Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting

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dc.contributor.advisorKauta, Ntambue
dc.contributor.advisorHeld Michael
dc.contributor.authorLaubscher, Kim
dc.date.accessioned2024-06-05T13:30:33Z
dc.date.available2024-06-05T13:30:33Z
dc.date.issued2023
dc.date.updated2024-06-05T12:56:45Z
dc.description.abstractBackground: Arthroplasty procedures in low-income countries are mostly performed at tertiary centers, with waiting lists exceeding 12 to 24 months. Recently, this is further exacerbated by the impact of the Covid-19 Pandemic on elective surgeries. Providing arthroplasty services at other levels of healthcare aims to offset this burden, however there is a marked paucity of literature regarding surgical outcomes. This study aims to provide evidence on the safety of arthroplasty at district level. Methods: Retrospective review of consecutive hip and knee primary arthroplasty cases performed at a District Hospital (DH), and a Tertiary Academic Hospital (TH) in Cape Town, South Africa between 1st January 2015 and 31st December 2018. Patient demographics, hospital length of stay, surgery related readmissions, reoperations, post-operative complications, and mortality rates were compared between cohorts. Results: Seven hundred and ninety-five primary arthroplasty surgeries were performed at TH level and 228 at DH level. The average hospital stay was 5.2±2.0 days at DH level and 7.6±7.1 days for TH (p<0.05). Readmissions within 3 months post-surgery of 1.75% (4 patients) for district and 4.40% (35) for tertiary level (p<0.05). Reoperation rate of 1 in every 100 patients at the DH and 8.3 in every 100 patients at the TH (p<0.05) was noted. Death rate was 0.4% vs 0.6% at district and tertiary hospitals respectively (p>0.05). Periprosthetic joint infection (PJI) rate was 0.43% at DH and 2.26% at TH. The percentage of hip dislocation requiring revision was 0% at district and 0.37% at tertiary level. During the study period, 228 patients received their arthroplasty surgery at the DH; these patients would otherwise have remained on the TH waiting list. Conclusions: Hip and Knee Arthroplasty at District health care level is safe and; for the reason that the DH feeds into the TH; providing arthroplasty at district level may help ease the pressure on arthroplasty services at tertiary care facilities in a Southern African context. Adequately trained surgeons should be encouraged to perform these procedures in district hospitals provided there is appropriate patient selection and adherence to strict theatre operating procedures.
dc.identifier.apacitationLaubscher, K. (2023). <i>Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting</i>. (). ,Faculty of Health Sciences ,Division of General Surgery. Retrieved from http://hdl.handle.net/11427/39876en_ZA
dc.identifier.chicagocitationLaubscher, Kim. <i>"Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting."</i> ., ,Faculty of Health Sciences ,Division of General Surgery, 2023. http://hdl.handle.net/11427/39876en_ZA
dc.identifier.citationLaubscher, K. 2023. Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting. . ,Faculty of Health Sciences ,Division of General Surgery. http://hdl.handle.net/11427/39876en_ZA
dc.identifier.ris TY - Thesis / Dissertation AU - Laubscher, Kim AB - Background: Arthroplasty procedures in low-income countries are mostly performed at tertiary centers, with waiting lists exceeding 12 to 24 months. Recently, this is further exacerbated by the impact of the Covid-19 Pandemic on elective surgeries. Providing arthroplasty services at other levels of healthcare aims to offset this burden, however there is a marked paucity of literature regarding surgical outcomes. This study aims to provide evidence on the safety of arthroplasty at district level. Methods: Retrospective review of consecutive hip and knee primary arthroplasty cases performed at a District Hospital (DH), and a Tertiary Academic Hospital (TH) in Cape Town, South Africa between 1st January 2015 and 31st December 2018. Patient demographics, hospital length of stay, surgery related readmissions, reoperations, post-operative complications, and mortality rates were compared between cohorts. Results: Seven hundred and ninety-five primary arthroplasty surgeries were performed at TH level and 228 at DH level. The average hospital stay was 5.2±2.0 days at DH level and 7.6±7.1 days for TH (p<0.05). Readmissions within 3 months post-surgery of 1.75% (4 patients) for district and 4.40% (35) for tertiary level (p<0.05). Reoperation rate of 1 in every 100 patients at the DH and 8.3 in every 100 patients at the TH (p<0.05) was noted. Death rate was 0.4% vs 0.6% at district and tertiary hospitals respectively (p>0.05). Periprosthetic joint infection (PJI) rate was 0.43% at DH and 2.26% at TH. The percentage of hip dislocation requiring revision was 0% at district and 0.37% at tertiary level. During the study period, 228 patients received their arthroplasty surgery at the DH; these patients would otherwise have remained on the TH waiting list. Conclusions: Hip and Knee Arthroplasty at District health care level is safe and; for the reason that the DH feeds into the TH; providing arthroplasty at district level may help ease the pressure on arthroplasty services at tertiary care facilities in a Southern African context. Adequately trained surgeons should be encouraged to perform these procedures in district hospitals provided there is appropriate patient selection and adherence to strict theatre operating procedures. DA - 2023 DB - OpenUCT DP - University of Cape Town KW - General Surgery LK - https://open.uct.ac.za PY - 2023 T1 - Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting TI - Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting UR - http://hdl.handle.net/11427/39876 ER - en_ZA
dc.identifier.urihttp://hdl.handle.net/11427/39876
dc.identifier.vancouvercitationLaubscher K. Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting. []. ,Faculty of Health Sciences ,Division of General Surgery, 2023 [cited yyyy month dd]. Available from: http://hdl.handle.net/11427/39876en_ZA
dc.language.rfc3066eng
dc.publisher.departmentDivision of General Surgery
dc.publisher.facultyFaculty of Health Sciences
dc.subjectGeneral Surgery
dc.titlePrimary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting
dc.typeThesis / Dissertation
dc.type.qualificationlevelMasters
dc.type.qualificationlevelMMed
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