OpenUCT :: Browsing by Subject "Groote Schuur Hospital"

Browsing by Subject "Groote Schuur Hospital"

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Open Access
A retrospective review (audit) of gynaecological emergency surgery at Groote Schuur Hospital for the period of January to December 2019
(2024) Hlako, Tebogo Clive; Adams, Tracey Sheridan
Background. Gynaecological emergencies are a common cause of morbidity and mortality among women of reproductive age worldwide. There is less audit done on the burden of emergency surgery in developing countries. Objectives. The planned study analysed the clinical processes and outcomes of gynaecological emergency surgeries performed at a tertiary level hospital in the Western Cape (Groote Schuur) in the year 2019. Methods. The study was a retrospective descriptive record review of patients who underwent emergency surgery at Groote Schuur Hospital. Data was captured manually and electronically using theatre data base. Statistical analysis was performed using SPSS Statistics for Windows 2021. Results. We analysed 290 completed women records. The mean age was 30.16, with 230 (79.3%) women of reproductive age. There were 234 (79.1%) pregnancy related surgical procedures done. The most common occurrence among pregnancy related surgeries was ectopic pregnancy, accounting for 112 (47.9%) cases. A total of 130 (44.8%) women had anaemia and 125 (43.1%) had a tachycardia prior to surgery. Twenty-seven (9.3%) women were in hypovolaemic shock before surgery. A total of 179 (61.7%) women had the surgery 4 hours after being booked in theatre. Only 46 (15.9%) women accessed surgery within 2 hours. Twenty (6.9%) women had to wait for more than 24 hours for their operation to be done. The most common reason for the 24-hour delay, accounting for 85% (N=17), was the lack of emergency theatre time, as other cases from different disciplines were given priority. There were 42 (14.5%) women with complications post operatively and no mortality recorded. Conclusion. The study indicates good outcomes for emergency gynaecological surgeries performed at Groote Schuur Hospital in 2019. However, significant delays between the decision for surgical intervention and the actual performance of the surgeries were highlighted. The delays in hypovolaemic women were attributed to the need to compete with other surgical disciplines for emergency theatre time.
Open Access
Audit of the reporting adequacy of magnetic resonance enterograph performed in patients with Crohn's disease at Groote Schuur Hospital
(2025) Smit, Elsabe Jacoba; Moosa, Sulaiman
Background: CD is an idiopathic inflammatory bowel disease with a predilection for the terminal ileum and the colon. MRE is the cornerstone imaging modality for evaluating and monitoring CD. This audit aims to assess the adequacy of radiology reports for MRE in CD patients, performed at GSH. Objectives: Determine the proportion reporting elements included in MRE reports for patients with CD and compare it to international recommendations of essential elements to include in MRE reports, Evaluate the lexicon usage, Evaluate the structure and clarity. Method: Retrospective audit, assessing adequacy of radiology reports for patients with CD who underwent MRE examinations at GSH. This forms the first leg of an audit cycle assessing local practice standards and make recommendations for future improvements should target standards not be met. Results: Overall, none of the data points collected met our 70% cut-off for minimum requirements. Technical factors were particularly poorly reported (8%), with some improvement in Radiological factors (66%). There was suboptimal use of correct nomenclature and documentation of treatment response. Structured reporting was not correlated to improved documentation but did increase readability (p<0.01). Conclusion: This audit shows there is suboptimal documentation of essential elements in the MRE reports for patients with CD at GSH, including poor use of correct nomenclature and documentation of treatment response. Structured reporting has a role to play in increasing readability of reports. Contribution: The findings suggest a complete audit cycle should be implemented with targeted education on reporting of MRE studies, followed by reauditing of the findings.
