Burden and profile of spinal pathology at a major tertiary hospital in the Western Cape, South Africa

Keywords spinal pathology epidemiology, spinal trauma, spinal tuberculosis, spinal surgery

Abstract

Background: Spinal pathology in the Western Cape is managed at three tertiary level hospitals, including Tygerberg Hospital. The Tygerberg Hospital Orthopaedic Spinal Unit is responsible for the management of spinal pathology for the 3.4 million people in the hospital’s catchment area. However, the unit’s overall burden of disease and associated resource use is currently unclear.


Aim: The first aim was to investigate the overall burden and clinical profile of spinal pathology presenting to the Tygerberg Hospital Spinal Unit over a one-year period. The second aim was to determine resource use associated with spine pathology admissions.


Methods: Overall burden was investigated by performing a retrospective review of all patients admitted to the Spine Unit between 1 October 2016 and 30 September 2017. Demographic and clinical data was collected, and patients were assigned to one of five spinal pathology sub-groups. Resource use was determined by length of hospital stay, waiting times, advanced imaging and theatre usage.


Results: Overall burden comprised 349 individual patients and 376 admissions, including readmissions. Trauma (51%) and infection (24%) accounted for the majority of admitted pathology with degenerative (10%), deformity (7%) and malignancy (7%) representing fewer admissions. Motor vehicle accidents were the primary mechanism of injury, accounting for 48% of spine trauma. Tuberculosis was the causative organism in 87% of spinal infections with 44% HIV co-infection. Hospital resource use was considerable with 92% of spine patients requiring advanced imaging, a median operating time of 3 h 36 min and a median hospital stay of 19 days. Infection and malignancy sub-groups had the longest waiting times for advanced imaging and theatre with a median wait of 14–16 days, accounting for approximately 62% of the typical total hospital stay.


Conclusions: The Spine Unit experienced a substantial patient burden requiring significant hospital resources. Reduced in-patient waiting times and upskilling of orthopaedic services at secondary hospitals represent key areas for health system strengthening. However, multi-sectoral strategies would be required to effectively address our high burden of largely preventable spinal pathology.


Level of evidence: Level 4

Author Biographies

Sanesh Miseer, Stellenbosch University

MBChB, FC Orth (SA); Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Tygerberg Hospital, Cape Town, South Africa

Theresa Mann, Stellenbosch University

PhD; Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Johannes Hendrick Davis, Stellenbosch University

MBChB, MMed(Ortho), FC Orth (SA); Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa

Published
2019-01-21
How to Cite
MISEER, Sanesh; MANN, Theresa; DAVIS, Johannes Hendrick. Burden and profile of spinal pathology at a major tertiary hospital in the Western Cape, South Africa. South African Orthopaedic Journal, [S.l.], p. 33-39, jan. 2019. ISSN 2309-8309. Available at: <http://journal.saoa.org.za/index.php/saoj/article/view/240>. Date accessed: 25 june 2019.

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