pattern of hospital admissions in surgical ward at al ... · pattern of hospital admissions in...

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ABSTRACT

OBJECTIVE: To see the frequency of the different diseases among patients admitted to surgical ward of the hospital.STUDY DESIGN: A Retrospective observational study.PLACE AND DURATION: At Department of Surgery Al-Nafees Medical College & Hospital Islamabad during the duration of six months

st thi.e. from 1 January 2016 to 30 June 2016. METHODOLOGY: During the study period data of all the patients admitted in male and female surgical wards were evaluated through hospital record. On a structured Performa, patients age, gender and diagnosis was recorded. Patients result were evaluated statistically at the end. RESULTS: Among the total 512 admissions 52% were female and 48% were male. Patients with soft tissue Pathologies were highest (23-63) followed by Hepato-biliary (21.48%) and Urology disease (13.87%) only 2.15% of the patients were admitted with vascular pathologies and 1.95% with upper GIT Pathologies. The more frequent diseases from all subspecialist were Cholelithiasis (19.92%), appendicitis (7.42%), soft tissue infections (7.62%), Lipoma (6.25%), Renal stone (4.69%), multi nodular goiter (4.3%) and Inguinal Hernia (3.71%).CONCLUSION: Our study shows that most of hospital admission in surgical ward are with gallstone disease, hernia, soft tissue pathologies, renal stone and goiter which cover almost more than half of the burden of total admissions are more common among population dependent on our hospital.KEY WORDS: Hospital admissions, Surgical diseases, Elective Admission, Emergency Admission, Surgical Ward

HOW TO CITE THIS:Ahmed W, Haq ZU, Ahmed I. Pattern of Hospital Admissions in Surgical Ward. Isra Med J. 2017; 9(3): 135-140.

This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (http://creativecommons.org/licenses/by-nc/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

ORIGINAL ARTICLE ISRA MEDICAL JOURNAL | Volume 9 - Issue 3 | May - Jun 2017

of the significance of the study of disease pattern is that by 2020, the World Health Organization (WHO) predicts that the causes of disease and mortality in Africa will undergo a significant change towards endemic non-communicable diseases, in contrary to the infectious diseases which were more prevalent in past. This shift in disease pattern will dictate changes in the placement of human and physical resources, to deal with upcoming health challenges. To cope up this transition

4,5an accurate data on disease burden will be required . Surgical conditions are always remained serious health problem

6and in many countries has been neglected in public health . However, once it is ascertained it will very helpful to the Health service organizations to formulate the strategies to cope up these diseases and may also promote research in prevalent diseases. Besides it may also help in planning the need for the training of doctors in specialty of need in future. Study of the patterns of hospital admissions also give us a guide line to the frequency of various disease present with different signs and symptoms and vary from one geographical area to another area. This type of data helps the health authorities or medical professionals to plan effective measures to overcome disease burden and promote awareness among public and to plan

7 better treatment for patients . Surgery is considered as costly and complex treatment most of the time and it is one of the reason that access to surgical treatment to everyone is not

8 possible in underdeveloped or developing countries . In this regards, the World Health Organization (WHO) tools for analysis

Pattern of Hospital Admissions in Surgical Wardat Al-Nafees Medical College & Hospital

INTRODUCTIONIn this era, the health of an individual is becoming an increasingly important priority due to more health awareness

1and it is also a part of the global health policy . Recent improvements in infant survival along with a reduction in overall mortality leads to an increase proportion of the adult

2population, mostly young adults . To improve the existing health services or to provide better health care, we should be aware of the disease burden in a specific area of the country. For this, the pattern of admissions in any hospital can be taken as a guide to the prevalence of various diseases among the

3,4population which is dependent on that hospital . An example

1. House Officer Benazir Bhutto Hospital, Rawalpindi2. House Officer Pakistan Institute of Medical Science (PIMS)3. Professor of Surgery Al-Nafees Medical College & Hospital Isra University Islamabad Campus Pakistan

Correspondence to:Wasim AhmedHouse OfficerBenazir Bhutto Hospital, RawalpindiEmail: [email protected]

Received for Publication: 18-08-16Accepted for Publication: 07-03-17

1 2 3Wasim Ahmed , Zaheer-ul-Haq , Ishtiaq Ahmed

ISRA MEDICAL JOURNAL | Volume 9 - Issue 3 | May - Jun 2017Wasim Ahmed et al.

