Browsing by Author "Nicol, Andrew"

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    Emergency vs elective surgery ratio in the cape metro area
    (2025) Heynes, Alana; Nicol, Andrew; Maswime, Salome; Peters, Shrikant
    Background: South Africa is classified as an upper middle-income country based on the World Bank classification. The access and delivery of surgical care in South Africa is only recently being investigated and understood. One study by Chu et al showed that while more than 80% of South Africans had two-hour access to district level hospitals, just over half of these hospitals had surgical capacity(1). The emergency to elective surgery ratio (Em:El), which measures the number of emergency surgeries per 100 elective surgeries has been used as a metric to assess the delivery of surgical care. This metric was based on a 2018 study, Emergency-to-Elective Surgery ratio: A global indicator of access to surgical care(2). In this study, the Em:El ratio was assessed pre-the COVID-19 pandemic, as a baseline of service delivery, as well as during the COVID-19 pandemic to assess how the ratio was affected as a result of the pandemic. Methods: A retrospective audit of the computerised database (Clinicom) and the logbooks of Groote Schuur (GSH), a tertiary referral centre and Victoria Wynberg hospital (VWH), a medium district hospital. Data was captured for all patients who underwent elective and emergency surgeries from January 2019 to June 2019 (pre- pandemic) and January 2021 to June 2021(during the pandemic). Results: Pre-pandemic GSH had an Em:El ratio of 60 emergency surgeries per 100 elective cases. During the phase out of lockdown restrictions in 2021 the Em:El ratio increased by 10% to 70 emergency cases per 100 elective cases, indicating the effect the pandemic had on the access to care. Excluding the trauma burden in South Africa and accounting for the positive effect of lockdown on the trauma rate in South Africa, the ratio would have been 28 per 100 cases in 2019 vs 56.9 per 100 cases in 2021, which better reflects the effects on access to surgical care during the Pandemic. VHW showed a doubling in the Em:El ratio when comparing pre-covid vs post-pandemic statistics. Conclusion: Compared to comparative data in high income countries in Europe where the Em:El ratio was 5.5, South Africa has poor access to surgical care as evident by our high Em:El ratio of 60 and 73.2 at GSH and VHW respectively. It is also evident from this study that the Covid pandemic significantly decreased the access to surgical care by increasing this ratio to 70 and 146 at GSH and VHW respectively.
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    Negative pressure wound therapy management of the "open abdomen" following trauma: a prospective study and systematic review
    (BioMed Central Ltd, 2013) Navsaria, Pradeep; Nicol, Andrew; Hudson, Donald; Cockwill, John; Smith, Jennifer
    INTRODUCTION: The use of Negative Pressure Wound Therapy (NPWT) for temporary abdominal closure of open abdomen (OA) wounds is widely accepted. Published outcomes vary according to the specific nature and the aetiology that resulted in an OA. The aim of this study was to evaluate the effectiveness of a new NPWT system specifically used OA resulting from abdominal trauma. METHODS: A prospective study on trauma patients requiring temporary abdominal closure (TAC) with grade 1or 2 OA was carried out. All patients were treated with NPWT (RENASYS AB Smith & Nephew) to achieve TAC. The primary outcome measure was time taken to achieve fascial closure and secondary outcomes were complications and mortality. RESULTS: A total of 20 patients were included. Thirteen patients (65%) achieved fascial closure following a median treatment period of 3 days. Four patients (20%) died of causes unrelated to NPWT. Complications included fistula formation in one patient (5%) with spontaneous resolution during NPWT), bowel necrosis in a single patient (5%) and three cases of infection (15%). No fistulae were present at the end of NPWT. CONCLUSION: This new NPWT kit is safe and effective and results in a high rate of fascial closure and low complication rates in the severely injured trauma patient.
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    Predicting mortality in damage control surgery for major abdominal trauma
    (2010) Timmermans, Joep; Nicol, Andrew; Kairinos, Nick; Teijink, Joep; Prins, Martin; Navsaria, Pradeep
    BACKGROUND: Damage control surgery (DCS) has become well established in the past decade as the surgical strategy to be employed in the unstable trauma patient. The aim of this study was to determine which factors played a predictive role in determining mortality in patients undergoing a damage control laparotomy. MATERIALS AND METHODS: A retrospective review of all patients undergoing a laparotomy and DCS in a level 1 trauma centre over a 3-year period was performed. Twenty-nine potentially predictive variables for mortality were analysed. RESULTS: Of a total of 1 274 patients undergoing a laparotomy for trauma, 74 (6%) required a damage control procedure. The mean age was 28 years (range 14 - 53 years). The mechanism of injury was gunshot wounds in 57 cases (77%), blunt trauma in 14 (19%) and stabs in 3 (4%). Twenty patients died, giving an overall mortality rate of 27%. Factors significantly associated with increased mortality were increasing age (p=0.001), low base excess (p=0.002), pH (p<0.001), core temperature (p=0.002), and high blood transfusion requirement over 24 hours (p=0.002). CONCLUSION: The overall survival of patients after damage control procedures for abdominal trauma was excellent (73%). The main factors that are useful in deciding when to initiate DCS are age, base excess, pH and the core temperature.
