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Mahlefahlo MT, Montwedi OD, Karusseit VOL. Perforated peptic ulcer - a case series and an African perspective. S AFR J SURG 2024; 62:66-71. [PMID: 38568129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/05/2024]
Abstract
BACKGROUND Perforation of peptic ulcer (PPU) is the most morbid complication of peptic ulcer disease (PUD) with scant recent reports from sub-Saharan Africa. The aim of this study was to describe a PPU series from a single centre in South Africa and contrast the findings with other recent reports from sub-Saharan Africa. METHODS A retrospective study of PPU at Kalafong Hospital in Pretoria was performed. The relationship of patient demographics, risk factors, ulcer pathology and severity scores to mortality were analysed. Recent similar reports from sub-Saharan Africa were reviewed and the findings compared to the current study and findings from high income countries (HIC). RESULTS The study comprised 121 patients. The majority were black men with an average age of 46.6 years, with few comorbidities. A large proportion of patients admitted to risk factors and most presented to hospital 48 hours after the onset of symptoms. The majority (71%) of the perforations occurred in the stomach. The patient sex, age, risk factors and the mortality at 4% were similar to other African studies, although perforations were mainly duodenal in most of the African studies. The median age of patients in the East African studies was lower by 13 years. Patients in HIC series of PPU were older, more likely to be female, have duodenal perforations and a higher mortality than in the African series. CONCLUSION Patients were mostly smokers, presented late to hospital and had gastric perforations. The findings of low mortality and male predominance concurred with those of other sub-Saharan African reports and were the opposite of trends in HIC.
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Affiliation(s)
- M T Mahlefahlo
- Department of Surgery, Faculty of Health Sciences, University of Pretoria, South Africa
| | - O D Montwedi
- Department of Surgery, Faculty of Health Sciences, University of Pretoria, South Africa
| | - V O L Karusseit
- Department of Surgery, Faculty of Health Sciences, University of Pretoria, South Africa
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Kluyts HL, Conradie W, Cloete E, Spijkerman S, Smith O, Alli A, Koto MZ, Montwedi OD, Govender K, Cronjé L, Grobbelaar M, Omoshoro-Jones JA, Rorke NF, Anderson P, Torborg A, Alphonsus C, Alexandris P, Mallier Peter A, Singh U, Diedericks J, Mrara B, Reed A, Davies GL, Davids JG, Van Zyl HA, Govindasamy V, Rodseth R, Matos-Puig R, Bhat KAP, Naidoo N, Roos J, Jaworska M, Steyn A, Dippenaar JM, Pearse RM, Madiba T, Biccard BM. Development of a Clinical Prediction Model for In-hospital Mortality from the South African Cohort of the African Surgical Outcomes Study. World J Surg 2020; 45:404-416. [PMID: 33125506 DOI: 10.1007/s00268-020-05843-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2020] [Indexed: 01/23/2023]
Abstract
BACKGROUND Data on the factors that influence mortality after surgery in South Africa are scarce, and neither these data nor data on risk-adjusted in-hospital mortality after surgery are routinely collected. Predictors related to the context or setting of surgical care delivery may also provide insight into variation in practice. Variation must be addressed when planning for improvement of risk-adjusted outcomes. Our objective was to identify the factors predicting in-hospital mortality after surgery in South Africa from available data. METHODS A multivariable logistic regression model was developed to identify predictors of 30-day in-hospital mortality in surgical patients in South Africa. Data from the South African contribution to the African Surgical Outcomes Study were used and included 3800 cases from 51 hospitals. A forward stepwise regression technique was then employed to select for possible predictors prior to model specification. Model performance was evaluated by assessing calibration and discrimination. The South African Surgical Outcomes Study cohort was used to validate the model. RESULTS Variables found to predict 30-day in-hospital mortality were age, American Society of Anesthesiologists Physical Status category, urgent or emergent surgery, major surgery, and gastrointestinal-, head and neck-, thoracic- and neurosurgery. The area under the receiver operating curve or c-statistic was 0.859 (95% confidence interval: 0.827-0.892) for the full model. Calibration, as assessed using a calibration plot, was acceptable. Performance was similar in the validation cohort as compared to the derivation cohort. CONCLUSION The prediction model did not include factors that can explain how the context of care influences post-operative mortality in South Africa. It does, however, provide a basis for reporting risk-adjusted perioperative mortality rate in the future, and identifies the types of surgery to be prioritised in quality improvement projects at a local or national level.