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RESULTS

A total of 512 patients were admitted during the study period. The age ranges from 07 month to 92 years. The majority of patients were females (n=266, 52%). Most of the patient's

th rdadmissions were in 4 decade (n=98, 19.1%), followed by 3 thdecade (n=98, 19.1%) and patients admissions in 5 decade

rd(n=69, 13.5%) were the 3 highest. Only 22 (4.3%) patients from both sexes were admitted above the age of 70 years. The patients less than 10 years of age were 7.8% (n=40) during the study period. Only 2 patients admitted with age greater than 80 years (Table - I).

TABLE-I: AGE AND SEX DISTRIBUTION OF ADMITTED PATIENTS (N=512)

* Mean age 37.2 yearsTable – II, shows the frequency of admission in different subspecialist or disciplines'. The admission due to soft tissue pathologies were the highest (n=121, 23.63%), followed by Hepato-biliary diseases (n=110, 21.48%) and Urology disease

rdadmission (n=71, 13.87%) were the 3 most common in frequency. Admission due to upper GIT pathologies (n=10, 1.95%) and vascular disease (n=11, 2.15%) were the lowest. About 6.25% (n=32) patients were admitted with Head and neck and 5.66% (n=29) females admitted with breast Diseases during the study period. None of the male patient admitted with breast pathology during study period.

of situation in order to evaluate emergency and critical surgical care is the largest effort in order to assess the surgical care

1 throughout the world . In order to improve the surgical care the first step is record keeping of the patients/diseases followed by

asystematic approach in order to access the available facilities, formulation of effective interventions of the health care

9 provision and analysis of cost-effectiveness of the treatment .Poor documentation and record keeping of the patients in hospital usually makes difficult to assess the problems and design strategy to improve hospital setup according to patients

10load and disease pattern . The pattern of illnesses responsible for the high mortality among adults in our setup has not been well characterized. In our country other than lack of central registry, there is no published or unpublished data available to assess the admission pattern and patient load on different specialties. Even no study was conducted at national level overall or exclusively on a specific group of patients at basic health units, tehsil, or district

7hospital level . Moreover, currently the health system in our country does not rely on research evidence for guiding policy interventions. To fulfill this, the community-based studies provide an accurate picture of the prevalence of e disease because these studies minimize the bias. In addition, these hospital-based surveys are always provide useful information which could be achieved from the analysis of well-conducted routine population and clinical surveillance activities. Here we are reporting a pattern of hospital admissions in department of surgery of our hospitals to determine the causes of admission and to characterize the methodological features of such studies

11 that are likely to yield useful data in the future . We have conducted this study to see the frequency of the different diseases among patients admitted to surgical ward of the hospital.

METHODOLOGY

This retrospective observational study was carried out in the Department of Surgery of Al-Nafees Medical College & Hospital

st thIslamabad from 1 January, 2016 to 30 June, 2016. Al-Nafees Medical College & Hospital is a tertiary care 500 bed teaching Hospital and located in semi urban area of Islamabad which is affiliated with Al-Nafees Medical College Islamabad. Most of the patient which comes to hospital belongs from Islamabad suburbs of village surrounding the Islamabad city and Northern Punjab. In addition most of the drainage area of this Hospital is Kahuta Tehsil, Murree Tehsil and Kashmir area. Patients from Taxilla and Chakwal area were also come for treatment in this Hospital. During the study period all the patients admitted in male and female Surgical Wards from OPD and ER were evaluated. OPD patients were excluded from the study. Hospital record was used to access the patient data and patients re-admitted with same diseases were excluded from the study. A structured Performa containing all important details for analysis i.e. patient age, gender and diagnosis was recorded carefully by the researchers. For statistical analysis SPSS version 20 was used. Frequencies and percentages were used for evaluation of data like diagnosis, gender, age, mode of payment etc.

TABLE – II: FREQUENCY OF VARIOUS DISEASE INACCORDANCE WITH SYSTEM INVOLVEMENT (N=512)


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The commonest disease pattern from subspecialist were, Cholelithiasis (n=102, 19.92%), soft tissue infections (n=39, 7.62%), appendicitis (n=38, 7.42%), Lipoma (n=32, 6.25), Renal stone (n=24, 4.69%) and multi nodular goiter (n=15, 2.93%). The frequency of other commonest disease are Inguinal Hernia (n=19, 3.71%) Benign prostatic Hypertrophy (n=15, 2.93%), Benign Breast Disease (n=13, 2.54%), Sebaceous Cyst (n=12, 2.34%) and Diabetic Foot (n=10, 1.95%). Among orthopedics, the lower limb fractures were the commonest admission (n=10, 1.95%) followed upper limb fractures (n=6, 1.17%) (Table-III).In upper GIT specialty, peptic ulcer disease was commonest (n=6, 60%) and Cholelithiasis were commonest (n=102, 92.73%) in Hepatobiliary discipline. Haemorrhoids (n=8, 40%) and Anal

