Incidence, causes and pattern of cancellation of elective surgical operations in a university teaching hospital in the Lake Zone, Tanzania.

BACKGROUND: Cancellation of elective surgical operations is recognized as a major cause of emotional trauma to patients as well as their families. This study was carried out to assess the incidence, causes and pattern of cancellation of elective surgical operations in our setting and to find the appropriate solutions for better patient management. METHODS: This was a prospective hospital-based study which was conducted in a teaching hospital at Bugando medical Centre from March 2009 to February 2010. RESULTS: A total of 3,064 patients were scheduled for elective surgical operations. Of these, 644 (21.0%) patients' operations were cancelled. General surgery had the highest rate of cancellations (31.5%) followed by orthopaedic surgery in 25.5%. Lack of theatre space and theatre facilities were the most common causes of cancellations in 53.0% and 28.4% of cases respectively. The majority of these cancellations were attributable to hospital administration in 82.0 % and most of them were preventable in 93.8% of cases. The mean hospital stay was 28.46 days and it was significantly related to the number of cancellations (p < 0.001). CONCLUSION: Cancellation of elective surgical operations is a significant problem in our hospital. To prevent unnecessary cancellations, efforts should be made to enhance cost effectiveness through careful planning and efficient utilization of the few available hospital resources.

Motorcycle injuries as an emerging public health problem in Mwanza City, north-western Tanzania.

Motorcycle injuries constitute a major but neglected emerging public health problem in developing countries and are a common cause of road traffic injuries. The aim of this study was to establish the prevalence, injury pattern and treatment outcome of motorcycle injuries among patients presenting to Bugando Medical Centre in Mwanza, Tanzania, between March 2009 and February 2010. Data was collected using a pre-tested, coded questionnaire. A total of 384 motorcycle injury patients were studied constituting 37.2% of all road traffic injuries. Over two-thirds (69.5%) of the patients were males (Male: Female ratio = 2.3:1). The mean age of the patients was 25.7 years (range: 4-87 years). The majority of patients were businessmen and students accounting for 68.8% and 42.2%, respectively. Motorcyclists accounted for the majority of motorcycle injury patients (212, 55.2%), followed by passengers (130. 33.9%) and pedestrians (42, 10.9%). Helmet use was recorded in 87 patients (22.7%). Most patients (352; 91.7%) sustained blunt injuries. Musculoskeletal (extremities) and head injuries were the most common body region injured affecting 234 (60.9%) and 212 (55.2%) patients, respectively. The majority of patients (244; 63.5%) were treated surgically. Wound debridement was the most common (86.9%) procedure performed. The overall mean length of hospital stay (LOS) was 19.23 days (range= 1-120 days). The LOS for non-survivors was 5.6 days (range= 1- 25 days). Patients with major trauma (ISS > 16), severe head injury (GCS 3-8) and those with long bone fractures stayed longer in the hospital and this was significant (P-value <0.001). Mortality rate was 16.7% (64 deaths). Age of the patient, non-helmeted patients, major trauma (ISS > 16), admission systolic blood pressure <90mmHg, severe head injury (GCS <9), need for intensive care unit admission and need for ventilatory support significantly influenced mortality (P-value < 0.001). Motorcycle injuries constitute a major but neglected emerging public health problem in Mwanza City and continue to be one of the most common cause or agent of road traffic injuries. The morbidity and mortality can be mitigated by encouraging use of protective gear like helmets and encouraging enforcement of traffic laws.

Missed Injuries in Multiple Trauma Patients: a Tertiary Care Experience in Tanzania

Background: Missed injuries remain a worldwide problem in all trauma centers and contribute significantly to high morbidity and mortality among trauma patients. There is paucity of information regarding missed injuries in Tanzania. The aim of this study was to establish the incidence; contributing factors; and short-term outcome of missed injuries among polytraumatized patients in our setting. Methods: This was a one-year duration (from January to December 2009) prospective cohort study involving all multiple trauma patients (ISS 16) admitted to Bugando Medical Centre. After informed consent to participate in the study; all patients were consecutively enrolled in the study. Data was collected using a pre-tested; coded questionnaire and analyzed using SPSS computer software version 11.5. Results: Ninety six of 462 patients (incidence; 20.1) had 112 missed injuries. Head and the neck (46.4) was the most common body region affected. Clinical error (57.1) was the most common factor contributed to the occurrence of missed injuries. Of the factors contributing to missed injuries; 57.4were potentially avoidable and 42.6were unavoidable. There was statistically significant difference in the mean ISS; mean GCS; orotracheal intubation; patient's arrival time and seniority of the attending doctor between patients with missed injuries and those without missed injuries (p-value 0.001). Mortality in patients with missed injuries was 19.8compared with 8.7in patients without missed injuries (p-value 0.001). Among the deaths in patients with missed injuries; 57.9were directly attributable to missed injuries (O.R. = 14.8; p-value =0.001; 95CI = 6.1- 32.46). Patients with missed injuries had longer stays in the hospital compared with patients without missed injuries (p-value 0.001). Conclusion: The incidence of missed injuries at BMC is high in patients with high ISS; low GCS; orotracheal intubation and those who reported during night hours. A high index of suspicious is needed when dealing with such a group of patients. The majority of missed injuries are potentially avoidable by repeated assessments both clinically and radiologically and by staff redistribution to address the increase of missed injuries during night hours. Implementation of a tertiary trauma survey should be routine in the Accident et Emergency department to minimize the occurrence of missed injuries.) had 112 missed injuries. Head and the neck (46.4) was the most common body region affected. Clinical error (57.1) was the most common factor contributed to the occurrence of missed injuries. Of the factors contributing to missed injuries; 57.4were potentially avoidable and 42.6were unavoidable. There was statistically significant difference in the mean ISS; mean GCS; orotracheal intubation; patient's arrival time and seniority of the attending doctor between patients with missed injuries and those without missed injuries (p-value 0.001). Mortality in patients with missed injuries was 19.8compared with 8.7in patients without missed injuries (p-value 0.001). Among the deaths in patients with missed injuries; 57.9were directly attributable to missed injuries (O.R. = 14.8; p-value =0.001; 95CI = 6.1- 32.46). Patients with missed injuries had longer stays in the hospital compared with patients without missed injuries (p-value 0.001). Conclusion: The incidence of missed injuries at BMC is high in patients with high ISS; low GCS; orotracheal intubation and those who reported during night hours. A high index of suspicious is needed when dealing with such a group of patients. The majority of missed injuries are potentially avoidable by repeated assessments both clinically and radiologically and by staff redistribution to address the increase of missed injuries during night hours. Implementation of a tertiary trauma survey should be routine in the Accident et Emergency department to minimize the occurrence of missed injuries