Surgical site infections at a quaternary South African Hospital: epidemiology and impact on healthcare resources.

Abstract

ABSTRACT Background: Studies focused on the epidemiology of surgical site infection (SSI) and its impact on healthcare resource utilisation in resource-constrained African settings are rare. This information is important for two reasons: 1) It facilitates the development of setting-specific risk stratification tools for identifying patients who might benefit fro m additional preventative interventions, and 2) It can guide public health specialists’ decisions around resource and budget allocations to surgical units and the degree to which this can be optimised through SSI prevention. The research comprising this PhD thesis sought to address these gaps in the knowledge. Methodology: This research is comprised of five stand-alone analyses involving surgical patient dataobtained from a South African quaternary hospital. The data was collected through patient medical chart review, as well as accessing the hospital’s and service laboratory’s administrative systems. Study designs used in this research include cohort, trend analysis, geospatial analysis, case-control, and prognostic study designs.

Results: The incidence of SSI in high-risk laparotomy patients was 16.6%. Risk factors for SSI in this group included infectious indication for surgery, preoperative non-steroidal anti-inflammatory use, preoperative hypoalbuminemia, Bogota bag use, and perioperative blood transfusion. A 10-year trend analysis of all surgeries performed at the hospital found no change in admissions for post-discharge SSI. Mortality in elderly SSI admissions declined. The geospatial analysis found that most postdischarge SSI admissions originated from urban areas. Analysis of the laparotomy dataset showed that SSI resulted in an additional 1.06 days of hospitalisation (additional cost of ZAR8900/ $1180), but only in patients who already had short hospital stays. While preoperative hypoalbuminemia demonstrates a similar prognostic performance to the more complex SENIC/NNIS risk stratification methods (Cstatistic 0.677 versus 0.652/0.634), preoperative serum sodium is unlikely to have the same prognostic utility. Conclusions: SSI is common among South African patients undergoing high-risk surgery. A settingspecific, multifactorial risk stratification tool might be of benefit in this population. Inpatient and postdischarge SSIs contribute to unnecessary healthcare utilisation a expenditure in this resource constrained setting. There is also great potential for certain routine preoperative laboratory tests to be used as simple, cost-effective SSI risk stratification tools in African settings.

Isizinda: Ucwaningo lugxile ekwakhiwenisimo sendawo ehlinziwe yokutheleleka (SSI) nomthelela wakho wokusetshenziswa komthombo wokunakekela ngokokwelapha ezizindeni esivaleleke e-Afrika nokungavamile. Lolu lwazi lubalulekile ngezizathu ezimbili: 1) Kusebenzisa intuthuko yamathuluzi okuchaza ingcuphe egxile esizindeni esiqondile sokuhlonza iziguli ezingazuza emizamweni eyongeziwe yokuvimbela, nokuthi 2) ingahola izinqumo zongoti bezempilo yomphakathi ngomthombo nokwabiwa kwezimali kuya ezikhungweni zokuhlinzwa kanye nezinga lapho enganyuswa khona ngokuvimbela nge-SSI. Ucwaningo okusekelwe kuyo le PhD kuhloswe ngalo ukubhekana nalezi zikhala olwazini. Indlelakwenza: Lolu cwaningo lunohlaziyo oluyisihlanu oluzimele olufaka imininingo yesigulo esihlinziwe olutholakele esibhedlela esisezingeni lesine. Imininingo iqoqwe ngokubuyekeza ishathi lokwelapha lesiguli, kanjalo nokufinyelela ezinhlelweni zesibhedlela kanjalo nezinsiza zaselabhorethri. Uhlelosakhiwo locwaningo olusetshenziswe kulolu cwaningo lufaka ikhohothi, ukuhlaziya okwenziwa kuleso sikhathi, ukuhlaziya umumomhlaba, ukulawula ucwaningonto, nohlelosakhiwo locwaningo oluyinhlonzasifo. Imiphumela: Ukwenzeka kwe-SSI ezigulini ezisengcupheni yelapharathomi ingama-16.6%. Izizathu zengcuphe ze-SSI kuleli qembu elifakwe izinkomba zokutheleleka, isidambisikuvuvukala okunganasteroydi angesikhathi sokuhlinzwa. Ukuhlaziya okwenzeka eminyakeni eyi-10 kokuhlinza okwenziwa esibhedlela akutholanga shintsho ekungenisweni esibhedlela emva kokukhishwa. Ukufa kwabadala ekufakweni esibhedlela nge-SSI kusukela ezindaweni zasemadolobheni. Ukuhlaziya kwedathasethi yelapharothomi ikhombise ukuthi i-SSI inomphumela wezinsuku ezi-1.06 ezongeziwe zokulaliswa esibhedlela (izindleko ezongeziwe zama-ZAR8900/$1180), kodwa yiziguli esezike zahlala kafushane esibhedlela. Ngesikhathi i-hypoalbuminemia ngaphambi kokuhlinzwa ikhombisa ukusebenza kokuhlonzwa kwesifo ezindlelenikwenza zokuchaza ingcuphe eyinkimbi ye-SENIC/NNIS (istathistikhi i-C0677 uma siqhathaniswa ne-0.652/0.634), isiramu yesodiyamu yangaphambi kokuhlinzwa okungenzeka ibe nenhlonzasifo efanayo. Iziphetho: I-SSI ivamile ezigulini zaseNingizimu Afrika ezisezingcupheni ezinkulu. Isizinda esiqondile, ithuluzi lokucacisa ingcuphe enezizathu eziningi zokuzuza eqoqwenibantu. Iziguli ezelashelwa esibhedlela nama-SSI emva kokukhishwa esibhedlela kufaka ukusetshenziswa kokunakekelwa ngokwezempilo nokusetshenziswa kulesi sizinda esincishelwe yimithombo. Kuphinde kube nokukwazi okusezingeni ngokwezivivinyo ezilungiswe ngaphambi kwesikhathi elabhorethri ukuba zisetshenziswe, njengamathuluzi alula, nashibhile okuchaza ingcuphe yama-SSI ezizindeni zase-Afrika.