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    Predicting mortality in damage control surgery for major abdominal trauma
    (Academy of Science of South Africa, 2010) Timmermans, Joep; Nicol, Andrew; Kairinos, Nick; Teijink, Joep; Prins, Martin; Navsaria, Pradeep
    Damage control surgery (DCS) has become well established in the past decade as the surgical strategy to be employed in the unstable trauma patient. The aim of this study was to determine which factors played a predictive role in determining mortality in patients undergoing a damage control laparotomy. Materials and methods. A retrospective review of all patients undergoing a laparotomy and DCS in a level 1 trauma centre over a 3-year period was performed. Twenty-nine potentially predictive variables for mortality were analysed. Results. Of a total of 1 274 patients undergoing a laparotomy for trauma, 74 (6%) required a damage control procedure. The mean age was 28 years (range 14 - 53 years). The mechanism of injury was gunshot wounds in 57 cases (77%), blunt trauma in 14 (19%) and stabs in 3 (4%). Twenty patients died, giving an overall mortality rate of 27%. Factors significantly associated with increased mortality were increasing age (p=0.001), low base excess (p=0.002), pH (p<0.001), core temperature (p=0.002), and high blood transfusion requirement over 24 hours (p=0.002). Conclusion. The overall survival of patients after damage control procedures for abdominal trauma is excellent (73%). The main factors that are useful in deciding when to initiate DCS are age, base excess, pH and the core temperature.
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    The role of computerised tomographic angiograms (CTA) and lateral neck radiographs in penetrating neck oesophageal injuries
    (2019) Oompie, Ferdinand Musawenkosi; Pennel, Timothy; Nicol, Andrew
    Background South Africa has a high rate of injuries related to violence which includes penetrating neck injuries (PNI’s). Of the 163 patients that are annually referred for contrast swallow studies to exclude associated pharyngo-oesophageal injuries (PPOI’s), only 0-14% contrast studies confirm injury. The contrast swallow is still viewed as the ‘gold standard’ for oesophageal pathology even in the modern era of digital general radiography and Multidetector Computerized Tomographic Angiogram (MDCTA). This procedure is however time consuming and requires good cooperation, sometimes from acutely ill patients which is not always possible. This contributes to delay in final management of the patient which is the most significant contributor to associated complications. The study reviewed whether the less time-consuming MDCTA’s and lateral soft tissue radiographs usually performed before the contrast swallow studies can also be used to diagnose POI’s. This will reduce dependence and possibly exclude the contrast swallow study, thus reducing the time delay in POI pre-operative investigations. Methods A retrospective review was undertaken of the radiological findings of all patients who presented at Groote Schuur Hospital over a 28-month period with suspected penetrating neck injuries and were investigated with a contrast swallow, MDCTA and lateral soft tissue radiograph. The time interval between request of the contrast swallow study and the final report was calculated as the difference in the time indicated on the Groote Schuur Hospital Philips Extended Internet Radiology Information System (XIRIS) by the requesting clinician and the time indicated on the radiology report after completion of the study on the Philips Picture Archiving and Communicating System (PACS). Results Of the 389 patients referred, 153 patients met the study criteria. Fourteen patients (9%) had PPOI’s on contrast swallow. The majority of the patients with PPOI’s had prevertebral air (12; sensitivity of 85.7%), however a majority of patients with prevertebral air had no POI’s (90; specificity of 35.3%). In 28 MDCTA’s where there was suspicion of PPOI’s, six contrast swallows confirmed oesophageal leaks (42.9% sensitivity). Although there was no suspicion of PPOI’S in 125 patients undergoing MDCTA’s, eight were found to be positive for leaks on contrast swallow (84.2% specificity). The mean time interval between request of the contrast swallow study and final report was 586 minutes. Conclusion Contrast swallow remains the gold ‘standard’ for diagnosing PPOI’s in patients with PNI’s. The lateral soft tissue radiograph was unreliable in predicting POI’s with a low specificity of 35%. MDCTA’s was also not contributory in assisting diagnoses of PPOI’s with a low sensitivity of 43%. The two modalities can thus not be considered as augmentation or alternative diagnostic modalities. The time delay between the request and reporting of the contrast swallow is longer than that in literature and needs improvement.
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    Violence against women : a prospective study of women presenting to a South African trauma centre
    (2015) Dedekind, Britta; Nicol, Andrew; Kahn, Delawir
    Background - Violence against Women is a major public health issue, and it is universally under reported. Objective - To conduct an injury surveillance of severe or life threatening violent acts against women, to determine the demographics of the injured women and to identify the nature of the perpetrators. Methods - A standardized structured questionnaire administered in an interview conducted on female patients admitted to the Trauma Centre at Groote Schuur Hospital as a result of interpersonal violence. Age, level of education, employment status, housing and substance abuse was recorded.