Open Access
Diagnostic utility of pericardial fluid pH in diagnosing infectious pericardial effusions among patients with moderate and large effusions undergoing pericardiocentesis at Groote Schuur Hospital: a subs-study of the IMPI trial
(2020) Kiggundu, Brian; Ntsekhe, Mpiko
Diagnosis of infectious pericardial disease has been challenging in the developing world despite improvement of treatment modalities. The diagnostic utility of pH in diagnosing infectious pericardial fluid is unknown, yet this concept is well studied in pleural fluid. This cross-sectional diagnostic study evaluated the diagnostic utility of pH in infectious compared to non-infectious pericardial effusions in a high-burden setting. Methods: Patients of 18 years with moderate to large effusion between the 1st February 2016 and 31st May2018 were enrolled at Groote Schuur Hospital in Cape Town, South Africa. After safe pericardiocentesis, pH was measured with a blood gas analyzer. Mycobacterium tuberculosis culture and/or gene Xpert for TB and/or bacteria culture and/or microscopy served as the reference standard for definite infectious pericardial effusions. We calculated sensitivity, specificity, positive and negative predictive values, negative and positive likelihood ratios for an a priori pH cut off of 7.35. Receiver operating characteristic curve analysis was used for selection of ideal pH cut off. RESULTS Using a set sensitivity of 70% we estimated that we needed to recruit a sample size of 149 subjects for a 95% confidence interval and power of 80%. We screened 200 patients, and excluded 60 because they did not meet the appropriate exclusion criteria. The prevalence of infectious pericarditis was 27.1% (n/N=34/140) as confirmed by the reference standard. We found the median pH (IQR) was 7.30(7.20-7.30) for definite infection, 7.30(7.30-7.35) for probable infection and 7.50(7.40-7.55) for non-infectious effusions p value <0.01 (test for trend). At a cut off or <7.35, the sensitivity was 89.5(95%CI: 75%.5-97.1%) and the specificity was 72.5% (95% CI: 62.8%-80.9%). The ideal ROC- determined cut off for pH that would give maximum sensitivity and specificity was ≤7.30 and the maximum sensitivity and specificity at optimum cut off are 86.8% (95% CI:71.9 - 95.6) and 86.8% (95% CI:71.9 - 95.6), respectively. The area under the curve at this cut-off point is 0.86 (95% CI 0.79 to 0.9), p<0. 001. CONCLUSION: In conclusion, pericardial PH offers diagnostic utility for infectious causes of pericardial effusions using both a PH of 7.35 and an ideal cut-off of 7.30. We recommend that given the simplicity of the test it should be adopted in evaluation of patients with pericardial effusions.
Open Access
Estimating the treatment cost of colon cancer at Groote Schuur Hospital
(2025) Nnene, Kelechi; Cunnama, Lucy; Moodley, Jennifer; Ataguba, John
Background: Due to the high mortality-to-incidence ratio of colon cancer in South Africa, urgent public health measures are needed to improve treatment outcomes. Costing studies can be leveraged to understand the treatment cost burden for colon cancer, providing crucial insights for allocating resources to finance such measures. This study aims to assess treatment options and costs for colon cancer treatment from the perspective of healthcare providers at a public healthcare facility in South Africa. Method: The study used an ingredient-based approach to assess colon cancer treatment costs by stage at the colorectal clinic and combined colorectal oncology unit at Groote Schuur Hospital. The costing process involved two steps: first, treatment options were defined according to facility guidelines and verified through expert interviews; then, these options were linked to relevant cost items for each cancer stage based on expert input. Second, a bottom-up costing method was used to estimate and aggregate per-patient costs across treatment components for each stage. One-way sensitivity analysis addressed uncertainties in post-surgical inpatient admissions and staff categories. All costs are presented in 2024 South African Rands (ZAR) and United States Dollars (USD). Results: Colon cancer treatment components include staging and risk assessment investigations, clinical consultations, surgery and chemotherapy. The estimated guideline-based per-patient costs for treatment are R60,156 ($3,216) for stages I and II (low-risk); R75,132 ($4,017) for high-risk stage II and stage III; and R171,935 ($9,193) for stage IV. Surgical treatment represents a major cost driver, with additional expenses from inpatient admissions following surgery. Sensitivity analysis indicates that reducing postoperative inpatient stay by 25% lowers the treatment cost by approximately 5% across all stages. Conclusion: Colon cancer treatment costs are significant, increasing with each colon cancer stage. To manage these escalating costs and reduce the overall healthcare burden, policies should prioritise early detection and invest in accessible, stage-appropriate interventions to improve patient outcomes.