Fissure (n=5, 25%) were commonest pathology observed in Colo Rectal disease. In Breast, the Benign Breast disease was highest in admissions (n=13, 44.83%) and Multi Nodular Goiter were among the highest (n=22, 68.75%) admissions in Head & Neck discipline. Among Hernia, admission due to Inguinal Hernia were highest (n=19, 61.3%) following by Paraumbilical Hernia (n=7, 22.59%). In Urology admissions, Renal Stones & BPH were the commonest pathologies found i.e. (n=24, 33.81%) and (n=15, 21.13%) respectively. Varicose Veins were commonest (n=7, 63.64%) among Vascular pathologies and admissions due to Ac Appendicitis were highest (n=38, 88.38%) in Acute Abdominal pathologies. (Table III)

TABLE - III: FREQUENCY OF DIFFERENT DISEASES AMONG PATIENTS ADMITTED IN ACCORDANCE WITH THE DISEASE OF VARIOUSSYSTEM (N=512)


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male were infectious and parasitic diseases, injuries and GIT disorders. HIV-related diseases were the leading cause of

5disability followed by non-communicable diseases . Similarly a meta-analysis about disease burden reported the leading causes of admission were infectious, parasitic and circulatory diseases with an increase of admissions from 3.9% in 1950-59 to 19.9% in 2000-2010 i.e. almost six folds. They concluded that the cardiovascular and infectious diseases are the leading

11causes of admissions and in-hospital deaths . A study by Ndjeka et al from South Africa shows an increasing trend in medical wards due to non-communicable diseases, with male preponderance and more than half were between 30-60 years of age. They also noticed more admissions burden in the wet season (April to September). They emphasized to take serious steps at revamping the health sector services and facilities, and to chalk out national and local strategies to combat the burden

14of non-communicable diseases . A study by Noor and colleagues observed the highest admissions were between 56-65-year of old age with majority of non-communicable diseases. The infectious or parasitic diseases were commonest, followed by circulatory, digestive and genito-urinary system diseases. They concluded that the burden of non-communicable diseases has exceed that of communicable

2diseases in contrary to the disease burden reported in past . Among our hospital admissions in surgical ward, shows the maximum case burden is of soft tissue pathologies (23.63%), Hepato-biliary (21.48%), urology (13.87%) and acute abdominal emergencies (8.4%). Among the different diseases, we observed that the gall stone diseases (19.92%), soft tissue swellings (6.25%), renal stones (4.69%), goiter (4.3%), benign prostatic hypertrophy (2.93%), and benign breast pathologies (2.54%) were the commonest admissions. We need to develop our resources and to train our young surgeons according to the disease burden of our department. An example of the advantage of this type of studies

18 19is that two studies conducted by Abebe and Derebew in Ethopia to analyze the pattern of pediatric surgical admission at a rural hospital with emphasis on the commonest diseases and factors affecting the outcome. They conclude that the majority of the pediatric patients can be treated well without referring to tertiary care hospital and recommended that it is better if a separate Pediatric unit is established in the hospital. Another

20study by Tekle et al has reported that many children with surgical pathologies can be managed at rural hospital. They recommend that to reduce burden of tertiary care hospitals, and to provide a better service the facilities at rural hospital should be improved. The quality of service can also be improved by frequent training of surgeons who are providing service at rural hospital. It is suggested that the tehsil level or secondary

DISCUSSION

To assess the varying limitations and qualities of infrastructure of a hospital which are necessary for the provision of proper health care services the study of pattern of illness and admission in a hospital is very important. Examples in this regards is that in a study of patients with severe head injury in

12the ICU of a Hospital Nigeria shows high mortality (68.4%) . Similarly, in another study from Nigeria reported the mortality of neurological and obstetric patients is 43.5% and 33%

13respectively . A similar study from Uganda about critical care of obstetric patients revealed a high mortality rate i.e., 60%, and

