The surgical burden of breast disease in KwaZulu-Natal province

Keywords: breast surgery, breast pathology, breast cancer, general surgery

Abstract

Background: The current surgical workload assessments in KwaZulu-Natal (KZN) are inadequate to inform strategies to improve surgical services. Breast diseases have a well-defined spectrum and surgical treatment options, analysis of which could guide health policy in the field. This project aimed to quantify and analyse the operative workload for breast pathology in KZN.

Method: A retrospective review of breast-related operations conducted at public sector hospitals in KwaZulu Natal province between 1 July and 31 December 2015 was undertaken. Data was collected from theatre operative registers and manually categorised as follows: sepsis, benign pathology, malignant pathology, and by hospital, according to geographic location, and complexity of care to determine factors to improve the service for breast care in the province.

Results: In the 6-month study period, 13 282 general surgical procedures were performed of which 776 (5.8%) were breast-related operations. There were 372 (47.9%) operations for breast sepsis, 140 (18%) for benign breast lesions, 17 (2.2%) for cosmetic indications and 27 (3.5%) for diagnostic procedures. There were 223 (28.7%) procedures for nonbenign disease: 21 (2.6%) wide local excisions (WLE), 203 (26.2%) mastectomies of which 161 (72.2%) mastectomies had an axillary lymph node dissection and 26 (11.7%) were performed as onco plastic procedures. Hospitals in the Durban and Pietermaritzburg metropolitan areas performed 75% of the breast-related procedures. The majority (69.6%) of sepsis-related procedures were performed at secondary/regional facilities, while 58.3% of non-benign breast surgeries were performed at tertiary and quaternary centres.

Conclusion: Breast sepsis accounts for almost 50% of the surgery and is mainly dealt with at hospitals above district level. One-third of breast surgery in KZN province is for non-benign disease. There is a paucity of breast conserving surgery. Elucidation of these observations can guide improvement in the provincial breast care service.

Author Biographies

V U Ehlers, KwaZulu-Natal Department of Health

Department of Surgery, Pietermaritzburg Metropolitan Hospital Complex, KwaZulu-Natal Department of Health, South Africa

C F Kohler, KwaZulu-Natal Department of Health

Department of Surgery, Pietermaritzburg Metropolitan Hospital Complex, KwaZulu-Natal Department of Health, South Africa

E Lutge, KwaZulu-Natal Department of Health

Epidemiology Unit, KwaZulu-Natal Department of Health and School of Nursing and Public Health, University of KwaZulu-Natal, South Africa

A Tefera, KwaZulu-Natal Department of Health

Epidemiology Unit, KwaZulu-Natal Department of Health, South Africa

D L Clarke, University of KwaZulu-Natal

Department of Surgery, Pietermaritzburg Metropolitan Hospital Complex, KwaZulu-Natal Department of Health and Department of Surgery, College of Health Sciences, Nelson R Mandela School of Medicine, University of KwaZulu-Natal, South Africa

I Buccimazza, KwaZulu-Natal Department of Health

Department of Surgery, Inkosi Albert Luthuli Hospital, KwaZulu-Natal Department of Health, South Africa

Published
2021-09-10
How to Cite
Ehlers, V., Kohler, C., Lutge, E., Tefera, A., Clarke, D., & Buccimazza, I. (2021). The surgical burden of breast disease in KwaZulu-Natal province. South African Journal of Surgery, 59(3), 108-112. Retrieved from http://sajs.redbricklibrary.com/index.php/sajs/article/view/3364
Section
Breast Surgery