A review of the epidemiology and average cost for the treatment of gunshot wounds of extremities at a single Academic Hospital in Johannesburg, South Africa

Abstract

Background: Prevalence of gunshot injuries in South Africa are comparable to countries at war. This places a large burden on the health care system and incurs a huge cost to the state. The aim of this study was to look at the epidemiological variables as well as the cost of gunshot wounds to extremities. The objectives were: (i) To determine the demographics and epidemiological variables of extremity gunshot injuries, (ii) to capture the type of surgery and the duration and (iii) to document the quantity and the cost of resources which were used in during the management of patients who had sustained a gunshot wound to an extremity. Methodology: This was a cross sectional, retrospective study. Records of patients that met the inclusion criteria were reviewed from 1 July 2018 to 31 July 2022. Relevant epidemiological variables were recorded. Six cost categories were used to determine the average cost of admitted patients. The six categories were inpatient admission, anaesthetic and operative, implants, ambulatory, physio- and occupational therapy and blood bank cost. The data was statistically analysed. Results: Seventy patients were included in the study. Descriptive statistics were used to report epidemiological variables as well as cost in the respective cost centres. As with comparable local studies, our study revealed male predominance and lower limb gunshot injuries being more common than upper limb. The average cost to treat an orthopaedic gunshot injury was R32612.32 with admission cost and implant cost being the most significant. Combined upper and lower gunshot injuries had a statistically significant higher total cost when compared to an isolated upper or lower limb gunshot injury. Discussion: Epidemiological variables were compared to local and international studies. Surgeries done were reviewed and compared to current international standards. Costs were comparable to previous local studies on orthopaedic gunshot injuries. Conclusion: This study re affirms the high burden of gunshot injuries on state hospitals as well as the large cost incurred to treat these injuries. The treatment at our hospital conforms to international standards and costs are comparable to other local centres. Intervention by government is still needed to attempt to reduce the prevalence of gunshot injurie