Browsing by Author "Kluyts, Hyla-Louise"

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    Critical care admission of South African (SA) surgical patients : results of the SA surgical outcomes study
    (Health and Medical Publishing Group, 2017) Skinner, David Lee; De Vasconcellos, Kim; Wise, Robert; Esterhuizen, Tonya Marianne; Fourie, Cate; Mahomed, Akhter Goolam; Gopalan, P. Dean; Joubert, Ivan; Kluyts, Hyla-Louise; Mathivha, L. Rudo; Mrara, Busisiwe; Pretorius, Jan P.; Richards, Guy; Smith, Ollie; Spruy, Maryke Geertruida Louise; Pearse, Rupert M.; Madiba, Thandinkosi E.; Biccard, Bruce M.
    Background. Appropriate critical care admissions are an important component of surgical care. However, there are few data describing postoperative critical care admission in resource-limited low- and middle-income countries. Objective. To describe the demographics, organ failures, organ support and outcomes of non-cardiac surgical patients admitted to critical care units in South Africa (SA). Methods. The SA Surgical Outcomes Study (SASOS) was a 7-day national, multicentre, prospective, observational cohort study of all patients ≥16 years of age undergoing inpatient non-cardiac surgery between 19 and 26 May 2014 at 50 government-funded hospitals. All patients admitted to critical care units during this study were included for analysis. Results. Of the 3 927 SASOS patients, 255 (6.5%) were admitted to critical care units; of these admissions, 144 (56.5%) were planned, and 111 (43.5%) unplanned. The incidence of confirmed or strongly suspected infection at the time of admission was 35.4%, with a significantly higher incidence in unplanned admissions (49.1 v. 24.8%, p<0.001). Unplanned admission cases were more frequently hypovolaemic, had septic shock, and required significantly more inotropic, ventilatory and renal support in the first 48 hours after admission. Overall mortality was 22.4%, with unplanned admissions having a significantly longer critical care length of stay and overall mortality (33.3 v. 13.9%, p<0.001). Conclusion. The outcome of patients admitted to public sector critical care units in SA is strongly associated with unplanned admissions. Adequate ‘high care-dependency units’ for postoperative care of elective surgical patients could potentially decrease the burden on critical care resources in SA by 23%. This study was registered on ClinicalTrials.gov (NCT02141867).
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    Maternal and neonatal outcomes after caesarean delivery in the African Surgical Outcomes Study : a 7-day prospective observational cohort study
    (Elsevier, 2019-04) Bishop, David; Dyer, Robert A.; Maswime, Salome; Rodseth, Reitze N.; Van Dyk, Dominique; Kluyts, Hyla-Louise; Tumukunde, Janat T.; Madzimbamuto, Farai D.; Elkhogia, Abdulaziz M.; Ndonga, Andrew K. N.; Ngumi, Zipporah W. W.; Omigbodun, Akinyinka O.; Amanor-Boadu, Simbo D.; Zoumenou, Eugene; Basenero, Apollo; Munlemvo, Dolly M.; Youssouf, Coulibaly; Ndayisaba, Gabriel; Antwi-Kusi, Akwasi; Gobin, Veekash; Forget, Patrice; Mbwele, Bernard; Ndasi, Henry; Rakotoarison, Sylvia R.; Samateh, Ahmadou L.; Mehyaoui, Ryad; Patel-Mujajat, Ushmaben; Sani, Chaibou M.; Esterhuizen, Tonya M.; Madiba, Thandinkosi E.; Pearse, Rupert M.; Biccard, Bruce M.
    Background: Maternal and neonatal mortality is high in Africa, but few large, prospective studies have been done to investigate the risk factors associated with these poor maternal and neonatal outcomes. Methods: A 7-day, international, prospective, observational cohort study was done in patients having caesarean delivery in 183 hospitals across 22 countries in Africa. The inclusion criteria were all consecutive patients (aged ≥18 years) admitted to participating centres having elective and non-elective caesarean delivery during the 7-day study cohort period. To ensure a representative sample, each hospital had to provide data for 90% of the eligible patients during the recruitment week. The primary outcome was in-hospital maternal mortality and complications, which were assessed by local investigators. The study was registered on the South African National Health Research Database, number KZ_2015RP7_22, and on ClinicalTrials.gov, number NCT03044899. Findings: Between February, 2016, and May, 2016, 3792 patients were recruited from hospitals across Africa. 3685 were included in the postoperative complications analysis (107 missing data) and 3684 were included in the maternal mortality analysis (108 missing data). These hospitals had a combined number of specialist surgeons, obstetricians, and anaesthetists totalling 0·7 per 100000 population (IQR 0·2–2·0). Maternal mortality was 20 (0·5%) of 3684 patients (95% CI 0·3–0·8). Complications occurred in 633 (17·4%) of 3636 mothers (16·2–18·6), which were predominantly severe intraoperative and postoperative bleeding (136 [3·8%] of 3612 mothers). Maternal mortality was independently associated with a preoperative presentation of placenta praevia, placental abruption, ruptured uterus, antepartum haemorrhage (odds ratio 4·47 [95% CI 1·46–13·65]), and perioperative severe obstetric haemorrhage (5·87 [1·99–17·34]) or anaesthesia complications (11·47 (1·20–109·20]). Neonatal mortality was 153 (4·4%) of 3506 infants (95% CI 3·7–5·0). Interpretation: Maternal mortality after caesarean delivery in Africa is 50 times higher than that of high-income countries and is driven by peripartum haemorrhage and anaesthesia complications. Neonatal mortality is double the global average. Early identification and appropriate management of mothers at risk of peripartum haemorrhage might improve maternal and neonatal outcomes in Africa.