Emergency vs elective surgery ratio in the cape metro area

Heynes, Alana

Emergency vs elective surgery ratio in the cape metro area

Thesis / Dissertation

2025

Publisher

University of Cape Town

Department

Division of General Surgery

Faculty

Faculty of Health Sciences

Abstract

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.

Keywords

Surgery

Cape Metro

Reference:

Collections

Masters

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