Changing trends in maxillofacial and oral surgery at Chris Hani Baragwanath Hospital: comparison between two time periods in 1987 and 2007
Mekonnen Damtew, Mesfin
INTRODUCTION Clinical audits of maxillofacial and oral surgery units in the United Kingdom have shown significant changes in the workloads of staff, in the social and demographic profiles of the patients, in the types of procedures performed and in the use of local or general anesthesia. This data allows the planning of a better service, of monitoring the increasing workload and the suitability of the procedures being performed for the training of registrars. AIMS AND OBJECTIVE The objective of this investigation were to carry out a clinical audit in the maxillofacial and oral surgery unit at CH Baragwanath Hospital for a six month period in 1987 and in 2007 and to compare this data in order to determine changing trends. MATERIALS AND METHODS A clinical audit for the periods 1 January to 30 June 1987 and 2007 was undertaken. The audit was based on a review of the surgical procedures register which records all surgical procedures carried out in the unit. The following information was extracted from the procedures register for the two time periods and statistically compared; numbers of patients, age, gender, race of patient, local or general anaesthesia, diagnosis, duration of operation and procedure performed. RESULTS. There were no significant changes in the demographic profiles of the patients treated except that in the second time period the sample contained 15 whites and 5 Indians. A decrease in trauma related diagnoses and an increase in presentation for wisdom teeth removal was found. There was also a significant shift from the use of general to local anaesthesia. There were no significant differences in the types of procedures performed although clearly there was a shift from trauma related surgery to surgery for removal of wisdom teeth. The range of operative procedures was inadequate for the training of registrars as virtually no exposure to implant related surgery nor to orthognathic surgery occurred in the unit. DISCUSSION This is the first audit of its kind to be performed in South Africa and very few similar audits have been performed internationally. While the data shows a distinct trend away from trauma related surgery, this was still the major activity in both the first and the second time periods. The change from predominantly general to local anaesthesia is partly the result of a critical shortage of anaesthesiologists in the public service in South Africa. CONCLUSION We recommend that: The scope of the data collected be expanded to include information on numbers of staff, waiting lists, work done in the Out-Patients Department (OPD) or on patients admitted by other specialties, referrals, length of hospital stay and cancellations and no-shows. A computerized audit system be introduced based on models in the UK. Clinical staff will have to take responsibility for capturing the data. Units should determine benchmark standards against which they can monitor their own performance.
MDent, Faculty of Health Sciences, University of the Witwatersrand, 2009