Open Access
Giving birth to a new approach: a retrospective comparison of radiation safety parameters between transradial and transfemoral approaches for uterine fibroid embolization at Groote Schuur Hospital, South Africa
(2025) Kassim, Jateel; Creamer, Dale Kurt
Background: Uterine artery embolisation (UAE) is a recognised minimally invasive, effective and fertility preserving treatment option for patients with symptomatic uterine leiomyomas. The conventional transfemoral access (TFA) in UAEs remains the method of choice for the majority of South African interventional radiologists. Transradial access (TRA) has grown as a viable alternate vascular access. The advantages of TRA over TFA have been well documented, however a lack of safety parameter comparison in procedures performed via TRA versus TFA remains. Objectives: To compare the mean radiation dose and accumulative fluoroscopy time between TRA and TFA UAEs performed for the treatment of uterine leiomyomas. Method A single-institution retrospective study was conducted on all female patients having undergone UAE for symptomatic uterine leiomyomas at GSH between 1 January 2018 and 31 March 2020. Safety parameters between TFA and TRA UAEs were compared. Results Of the 61 patients having undergone UAEs, 29 were TFA and 32 TRA UAEs. No statistical difference was observed between the procedural and screening times, however there was a statistically significant difference for mean radiation dose: TFA recorded a mean radiation dose of 1 158 (95% CI 721- 1596), TRA had a mean of 639 (95% CI 36-1243 units) higher than TFA (p-value = 0.038). Conclusion: The comparison of the majority of the safety parameters between TRA and TFA UAEs in our study demonstrated no statistical significance. The increase in radiation dose in the TRA vs TFA group is comparable to other studies and although statistically significant, is small. Therefore, TRA still forms a safe viable alternate form of access for UAEs
Open Access
Investigation of circulatory and tissue-specific metabolomic biomarkers in valvular heart disease using mass spectrometry
(2025) Mutithu, Daniel Wakiri; Ntusi, Ntobeko; Naidoo, Richard; Skatulla, Sebastian
The work presented in this thesis was based on an investigation of the circulatory and tissue specific metabolic biomarkers in patients with rheumatic heart disease (RHD) and degenerative aortic stenosis (AS), compared to matched, healthy controls. The study hypothesis was that cardiac tissue obtained from heart valve biopsies from RHD and degenerative AS patients would have distinct histological features. The second hypothesis was that severe RHD and degenerative AS patients have distinct serum and tissue specific metabolic profiles. The third hypothesis was that pathologic regions on heart valves would have distinct spatial metabolomic profiles compared to non-diseased regions of the valves. Whole blood samples were collected from matched participants with a diagnosis of RHD and degenerative AS, as well as matched controls recruited from the Cardiac Clinic at Groote Schuur Hospital. Valve tissue samples were collected from patients undergoing valve replacement surgery at Groote Schuur Hospital. Haematoxylin and eosin staining was used to assess the histopathological features of the heart valves. Untargeted metabolomics was performed on serum and valve tissues using ultra-performance liquid chromatography with quadrupole time-of-flight mass spectrometry. In-situ biomarker localisation was performed with matrix assisted laser desorption ionisation mass spectrometry imaging. Univariate and multivariate statistical analyses was used to explore covariation with the potential metabolomic biomarkers and bioinformatics tools used to explore the gene-metabolite interactions. The study had several key observations. First, though rare, we reported that chronic RHD may be admixed with features of acute rheumatic fever, within the same patient. Second, using an untargeted/discovery approach, we identified metabolites involved in the major energetic pathways, amino acids metabolism, and inflammation regulation which were altered in RHD and degenerative AS. The identified biomarkers were associated with cardiovascular imaging-based remodelling parameters. Third, RHD patients with single or double valve replacement, and degenerative AS patients demonstrated distinct tissue-specific metabolic signatures. Metabolites involved in amino acid, fatty acid, and crucial biomolecule metabolism were associated with histopathological and cardiovascular imaging-based parameters of valvular heart disease. Finally, tissue-specific metabolites could be localised on valve biopsies obtained from RHD and degenerative AS participants, though no differences were observed between the two group.
