Private healthcare sector spine surgery: patient and surgeon profiles from a large open medical scheme in South Africa.

Background It is generally understood that the profile of spine surgery varies by setting, based on factors such as the age profile of the population, the economic context and access to healthcare. Relatively little is known about the profile of spine surgery in South Africa, although one previous report from the public healthcare sector suggested a high burden of trauma and infection-related surgery. To our knowledge, there has been no formal investigation in the private sector. A holistic understanding of spine surgery within our setting may be beneficial for applications such as resource allocation and informing the training needs of future specialists.   Objectives To provide insight into spinal surgery in the South African private healthcare sector by describing spine surgery characteristics within a large open medical scheme, including both patient and surgeon profiles.   Methods This retrospective review included adult inpatient spine surgeries funded by the largest open medical scheme in South Africa between 2008 and 2017. An anonymized dataset extracted from the scheme records included patient demographics, ICD-10 codes, procedure codes and surgeon specialization. Descriptive patient and surgery data were presented. Furthermore, the association between patient and surgery factors and surgeon specialization was investigated using univariate and multivariate analyses.   Results A total of 49,576 index spine surgeries were included. The largest proportion of surgeries involved members 40-59 years old (n=23,543, 48%), approximately half involved female members (n=25,293, 51%) and most were performed by neurosurgeons (n=35,439, 72%). At least 37,755 (76%) surgeries were for degenerative pathology, 2,100 (4%) for trauma and 242 (0.5%) for infection. Adjusted risk ratios (aRR) significantly associated with orthopaedic surgeon specialization included cervical spine region aRR = 0.49 (95% C.I. 0.39-0.61), trauma aRR = 1.50 (95% C.I. 1.20-1.88), deformity aRR = 1.77 (95% C.I. 1.33-2.35) and blood transfusion aRR = 1.46 (95% C.I. 1.12-1.91).   Conclusion Spine surgery in South Africa's largest open medical scheme was dominated by surgery for degenerative pathology in older adults and was performed largely by neurosurgeons. This constituted a stark contrast to a previous report from the public sector and highlighted a mismatch between exposure during public sector registrar training and private practice post-specialization. The findings support the need for private-public collaboration as well as the importance of spine fellowships for all specialists intending to practice spine surgery.

Incidence and aetiology of traumatic spinal cord injury in Cape Town, South Africa: a prospective, population-based study.

STUDY DESIGN: Prospective, regional population-based study. OBJECTIVES: To provide the incidence, aetiology and injury characteristics of traumatic spinal cord injury (TSCI) in the City of Cape Town, South Africa. SETTING: All government-funded hospitals within the City of Cape Town, South Africa. METHODS: All survivors of acute TSCI, given that they met the inclusion criteria, were prospectively included for a 1-year period. The International Spinal Cord injury Core Data Set was used and systematically completed by specialist doctors. Further, international standards for neurological classification were adhered to. RESULTS: In total, 147 cases of acute TSCI were identified and 145 were included in the study. The male to female ratio was 5.9:1 and the mean age was 33.5 years, ranging from 18 to 93. The crude incidence rate was 75.6 per million (95% CI: 64.3-88.8) with assault as the main cause of injury, accounting for 59.3% of the cases, followed by motor vehicle accidents (26.3%) and falls (11.7%). Most injuries occurred in the cervical spine (53.1%), and American Spinal Injury Association Impairment Scale A severity was most common (39.3%) in the cohort. CONCLUSION: The incidence rate of TSCI in a region of South Africa was high when compared to previously postulated figures for the country. There is a need for primary preventative strategies to target younger men that are exposed to violent activities. A national study is required to learn whether these findings are only locally applicable or generalisable.