Waiting time for emergency surgeries in a tertiary care public hospital - a performance audit

To find out the waiting time for emergency surgeries and to identify causes responsible for this delay in a tertiary care public hospital.Settings: Surgical Unit IV, Civil Hospital, Karachi.Patients and Patients admitted through emergency for immediate emergency operations during the month of November and December, 2003 were included in the study. For data collection a proforma was made which included diagnosis, operation performed, time of planning immediate surgery, time of surgery, causes responsible for delay apart from demographic information.Main outcome measures: Waiting time for emergency surgeries, different causes responsible for the delay. A total of 45 patients were enrolled in the audit study. Majority of patients 14 [31.1%] were suffering from acute appendicitis. 33 [73.3%] of patients had to wait for more than 3 hours before their emergency surgery. Major cause of this delay in 33.6% of patients was due to surgical team doctor's inefficiency. In 7 [21.2%] patients surgery was delayed due to late night admission and in 6 [18.1%] due to non-availability of cross matched blood. In 5 [15.1%] patients surgery was delayed due to unavoidable causes like busy theatre and arrival of more serious patients. A substantial number of patients needing emergency surgery waited too long for the surgical management. Majority of delays were due to causes which can be addressed to improve the patients care

Problem in the management of carcinoma of prostate: a study of 44 cases

Fifty-three cases of carcinoma of prostate were registered in Civil Hospital, Karachi, Surgical Unit III and JPMC from 1st July, 1988 to 1st April, 1993. Nine patients were lost to follow-up, while 44 were included in this study. Carcinoma of prostate comprises 1.8% of all malignancies in male as reported in cancer registry of JPMC. Majority of the patients were between 61-70 years of age and almost half of them had one or more associated diseases, acute urinary retention was the commonest complaint at presentation followed by prostatism and haematuria. In seventy-five% of cases the disease was diagnosed in the stage where palliative rather than curative treatment could be undertaken. However, satisfactory palliation was obtained as the course of the disease is indolent. Those who received hormonal treatment more than thirty-one% developed complication attributable to treatment while the incidence of complications due to radiotherapy was about thirty-eight%. Chemotherapy was not found effective

Typhoid perforation of bowel

A retrospective review of 45 patients with perforated typhoid enteritis. Managed operatively from January 1990 to December 1993. There were 39 male and 6 female, presenting symptoms were pain, vomiting, fever and constipation [or loose motions]. Post dehiscence and leaking from suture lines. There were 9 deaths most of the deaths were attributed to overwhelming sepsis. Enteric perforation is a common surgical problem of developing world

Pattern of thyroid disease at civil hospital, Karachi

A clinical study on 72 cases of Goitres was conducted at Surgical Unit III Civil Hospital Karachi attached to Dow Medical College from January 1990 to June 1993. Majority of the patients were young female between 20-30 years. Out of 72, female were 64 [89%] and male 8 [11%]. Male to female ratio was 1 : 8. The distribution of thyroid pathology was - multi nodular Goitre 39%,- solitary nodule 36%, - solitary toxic nodule 14%, - diffuse toxic Goitre 5.5%, - toxic multi nodular Goitre 5.5%, - diffuse simple Goitre 5.5%. All these cases were treated surgically. Post operative complications included, hypocalcaemia [5.5%], haematoma formation [4.1%], wound infection [8.3%], recurrent laryngeat nerve palsy [2.7%], thyroid crisis [1.3%]. Incidence of malignancy in cold nodule was 15%