Open Access
Outcomes of mechanical thrombectomy at a single-centre tertiary level public health care hospital in South Africa
(2025) Kiriinya, Martin; Taylor, Allan; Bateman, Kathleen; Le Feuvre, David
Introduction: Mechanical thrombectomy (MT) is standard of care for acute ischemic stroke from large vessel occlusion following randomized controlled trials performed largely in high-income countries. Limited data exists on its effectiveness in the real-world setting, particularly in low- and middle-income countries. We aimed to evaluate the safety and efficacy of MT in a public hospital in Cape Town, South Africa. Methods: We evaluated acute ischaemic stroke patients presenting consecutively to Groote Schuur Hospital between 01 January 2018 to 01 January 2022 with proximal intracranial occlusion in the anterior circulation treated with MT within 6 hours from onset using CT and CTA imaging-based protocols. Demographic, clinical, radiological and procedural data were obtained from the stroke unit database. Recanalization was evaluated post-procedure by modified Treatment in Cerebral Infarction score (mTICI). We assessed functional independence (modified Rankin scores (mRS) 0-2) and mortality at 90 days. Results: Thrombectomies were performed in 84 patients during the study period. The median age was 56 years and 51% of participants were female. Median National Institute of Health Stroke Score was 18 and median baseline Alberta Stroke Programme Early CT score was 8. Bridging thrombolysis was given to 65% of participants. Median time from symptom onset to reperfusion was 339 minutes. Successful recanalization (mTICI 2b/3) was obtained in 62%. At 90 days, 34 % of participants reached functional independence and mortality was 34% . Conclusions: We achieved similar rates of recanalization and functional independence to that seen in trials in high-income countries using basic imaging despite a higher mortality and longer median time to reperfusion. These data support the effectiveness of MT in a public hospital in south Africa despite the challenges of providing emergent stroke care in a resource-constrained setting.
Open Access
Pain assessment and management: An audit of practice at a tertiary hospital
(2019) Prempeh, Nana Agya Boakye Atonsah; Parker, Romy; Duys, Rowan; De Vaal, Alma
Background: Despite advances in techniques and analgesics for pain management, pain remains a major health problem. Regular assessment and reassessment of pain using guidelines with measurable goals is essential for effective pain management in acute hospital settings. Unfortunately, no such guidelines exist in South Africa. To implement appropriate precepts for the South African context, current practice must be understood. Aim: To evaluate pain assessment and management of patients in two surgical wards at Groote Schuur Hospital. Setting: Groote Schuur Hospital is a government-funded tertiary academic institution within the Western Cape Province of South Africa. The patients at this hospital are generally from the low-income strata and live in resource-poor communities. Methods: A cross-sectional, retrospective medical record audit was conducted. The folders of all 215 patients admitted to a specific orthopaedic trauma and urogynaecological ward at Groote Schuur Hospital in June 2015 were targeted for review. Medical folders not available or with missing notes were excluded. Variables evaluated included the number of pain assessments recorded, pain assessor, assessment tool and management plan. Results: 168 folders were available for review. Nearly half of the patients had no documented pain assessment. When pain assessment was conducted, the verbal rating scale was the predominant tool used, and assessments were mostly conducted by the ward doctor. Pain interventions appeared to be primarily based on the professional knowledge and experience of the practitioner and were not evidence-based. Conclusion: Pain assessment and management was a problem in the two wards reviewed, which is similar to the findings of studies referenced in this text. Health professionals need to be empowered to manage pain adequately. An assessment tool, which integrates the biopsychosocial factors that influence the pain experience, should be routinely employed by a multidisciplinary team to facilitate goal-directed therapy.
