Provision of an emergency theatre in tertiary hospitals is cost-effective: Audit and cost of cancelled planned elective general surgical operations at Pietersburg Hospital, Limpopo Province, South Africa

Background. Cancellations of planned elective surgical operations increase financial cost to the patient and the hospital.Objectives. To determine the rate and reasons for cancellations, estimate the cost incurred by such cancellations and recommend possible solutions.Methods. We did a prospective descriptive study of cancellations of elective general surgical operations over the 1-year period January - December 2014 in the main theatre at Pietersburg (PTB) Hospital, Limpopo Province, South Africa. All patients listed on the theatre booking slate for elective general surgical operations before the cut-off time of 13h00 on the day before the anticipated operation were included. Epi Infoversion 7 was used to analyse the data and derive the descriptive statistics.Results. There were 537 booked patients (median age 47 years, range 1 - 94); a total of 298 operations were performed, and 239 were cancelled (cancellation rate 44.5%). Reasons for cancellation were as follows: theatre needed for an emergency n=154 (64.4%), theatre equipment failure and lack of consumables n=17 (7.1%), non-theatre equipment failure n=10 (4.2%), prolonged time of operations n=13 (5.4%), abnormal blood results n=8 (3.3%), patient comorbidity and poor general condition n=9 (3.8%), patients absent from the ward n=8 (3.3%), patients not starved n=2 (0.8%), patients' condition improved significantly n=3 (1.3%), nurses' strike n=5 (2.1%), rebooking of cases for senior surgeons or other specialty n=2 (0.8%), and other reasons n=8 (3.3%). The cost per inpatient per day was estimated at ZAR4 890 at PTB Hospital and ZAR2 100 at district hospitals, and the total cost per cancelled operation was ZAR25 860.Conclusions. Over the 1-year period 44.5% of elective operations at PTB Hospital were cancelled, 64.4% because the theatre was needed for an emergency operation. We recommend that a theatre dedicated to emergencies be opened at PTB Hospital. The cost incurred due to cancellations was about ZAR6 million for the hospital, with additional cost and emotional trauma for the patients

Management of sigmoid volvulus in Polokwane-Mankweng Hospital

Objective. To evaluate the outcome of treatment ofpatients with sigmoid volvulus in the Polokwane-Mankweng Hospital and to identify the best managementoptions for these patients. Methods. A retrospective study was undertaken of 85patients with sigmoid volvulus treated in Polokwane-Mankweng Hospital during the period July 1997 - May2004. Results.In total, 85 patients were evaluated (77 malesand 8 females, male/female ratio 9:1). The age range was7 - 80 years (mean 42 years). Sigmoidoscopic derotationwas attempted in 17 patients, and was successful in 10patients. Laparotomy was done in 84 patients, viz. 75emergencies and 9 electives. During laparotomy, gan-grenous sigmoid colon was found in 30 patients and viablesigmoid in 54 patients. Resection with primary anastomo-sis was done in 44 patients. Hartmann's procedure wasperformed in 33 patients. Sigmoidopexy was done in 7patients. Total hospital mortality was 6% (5 deaths).Mortality in the 84 operated cases was 5% (4 deaths). Conclusions.There was no mortality in patients undergo-ing elective resection and primary anastomosis aftersuccessful preoperative deflation and in patients withviable sigmoid volvulus who underwent an emergencyHartmann's procedure. There was low mortality in thosepatients with resection and primary anastomosis on viablesigmoid (3%, 1:39). The highest mortality (1:5) occurredin cases of resection and primary anastomosis of gan-grenous sigmoid colon