interval (CI) 23.5 - 32.5); 55/105 patients (52%) had moderate and 11/105 (11%) severe anaemia. Iron deficiency was the cause of anaemia in 37% (32/87; 95% CI 26.6 - 46.9), but only 9% of irondeficient patients received iron supplementation prior to surgery. Conclusions. Preoperative anaemia was common in this study, and more than half of the affected patients had moderate to severe anaemia. Iron deficiency was responsible for almost 40% of cases. Iron supplementation was under-utilised in the preoperative period as a means of increasing haemoglobin. The introduction of system-wide policies would empower perioperative physicians to mitigate the risk associated with preoperative anaemia in the Western Cape.
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    An audit of the prevalence of abnormal fasting blood glucose levels in patients presenting for elective surgery at a selection of Western Cape government hospitals
    (2019) Biesman-Simons, Tessa; Nejthardt, Marcin; Biccard, Bruce; Roodt, Francois
    Background. Diabetes mellitus (DM) is a common condition. The high burden of undiagnosed DM and lack of large population studies make accurate prevalence estimations difficult, especially in the surgical environment. Furthermore, poorly controlled DM is associated with an increased risk of perioperative complications and mortality. Objectives. The primary objective was to establish the prevalence of DM in elective adult non-cardiac, non-obstetric surgical patients in Western Cape hospitals. The secondary objectives were to assess the glycaemic control and compliance with treatment of known diabetics. Methods. This was a five-day, multicentre, prospective observational study performed at six government-funded hospitals in the Western Cape. Screening for DM was done using fingerprick capillary blood glucose (CBG) testing. Patients found to have a CBG of ≥ 6.5 mmol/L had an HbA1c level done. DM was diagnosed based on the Society for Endocrinology, Metabolism and Diabetes of South Africa (SEMDSA) diagnostic criteria. Patients known with DM had an HbA1c performed and Morisky Medication Adherence Scale (MMAS-4) questionnaires completed, to assess glycaemic control and compliance with treatment. Results. Of the 379 participants, 61 were known diabetics (16.15%; 95% CI 12.4-19.8%). After exclusion of eight patients with incomplete results, a new diagnosis of DM was made in five out of 310 patients (1.6%; 95% CI 0.2-3.0%). Overall prevalence of DM was 17.8% (66/371; 95% CI 13.9-21.7%). HbA1c results were available in 57 (93.4%) of the 61 known diabetics. Of these 27 (47.4%; 95% CI 34.4-60.3%) had an HbA1c level≥8.5% and 14 (24.6%; 95% CI 13.4 - 35.8%) had an HbA1c ≤7%. Based on positive responses to two or more questions on their MMAS-4 questionnaires, 12 out of 60 participants (20%) were deemed non-compliant. Conclusion. There is a low rate of undiagnosed DM in our elective surgical population; however there is a large proportion of poorly controlled DM. Since poorly controlled DM is known to increase postoperative complications, this likely increases the burden of perioperative care. Resources should be focused on improvement of long-term glycaemic control in patients presenting for elective surgery.
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    The prevalence of substance use in anaesthesia practitioners in South Africa
    (2020) van Der Westhuizen, Justine; Dyer, Robert; Nejthardt, Marcin
    Introduction: Substance abuse has twice the mortality in United States anaesthesia- than non-anaesthesia residents. Since no data exist, the primary objective of this cross-sectional study was to establish the prevalence of substance use in South African anaesthesia practitioners. Secondary objectives were to compare the prevalence in male and female practitioners, and in private- and state practice anaesthetists. Years of experience and level of training were explored as possible risk factors for hazardous or harmful use. Method: Participants completed a self-administered, validated WHO questionnaire, run for ten days surrounding the 2018 South African Society of Anaesthesiologists (SASA) congress. All doctors practicing anaesthesia in South Africa were eligible. Recruitment was via an email link sent to all SASA members, as well as a web-based link at the congress. Results: A total of 1961 SASA members and 113 non-members (anaesthesiologists, registrars and non-specialists) were invited to participate (total 2074). There were 434 responses (response rate 20.9%, margin of error 4.18%); 364 were suitable for analysis. The most commonly lifetime-used substances were alcohol (92.8%), tobacco (42.3%), cannabis (34.7%), and sedatives (34.4%). Questionnaire scores defined low-, medium- and high-risk categories according to substance use during the previous 3 months. Sedative (12.6%) and alcohol (12.1%) users were deemed to be at moderate risk. The prevalence of opioid use was 1.9% (n=7). Prevalence of substance use was similar in male and female practitioners, as well as in those working in private practice or in state hospitals. Conclusion: The prevalence of current use of alcohol and sedatives is of major concern. A significant proportion of respondents were assessed to be at moderate risk of hazardous or harmful substance use. Gender and practice setting have little impact on substance use. Wellness efforts should be aimed at all anaesthesia practitioners in South Africa.