Open Access
The costing of COVID-19 intensive care units at a tertiary hospital in Cape Town, South Africa
(2024) Hood, Kirsten; Joubert, Ivan; Cunnama, Lucy; Peters, Shrikant
Background: The expansion of Groote Schuur Hospital's (GSH) Intensive Care Unit (ICU) capacity to accommodate an unprecedented number of patients during the COVID-19 pandemic was an expensive undertaking. There are currently no published formal retrospective analyses of the financial costs of running and expanding COVID-ICUs in South Africa. Objectives: To conduct a cost analysis of the COVID-ICU service at a tertiary state hospital in Cape Town, South Africa. This analysis included the cost of COVID-ICU admissions relating to the first four COVID waves. Aims were to estimate total costs, in-patient day costs, and cost drivers for COVID-ICU. Methods: A retrospective cost analysis (quantitative observational study) using a mixed methods costing approach, was conducted across the COVID-ICUs at GSH. The data used included two consecutive hospital financial years, between April 2020 and March 2022. Costs were calculated monthly and then combined to achieve a total cost over the two-year period. COVID-ICU in-patient days were used as the primary allocation factor. Cost inputs included recurrent costs such as human resources, diagnostics, pharmaceuticals, oxygen, enteral feeds, blood products, consumables, and overheads, as well as capital costs including equipment, and building space. Results: The study period covered the four COVID waves that affected GSH ICU units between April 2020 and March 2022. This period included 10 497 COVID-ICU in-patient days resulting from a total of 776 COVID-ICU admissions. The total calculated spending across the two financial years was R262 482 904, resulting in a cost per in-patient day of R25 006, and a utilisation of 4,4% of the total hospital budget during the same period. The median length of stay was nine days, resulting in a median cost per admission of R225 050. The top five cost drivers were human resources (60%), consumables (9%), pharmaceuticals (8%), oxygen (5%), and overheads (5%). Conclusion: This is a retrospective costing study of the COVID-ICUs at a tertiary hospital in Cape Town, throughout the entire portion of the pandemic that required ICU admissions in South Africa. This analysis provides useful financial insights, a potential economic model for ICU budgeting, and creates a platform for future economic analyses and policy planning regarding level-of-care decisions for general ICU admissions or for similar future pandemics within the South African and LMIC hospital setting.
Open Access
Therapeutic drug monitoring of anti-TNF biologics in patients with Crohn's disease at Groote Schuur Hospital, Cape Town, South Africa
(2024) Sungay, Mohamed Yaaseen; Watermeyer, Gillian; Setshedi, Mashiko
Monoclonal antibodies targeting Tumour Necrosis Factor-α (TNF α) have revolutionised the management of Inflammatory Bowel Disease (IBD) and have proved highly effective in both inducing and maintaining remission in both ulcerative colitis (UC) and Crohn's disease (CD). The advent of Therapeutic Drug monitoring (TDM) in recent years has allowed further optimisation of their use. TDM involves the measurement of serum trough levels (TLs) and anti-drug antibodies (ADAs), with higher serum drug concentrations and the absence of ADAs associated with favourable therapeutic outcomes. Adjustment of anti-TNF therapy based on reactive TDM in patients who are either primary non-responders or have secondary loss of response to these biologics is associated with superior clinical outcomes when compared to empiric escalation of therapy. In this study we explore the efficacy of TDM since it was first implemented in our practice and the impact on clinical outcomes in patients with CD in our resource limited setting. Method A retrospective cohort study was performed on all patients with CD treated with an anti-TNF biologic, either infliximab or adalimumab, who underwent TDM since it was first implemented in the IBD clinic at Groote Schuur hospital, Cape Town, South Africa in between July 2018, and March 2023. Hospital records were analysed, and relevant demographic variables and clinical outcomes were extracted. Results Sixty-nine patients with Crohn's Disease started treatment with an Anti TNF, of which 53 were identified to have had undergone reactive TDM. Forty seven (90%) were treated with an immunomodulator prior to starting anti TNF therapy. The median time from initiation of anti TNFs to first TDM was 9.5 months (IQR5-35); 35 patients (67%) had sub-therapeutic trough levels at that time. No significant predictors of sub-therapeutic trough levels were identified, notably there was no association with disease activity, behaviour, location, or the presence of perianal disease. Adjustment of anti-TNF therapy based on reactive TDM was only performed in 24 patients (45.3%); in all other patients there was no adjustment to the anti TNF therapy. Escalation of biologic therapy based on TDM results in patients with sub- therapeutic TL and no ADAs did not impact clinical remission or response rates at 3 or 6 months of follow up. Conclusion In our cohort most patients that underwent TDM had sub-therapeutic trough levels; no significant predictors of sub-therapeutic trough levels were identified. Neither dose optimisation or switching to a 2nd anti-TNF proved effective in achieving clinical remission at either 3 or 6 months of follow up.

Browsing by Subject "Groote Schuur Hospital"

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