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Affiliation(s)
- Hyla-Louise Kluyts
- Department of Anaesthesiology, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa.
| | - Wilhelmina Conradie
- Department of Surgery, Tygerberg Hospital, University of Stellenbosch, Cape Town, Western Cape Province, South Africa
| | - Estie Cloete
- Department of Anaesthesia and Perioperative Medicine, Groote Schuur Hospital, University of Cape Town, Cape Town, Western Cape Province, South Africa
| | - Sandra Spijkerman
- Department of Anaesthesiology, Steve Biko Academic Hospital, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Oliver Smith
- Department of Anaesthesia and Critical Care, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Ahmed Alli
- Department of Anaesthesia and Critical Care, Charlotte Maxeke Johannesburg Academic Hospital, University of the Witwatersrand, Johannesburg, Gauteng, South Africa
| | - Modise Z Koto
- Department of Anaesthesiology, Dr George Mukhari Academic Hospital, Sefako Makgatho Health Sciences University, Pretoria, Gauteng, South Africa
| | - Odisang D Montwedi
- Department of Surgery, Kalafong Hospital, University of Pretoria, Pretoria, Gauteng, South Africa
| | - Komalan Govender
- Prince Mshiyeni Memorial Hospital, Umlazi, KwaZulu-Natal, South Africa
| | - Larissa Cronjé
- King Edward VIII Hospital, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Mariette Grobbelaar
- Edendale Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Jones A Omoshoro-Jones
- Department of Surgery, Chris Hani-Baragwanath Academic Hospital, University of the Witwatersrand, Johannesburg, South Africa
| | - Nicolette F Rorke
- Department of Anaesthesiology, RK Khan Hospital, University of KwaZulu-Natal, eThekwini, KwaZulu-Natal, South Africa
| | - Philip Anderson
- Kimberley Hospital Complex, University of the Free State, Kimberley, Northern Cape Province, South Africa
| | - Alexandra Torborg
- Department of Anaesthesiology, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa
| | - Christella Alphonsus
- Department of Anaesthesiology, Inkosi Albert Luthuli Central Hospital, University of KwaZulu-Natal, Durban, South Africa
| | - Panagiotis Alexandris
- Port Elizabeth Hospital Complex, Port Elizabeth, Eastern Cape Province, South Africa
| | - Aunel Mallier Peter
- Klerksdorp/Tshepong Hospital, University of the Witwatersrand, Klerksdorp, North West Province, South Africa
| | - Usha Singh
- Department of Anaesthesiology, Addington Hospital, University of KwaZulu-Natal, Durban, KwaZulu-Natal, South Africa
| | - Johan Diedericks
- Department of Anaesthesiology, Universitas Hospital, University of the Free State, Bloemfontein, Free State, South Africa
| | - Busisiwe Mrara
- Department of Anaesthesiology, Nelson Mandela Academic Hospital, Walter Sisulu University, Mthatha, Eastern Cape Province, South Africa
| | - Anthony Reed
- New Somerset Hospital, University of Cape Town, Cape Town, Western Cape Province, South Africa
| | - Gareth L Davies
- Paarl Provincial Hospital, Paarl, Western Cape Province, South Africa
| | - Jody G Davids
- George Regional Hospital, University of Cape Town, George, Western Cape Province, South Africa
| | - Hendrik A Van Zyl
- Department of Anaesthesiology, Worcester Hospital, Worcester, Western Cape Province, South Africa
| | | | - Reitze Rodseth
- Department of Anaesthetics, Grey's Hospital, University of KwaZulu-Natal, Pietermaritzburg, KwaZulu-Natal, South Africa
| | - Roel Matos-Puig
- General Justice Gizenga Mpanza Regional Hospital, Stanger, KwaZulu-Natal, South Africa
| | - Kajake A P Bhat
- Department of Anaesthesiology, Cecilia Makiwane Hospital, Walter Sisulu University, East London Hospital Complex, Eastern Cape Province, South Africa
| | - Noel Naidoo
- Department of Surgery, Port Shepstone Regional Hospital, University of KwaZulu-Natal, Port Shepstone, KwaZulu-Natal, South Africa
| | - John Roos
- Department of Anaesthesia, Mitchells Plain Hospital, Cape Town, South Africa
| | - Magdalena Jaworska
- Helderberg and Karl Bremer Hospitals, University of Stellenbosch, Cape Town, Western Cape Province, South Africa
| | - Annemarie Steyn
- Department Anaesthesiology, Potchefstroom Hospital, Potchefstroom, North West Province, South Africa
| | - Johannes M Dippenaar
- Oral and Dental Hospital, University of Pretoria, Pretoria, Gauteng, South Africa
| | - R M Pearse
- Royal London Hospital, Queen Mary University of London, London, UK
| | | | - Bruce M Biccard
- Groote Schuur Hospital, University of Cape Town, Cape Town, South Africa
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