AFJOG

African Journal of Obstetrics and Gynaecology | Volume 2 | Issue 2 | 2024 | 26 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. participants who were in hypovolaemic shock, none of them went to theatre within 30 minutes of being booked. A total of 25 (92.6%) participants took beyond an hour to get to theatre. One (3.7%) woman in shock took between 10-15 hours before the definitive surgery was accessible (Table 6). Table 5. Time taken to get to theatre. Valid Frequency Percentage <0.5hour 1 .3 0.5-1hour 7 2.4 1-2hours 38 13.1 2-4hours 65 22.4 4-10hours 106 36.6 10-15hours 31 10.7 15-24hours 22 7.6 >24hours 20 6.9 Total 290 100.0 Table 6. Time taken to get to theatre for patients in hypovolaemic shock. (N=27) Time h Frequency Percentage <0.5hour 0 0 0.5-1hr 2 7.4 1-2hrs 9 33.3 2-4hrs 10 37.0 4-10hrs 5 18.5 10-15hrs 1 3.7 >15hrs 0 0 Total 27 100.0 Reasons for the delays more than 24hours The total number of women who had a delay of greater than 24 hours were 20 (6.9%). A total of 17 women (85% of the 20 cases) were delayed due to lack of theatre time as other cases were prioritised. Two of the cases were postponed by the surgeon and one delayed by the anaesthetist as she was medically unfit for theatre. The other reasons we explored were if the patient had initially declined surgery, surgery cancelled, or patient had eaten. None of the other mentioned reasons were found among the delayed cases in this cohort. Hospitalisation duration A total of 193 participants (67%) were admitted for 3 nights and less. Whereas 97 patients (33%) stayed longer than 4 nights. Prolonged hospital stay was defined as beyond 3 nights post-operation, as majority of the emergency gynaecological surgeries cases gets discharged on day 3 after surgery. The most common reasons found for prolonged hospital stay were due to infections by 22 cases (22.7%) and incidental medical findings by 25 cases (25.8%). There were 13 women with wound sepsis (13.4%), 12 persistent tachycardia (12.4%), 4 ongoing bleeding (4.1%), 2 venous-thromboembolism (2%) and 1 for socio-economic reason (1%). Among the eighteen other reasons (18.6%), 8 were attributed to ongoing sepsis, 1 to relook laparotomy, and in 9 cases, the reasons were not clear. 4. DISCUSSION: Gynaecological emergency surgeries form part of the main emergency surgeries done amongst women both nationally and internationally. [15] Emergency surgeries burden e healthcare systems especially in developing countries resulting in increased morbidity and mortality, yet there are few audit studies analysing emergency surgeries in gynaecology. [21,22,23] The aim of the present study was to analyse the clinical processes and outcomes of gynaecological emergency surgeries performed at Groote Schuur in the year 2019. Our findings indicated that 79.1% of the emergency surgeries conducted were related to pregnancy procedures. Ectopic pregnancy accounted for 47.9% of all pregnancy related indications, making it the leading reason as expected. This finding is also consistent with most studies worldwide. [23,24] The second common indication was evacuation of the uterus. A surprising finding was that 5.6% of evacuation of the uteri was attributed to products of conception post caesarean section (Table 2). Many women (79.3%) were predominantly of reproductive age with a median of 30.16 years, and this aligns with the fact that only 15.5% had medical co-morbidities. The median age has some similarities to other local studies done in SA, like the study done in Gauteng district hospital by Nzaumvila D where their median age was 28.9. [16] The study aimed to determine the incidence of ectopic pregnancy and assess the profile of women who presented to the Odi district hospital between 2010 and 2014. [16] Our audit found that 66.6% women were discharged from the hospital with their HIV statuses unknown, and most of them were pregnant. It is expected according to the South African national guidelines that all pregnant women get tested for HIV. This may be a reflection of early pregnancy complications in that many of these women did not realize that they were pregnant yet, or had not yet had an opportunity for antenatal booking. Within the period, 24.3% of women in the cohort were smoking, which correlated with the Western Cape having the highest prevalence of tobacco smokers among women in South Africa at 26.8%, based on the South African National Health and Nutrition examination in 2012. [25] The Western Cape has also been found to have the highest prevalence of tobacco smokers at 32.9% among both genders, surpassing all other provinces. [25] Evidence has shown smoking to be one of the risk factors for ectopic pregnancy, which might have contributed to the increased incidence during the period of the study. [26] Further studies need to be done to confirm if this can be linked to ectopic pregnancy in our local population. The preoperative findings revealed anaemia (45%), tachycardia (43%) and hypovolaemia (9.3%) even in the women who were delayed. Similar to hypovolaemic shock, anaemia has been shown to be associated with an increased risk of mortality and morbidity, such as acute kidney injury and sepsis. [34] This indicates a significant burden on Groote Schuur Hospital’s emergency surgical case management. The high prevalence of anaemia pre- operatively impacts on outcomes, as well as complications post-operatively as anaemia was the commonest complication in this review. Research has showed that prompt and timely response in the emergency conditions requiring surgical intervention can significantly affect the surgical outcomes of patients. [7,27] Appropriate triaging is critical in patients who need surgical emergencies. Triage is the procedure of determining the priority of patient management based on the urgency of their disease and clinical condition. [27] This process is of paramount significance when there is an inadequate supply of resources to meet the demand of patients. [27] It is more valid in our hospital settings in South Africa, where the same theatre space gets to be shared