14the mortality rate in the ICU population was found to be 25% . The statistics clearly shows that facilities for the treatment of these conditions needs improvement on priority basis to reduce the mortality.Study done by McCord and Chowdhury reported an improvement mortality in most of the South Asian countries due to improvements in health awareness, economic status, better nutrition, family planning and availability of the common diseases treatment at local hospitals. However, the mortality is still high in some parts of world due to lack of facilities requiring basic medical services like surgery for pregnancy complications, trauma management and infectious disease treatment, availability of intravenous fluids, blood transfusion, antibiotics,

15oxygen etc . We observed that young adults (21-30 years of ndage) were the 2 highest number of admissions (19.1%) in our

hospital. Study done by Grimes and colleagues shows that the majority of people are young adults which are affected by disease and require surgery which have negative effect on their

16earnings and also affect the overall economy of the country . A study conducted by Islam and his colleagues shows that among the pattern of admissions in a general surgical unit of tertiary care hospital, the trauma and appendicitis were the most common surgical emergencies. Among elective admissions, the Hernias, Anorectal conditions and Gall bladder diseases were

7the most frequent admissions . Another study from Nigeria by Onyemaechi et al reported more male to female admission ration of 1.6:1 with an age raged from 8 days to 95 years. Acute abdomen, traumatic brain injury and malignancy were the

17commonest surgical diagnosis . In our patients, the most common surgical emergency encounter by us is appendicitis (7.43%), followed by soft tissue infections. Trauma is not a leading frequency of admissions in our hospital due to lack of trauma center. The Etyang et al from Kenya studied the pattern of admissions to hospital in women and observed that the infectious and parasitic diseases, pregnancy-related disorders and circulatory illnesses are the commonest. Leading causes of admission in

A total of 71 (13.87%) patients admitted with urogenital pathologies and among then stone disease were the highest (n=24, 4.69%),followed by BPH (n=15, 2.93 %) and ureteric colic (n=10, 1.95%) (Table - III)


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Disclaimer: None.Conflict of Interest: None.Source of Funding: None.

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care hospitals should take the load off from tertiary care or teaching hospitals in regard to routine cases. However the enormity of the task of bringing about these changes is appreciated and some short-term measures to improve the facilities and services in hospital should be adopted. For example, the duration of pre-operative stay in elective cases could be reduced by having pre-operative evaluations on the OPD basis. This shortening of the pre-operative stay will automatically reduce the morbidity from infections with resistant hospital organisms which ultimately reduce the length of post-operative hospital stay.The main objectives of our study was to check the frequency of different diseases in the community which need surgical interventions and to diagnose the various common surgical illness in the hospital setup early in order to reduce the mortality and morbidity and also to control the prevalence of common illness which would ultimately reduce the burden of hospital admissions. Our study shows a disease trend of population dependent on our hospital but needs to be conducted at large scale to achieve reliable results and chart out strategies for future. Studies also shows that high costs, patient perceptions and demographic factors limited utilization of

21,22 surgery . Reduction of the diseases in population could be done by addressing the high burden diseases and their cost effective interventions which are effectively adopted by conducting properly designed studies. Etyang et al has also pointed out in their meta-analysis that that the methodological deficiencies have limited the usefulness of previous studies in

11defining national patterns of disease in adults . To achieve this, it is very important that large scale and properly designed studies should be conducted at frequent intervals.

CONCLUSION

Our study shows that most of hospital admission in surgical ward are with gallstone disease, hernia, soft tissue pathologies, renal stone and goiter which cover almost more than half of the burden of total admissions are more common among population dependent on our hospital.

RECOMMENDATIONS

Hospital service and resources should be targeted towards those surgical diseases which are more commonly encountered in our hospital and there is a dire needs for future studies, and to start educational and awareness programs for population about these diseases, and also need to train more doctors in respective specialties in order to decrease the burden of hospital admissions.

Contribution of Author:Ahmed W: Designed Research Study, Data Collection, Statistical Analysis, Manuscript Writing, Literature Review.Haq ZU: Data Collection, Statistical Analysis, Literature ReviewAhmed I: Conceived the Idea, Manuscript Final Reading and Approval


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16. Grimes CE, Billingsley ML, Dare AJ, Day N, George PM, Kamara TB et al. The demographics of patients affected by Surgical Disease in District Hospitals in two sub-Saharan African countries: a retrospective descriptive analysis. Springer Plus. 2015; 4:750.

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18. Abebe G, Mariam A. Two year retrospective review of reason for pediatrics admission to Chiro hospital eastern

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