Changing Pattern of Incidence; Aetiology and Mortality from Acute Pancreatitis at Kalafong Hospital; Pretoria; South Africa;1988-2007: A Retrospective Evaluation

Background: Literature reports from Western countries suggest an increasing incidence of acute pancreatitis (AP) and changing pattern over the past two decades. The aim of thisstudy was to document the incidence; aetiology and mortality from AP over two decades and to examine any emerging trends.Methods: A retrospective study of all confirmed cases of AP admitted over a 20-year period to thesurgical department was performed. Patients' demographics; year of admission;number of attacks; aetiology; management and outcome were entered on a specialstudy proforma.Results: Altogether 707 attacks of AP (M: F; 5.7: 1) were recorded. The proportion of gallstone APincreased (3.1to 12.7) and that of alcohol-related AP decreased (84to 67.6). Alcohol was themain aetiological factor for AP. Drugs; hyperlipidaemia; human immunodeficiency virus (HIV) andendoscopic pancreatography-related AP increased in the second decade. The in-hospital mortality rateduring the respective periods was 6.5and 3.1.Conclusion: Gallstone AP increased during second decade from more Caucasian admissions and increased gallstones among Blacks. The reduced mortality was attributed to changing trends in the nature and aetiology of AP recorded; heightened awareness of the condition and improved management

A clinicopathological review of 324 appendices removed for acute appendicitis in Durban, South Africa: a retrospective analysis.

INTRODUCTION: Acute appendicitis remains a common surgical condition and the importance of specific elements in the clinical diagnosis remain controversial. A variety of neoplastic and inflammatory conditions mimic acute appendicitis. The purpose of this study was to determine the presenting pattern of acute appendicitis and to review the pathological diagnosis. PATIENTS AND METHODS: This is a retrospective analysis of 324 patients who had appendicectomy for acute appendicitis at Prince Mshiyeni Memorial Hospital (Natal, South Africa) during the period January 2002 to December 2004. Patient demographics, clinical features, white cell count, operative findings, outcome and histology results were recorded on a special patient proforma. RESULTS: A total of 371 patients underwent appendicectomy during this period and 324 (M:F, 3.6:1) were available for analysis. The majority of our patients were in the second decade (43.1%) with only 29.3% presenting within 24 h of onset of symptoms. The most common symptoms were abdominal pain (100%), vomiting (57.4%) and anorexia (49.0%). Generalised and localised abdominal tenderness were present in 62.0% and 19.4% of patients, respectively. Pyrexia was noted in 41.0%. Localised and generalised peritonitis were present in 26.4% and 14.0%, respectively. The most common incisions were lower midline laparotomy (47.2%) and gridiron (37.3%). The negative appendicectomy rate was 17.0%. Acute appendiceal inflammation and gangrenous appendicitis was present in 36.1% and 9.6%, respectively. The perforation rate was 34.0% and there was a direct correlation with delayed presentation. There were no patients with carcinoid tumour or adenocarcinoma. Parasites and other associated conditions were seen in 8.6% of cases. Postoperative complications included: wound sepsis (25.3%), prolonged ileus (6.2%), peritonitis (4.6%) and chest infection (3.4%). Four patients died (1.2%) all from the perforated group. CONCLUSIONS: Our patients present late with advanced disease and complications. All surgeons should bear in mind the possibility of parasitic infestations mimicking acute appendicitis and the presence of significant unusual histological findings in our setting justifies routine histopathological examination of appendices.

Why is surgery cancelled? A retrospective evaluation.

INTRODUCTION: The cancellation of surgery wastes theatre time and creates hardship for patients, who often plan their working and family lives around the proposed operation date. METHODS: A retrospective evaluation of cancellations of scheduled elective and urgent operations was done using theatre records from May 2006 to April 2007. The reasons for cancellation were examined. RESULTS: Of a total of 5,786 operations, 5.6% were cancelled or postponed. Lack of medical clearance and patient preparation (65.1%) was the most common reason for cancellation. Lack or failure of instruments and patient cancellation constituted 2.8% and 1.8% of the cancellations respectively. CONCLUSION: Last-minute cancellation of surgery was a significant problem, and appreciation of the usual reasons for cancellations can improve theatre utilisation and avoid inconveniencing patients and their families.

Setting the records straight--a prospective audit of the quality of case notes in a surgical department.

BACKGROUND: A high standard of medical record keeping is important for safe patient care and provides information for research, audit and medicolegal purposes. Standards exist on what entries should contain, but as far as we are aware these standards are not regularly used in South Africa. We compared surgical case notes at Prince Mishyeni Hospital with guidelines from the Royal College of Surgeons of England. PATIENTS AND METHODS: A prospective series of 204 case notes was randomly selected and reviewed. RESULTS: There was an 80% compliance rate for 16/35 standards, and 100% was achieved for 8 operation sheet standards. The following fell short of 80% compliance: patient's name on every page (71%), hospital number on every page (50%), every entry timed (16%), clinician's name printed on every note (8%), clinician's designation on every entry (2%), an entry each weekday (77%), type of admission (9%), presenting complaint (61%), history of presenting complaint (65%), previous medical history (76%), drug history (47%), allergies (59%), social history (34%), family history (11%), each entry legible (65%), and anaesthetist's name (69%). Test results were signed and radiograph test results initialled in 25% and 17% of cases respectively. CONCLUSION: Legal requirements, good practice, research and teaching all demand notes that are detailed and of high quality. This study shows that medical records are grossly inadequate in many respects. Better education of junior staff and regular auditing of medical records could improve this.