AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | 24 ORIGINAL RESEARCH African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | A retrospective review of gynaecological emergency surgery at Groote Schuur Hospital for the period of January to December 2019: a snapshot into women’s health in a Middle-Income Country, South Africa. emergency surgeries in gynaecology. [16,17] In Africa, there is limited data concerning the factors influencing the decision to intervention time in the management and therapeutic outcome of emergency gynaecological surgeries. [18] Yet the delays in the emergency surgeries have been found to contribute to poor clinical outcomes of the patients. [19] The Lancet Commission identified timely access to essential surgery as a fundamental indicator for tracking universal access to safe health systems. [9] AIM OF THE STUDYAND OBJECTIVES: Thisplannedstudyanalysedtheclinicalprocessesadoutcomes of the gynaecological emergency surgeries performed at a tertiary level hospital in the Western Cape (Groote Schuur) in the year 2019. This gave us insight into the burden of gynaecological disease, the waiting times and outcome. Primary objective: We reviewed the number of women who underwent emergency gynaecological surgery in that period and their demographics. We explored the reasons for the surgery, outcomes, and complications. Secondary objectives: We assessed the time interval between decision to intervention i.e, surgical intervention We specifically looked at reasons for the surgery delays, the time spent in the hospital and the reasons if more than 3 days were spent in the hospital post operatively. Inclusion criteria were all women booked for the emergency gynaecological surgery. Women who were booked by other specialities and found to have gynaecological conditions intraoperatively were excluded as their primary surgical indication was non gynaecological. 2. METHODOLOGY: 2.1 Study design and setting We conducted a retrospective descriptive record review of patients who underwent emergency gynaecological surgery at Groote Schuur hospital during the period 1 January 2019 to 31 December 2019. 2.2 Data collection Groote Schuur Hospital has the main theatre and a separate maternity centre theatre for caesarean sections. The main theatre provides both the acute and elective theatre services. There are 2 dedicated emergency theatres offering services 24 hours per day. The emergency theatre database is manually and electronically captured. Main theatre emergency booking registers were used initially to retrieve all the names, and this was confirmed with the electronic capture by the institution to ensure that no cases weremissed. Folder numbers of the patients who had the emergency gynaecological surgery during 2019 were collected and these were used to retrieve the patient’s files from the records department. A data collection sheet designed for the audit was used to collect information from the folders of the patients and was entered into an excel spreadsheet. All the women included in the study were anonymised during the data collection and assigned a specific study number. 2.3 Data analysis Statistical analysis was performed using SPSS Statistics for Windows (IBM Corp. Released 2021. IBM SPSS Statistics for Windows, Version 28.0. Armonk, NY: IBM Corp). Descriptive statistics were used as well as frequency tables, distribution with counts and percentages. Data was presented using flow diagrams, bar, and histogram graphs. 2.4 Ethical consideration Ethical clearance was obtained from the University of Cape Town Human Research Ethical Committee (HREC Ref 563/2021). The Department of Obstetrics and Gynaecology Research committee and institutional approval also granted the permission to proceed with the research. There was no consent required from the participant as it was a retrospective review study and data was obtained in a strictly anonymised technique. The study is in keeping with the Declaration of Helsinki. [20] 3. RESULTS: Demographic data A total of 304 women received emergency gynecological surgery and 290 (95%) of their folders were reviewed in the study. Ten folders were missing, and 4 folders had incomplete notes. The mean age was 30.16 (range, 16-55 years) and a mean parity of 1.43. Figure 1 indicates that 230 (79.3%) women who underwent the surgery were in the reproductive age group (between 21-41 years). There were 45 (15.5% of the entire cohort) women with medical comorbidities (table 1), of which 32 (71.1%) were found to be more than 40 years of age. This did not include HIV status. Twenty-seven women were HIV positive (9.3%), while the HIV status of 193 (66.6%) women were unknown (figure 2). Within the cohort of 27 HIV positive women, 11 (40.7%) were virally suppressed and in 9 (33.3%) women, the viral load was unknown. Only 8 (29.6%) women had the latest CD4 >500 and in 7 (25.9%), the CD4 count was unknown. Seventy (24.1%) participants were found to be smokers and in 75 women (25.9%) the smoking history was unknown. Table 1. Co-morbidities- 45 participants (15.5% of 290 women) Comorbidities Percentage 15.5% (N=45 of 290 women) DM 17.8% (8) Hypertension 42.2 (19) Cardiac 6.7% (3) Anaemia 24.4% (11) TB 2.2% (1) Others 6.7% (3) Total 100% (45) Figure 1: Age groups of the study population (N=290)