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Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting
Background: Arthroplasty procedures in low-income countries are mostly performed at tertiary centers, with waiting lists exceeding 12 to 24 months. Recently, this is further exacerbated by the impact of the Covid-19 Pandemic on elective surgeries. Providing arthroplasty services at other levels of h...
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| Format: | Thesis |
| Language: | English |
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Division of General Surgery
2024
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| _version_ | 1867613216987676672 |
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| access_status_str | Open Access |
| author | Laubscher, Kim |
| author2 | Kauta, Ntambue |
| author_browse | Kauta, Ntambue Laubscher, Kim |
| author_facet | Kauta, Ntambue Laubscher, Kim |
| author_sort | Laubscher, Kim |
| collection | Thesis |
| description | Background: Arthroplasty procedures in low-income countries are mostly performed at tertiary centers, with waiting lists exceeding 12 to 24 months. Recently, this is further exacerbated by the impact of the Covid-19 Pandemic on elective surgeries. Providing arthroplasty services at other levels of healthcare aims to offset this burden, however there is a marked paucity of literature regarding surgical outcomes. This study aims to provide evidence on the safety of arthroplasty at district level. Methods: Retrospective review of consecutive hip and knee primary arthroplasty cases performed at a District Hospital (DH), and a Tertiary Academic Hospital (TH) in Cape Town, South Africa between 1st January 2015 and 31st December 2018. Patient demographics, hospital length of stay, surgery related readmissions, reoperations, post-operative complications, and mortality rates were compared between cohorts. Results: Seven hundred and ninety-five primary arthroplasty surgeries were performed at TH level and 228 at DH level. The average hospital stay was 5.2±2.0 days at DH level and 7.6±7.1 days for TH (p<0.05). Readmissions within 3 months post-surgery of 1.75% (4 patients) for district and 4.40% (35) for tertiary level (p<0.05). Reoperation rate of 1 in every 100 patients at the DH and 8.3 in every 100 patients at the TH (p<0.05) was noted. Death rate was 0.4% vs 0.6% at district and tertiary hospitals respectively (p>0.05). Periprosthetic joint infection (PJI) rate was 0.43% at DH and 2.26% at TH. The percentage of hip dislocation requiring revision was 0% at district and 0.37% at tertiary level. During the study period, 228 patients received their arthroplasty surgery at the DH; these patients would otherwise have remained on the TH waiting list. Conclusions: Hip and Knee Arthroplasty at District health care level is safe and; for the reason that the DH feeds into the TH; providing arthroplasty at district level may help ease the pressure on arthroplasty services at tertiary care facilities in a Southern African context. Adequately trained surgeons should be encouraged to perform these procedures in district hospitals provided there is appropriate patient selection and adherence to strict theatre operating procedures. |
| format | Thesis |
| id | oai:open.uct.ac.za:11427/39876 |
| institution | University of Cape Town (South Africa) |
| language | eng |
| last_indexed | 2026-06-10T12:32:37.404Z |
| license_str | Not specified — see source repository |
| provenance_str_mv | Harvested via OAI-PMH from UCTD — University of Cape Town Open Access Repository |
| publishDate | 2024 |
| publishDateRange | 2024 |
| publishDateSort | 2024 |
| publisher | Division of General Surgery |
| publisherStr | Division of General Surgery |
| record_format | dspace |
| source_str | UCTD — University of Cape Town Open Access Repository |
| spelling | oai:open.uct.ac.za:11427/39876 Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting Laubscher, Kim Kauta, Ntambue Held Michael General Surgery Background: Arthroplasty procedures in low-income countries are mostly performed at tertiary centers, with waiting lists exceeding 12 to 24 months. Recently, this is further exacerbated by the impact of the Covid-19 Pandemic on elective surgeries. Providing arthroplasty services at other levels of healthcare aims to offset this burden, however there is a marked paucity of literature regarding surgical outcomes. This study aims to provide evidence on the safety of arthroplasty at district level. Methods: Retrospective review of consecutive hip and knee primary arthroplasty cases performed at a District Hospital (DH), and a Tertiary Academic Hospital (TH) in Cape Town, South Africa between 1st January 2015 and 31st December 2018. Patient demographics, hospital length of stay, surgery related readmissions, reoperations, post-operative complications, and mortality rates were compared between cohorts. Results: Seven hundred and ninety-five primary arthroplasty surgeries were performed at TH level and 228 at DH level. The average hospital stay was 5.2±2.0 days at DH level and 7.6±7.1 days for TH (p<0.05). Readmissions within 3 months post-surgery of 1.75% (4 patients) for district and 4.40% (35) for tertiary level (p<0.05). Reoperation rate of 1 in every 100 patients at the DH and 8.3 in every 100 patients at the TH (p<0.05) was noted. Death rate was 0.4% vs 0.6% at district and tertiary hospitals respectively (p>0.05). Periprosthetic joint infection (PJI) rate was 0.43% at DH and 2.26% at TH. The percentage of hip dislocation requiring revision was 0% at district and 0.37% at tertiary level. During the study period, 228 patients received their arthroplasty surgery at the DH; these patients would otherwise have remained on the TH waiting list. Conclusions: Hip and Knee Arthroplasty at District health care level is safe and; for the reason that the DH feeds into the TH; providing arthroplasty at district level may help ease the pressure on arthroplasty services at tertiary care facilities in a Southern African context. Adequately trained surgeons should be encouraged to perform these procedures in district hospitals provided there is appropriate patient selection and adherence to strict theatre operating procedures. 2024-06-05T13:30:33Z 2024-06-05T13:30:33Z 2023 2024-06-05T12:56:45Z Thesis / Dissertation Masters MMed http://hdl.handle.net/11427/39876 eng application/pdf Division of General Surgery Faculty of Health Sciences |
| spellingShingle | General Surgery Laubscher, Kim Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting |
| thesis_degree_str | Master's |
| title | Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting |
| title_full | Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting |
| title_fullStr | Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting |
| title_full_unstemmed | Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting |
| title_short | Primary Hip And Knee Arthroplasty At District Level Is Safe And May Reduce The Burden On Tertiary Care In A Low-Income Setting |
| title_sort | primary hip and knee arthroplasty at district level is safe and may reduce the burden on tertiary care in a low income setting |
| topic | General Surgery |
| url | http://hdl.handle.net/11427/39876 |
| work_keys_str_mv | AT laubscherkim primaryhipandkneearthroplastyatdistrictlevelissafeandmayreducetheburdenontertiarycareinalowincomesetting |