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Objective: To define the epidemiological profile of the neurosurgical activity of
hospitalized patients.
Patients and methods: We conducted a descriptive retrospective study from
January 2018 to August 2019 (18 months) in the neurosurgery department of the
Loandjili General Hospital in Pointe Noire, including patients hospitalized for
a neurosurgical condition. The parameters evaluated were epidemiological,
diagnostic, therapeutic and progressive.
Results: 214 patients were hospitalized during the study period of which 143 cases
were included in our study. The average age of our patients was 37.9 years with
a sex ratio of 1.8 and a mortality of 28.85%. Traumatic pathology accounted for
81.11% of cases.
Conclusion: Neurosurgical conditions remain a major public health problem.
Neuro-traumatic emergencies remain the main activity of our service. There is
an interest in setting up teams that are competent and equipped to improve the
management of patients.
Keywords: Epidemiology,
Neurosurgery, Loandjili, Pointe Noire
INTRODUCTION
The exercise of neurosurgery requires a team
and a technical platform adequate and competent [1]. In sub-Saharan Africa, the
conditions of practice of neurosurgery are insufficient, marked by the
difficulties of access to care of the populations, the lack of neurosurgeons
and especially the insufficiency of the technical plateau [2]. Few studies have
made it possible to assess the qualitative and quantitative needs for defining
epidemiology in neurosurgery. In the Republic of Congo, there are two treatment
centers for neurosurgical pathologies. It is the multipurpose surgery
department of the University Hospital of Brazzaville with 4 neurosurgeons and
the neurosurgery department of the General Hospital of Loandjili in Pointe
Noire with only 1 neurosurgeon. An overview of the epidemiology of
neurosurgical diseases has already been reported on Brazzaville. However,
although being in the same country with almost identical socio-economic
realities, no study has been conducted on Pointe Noire to define a profile of
neurosurgical pathologies.
OBJECTIVE
This study has been to define the
epidemiological profile of the neurosurgical activity of hospitalized patients.
PATIENTS AND METHODS
We conducted a descriptive retrospective
study from January 2018 to August 2019. This study was conducted in the only
Neurosurgery Department in the city of Pointe-Noire. This city is the second of
the country (coastal city) after Brazzaville, economic capital, located in the
extreme south of the country. Its population is 1 100 000 inhabitants with
The intensive care unit is a polyvalent
reanimation with 4 beds.
We included all inpatients in the
neurosurgery department during the study period and excluded all incomplete and
unusable record.
Data collection was based on the hospital
records of the department as well as the operating and reanimation rooms and
the patients' clinical records. All data was saved in a database and then
analyzed using Epi info version 7.2.2.2 and processed using the office 2010.
The studied parameters are the
epidemiological, diagnostic, therapeutic and evolutionary aspects.
RESULTS
During the study period, 214 patients were
hospitalized for neurosurgical pathology. We selected 143 incoming patients in
our selection criteria.
The average age of our patients was 37.9
years ± 20.36 with extremes of 8 months to 82 years. The sex ration male/female
was 1.48. The distribution of patients by age group is shown in Figure 1.
Figure 2 shows the distribution of
patients by origin.
Table 1 represents the distribution of
patients by condition. The mean duration of hospitalization was 7.29 days ±
5.71 with extremes of 1 to 32 days.
CT was the first-line test in 95.5% of cases,
followed by standard radiography. Table
2 shows the distribution of patients according to the radiological
examinations carried out. Mean time to diagnosis was 1 day ± 0 to 14 days.
The overall favorable outcome of patients was
favorable in 78.69% of cases. Table 3
shows the distribution of patients by diagnosis and evolution.
DISCUSSION
We conducted a retrospective descriptive
study over 18 months. This study reflects a global aspect without specific
clinical description.
The interest of this study is to report the
general neurosurgical profile and to evaluate the results taking into account
the conditions of management. This knowledge of the profile of patients to be
treated in neurosurgery in a context of recent practice makes it possible to
prepare practitioners for equipment and an attitude adapted to the needs of
populations [3].
Unlike some services [4,5] which are
coexisting with other surgical services, the independence of the service
promotes a better quality of care but also, adequate training of the nursing
staff. However, there is still some delay in the management of emergencies, in connection
with the operation of the operating room. Indeed, it is not totally dedicated
to neurosurgery. It is shared with other specialties (ORL, Orthopedics,
Ophthalmology, Stomatology).
The exercise of neurosurgery imposes material
means of diagnosis and therapeutics namely CT and MRI [1]. These two feasible
tests on Pointe Noire, facilitated the diagnosis and treatment. However, these
remain virtually inaccessible to the population that makes up the majority of
patients in care. Indeed, in the general hospital of Loandjili, only CT is
feasible for 121.95 euros and 152.44 euros respectively for a CT without
injection and injection of contrast. In addition to this reference center, the
scanner can also be performed in private centers where it ranges from 137.2
euros to 182.93 euros. These different centers facilitate availability, but its
accessibility is still a hindrance to its implementation. In addition, the MRI
has since been considered a luxury for its realization first of all because it
is available only in a single private center but also related to its cost that
remains inaccessible to all. Indeed, its cost varies between 381.12 euros and
411.61 euros, respectively, for an MRI with and without injection of contrast
medium. The systematic reduction of the cost of these examinations and the
installation of the MRI in the general hospital of Loandjili would allow a
better management of the patients. In addition, a free system should be set up
in agreement with the social services for the most disadvantaged patients.
Also, the equipment of general hospitals (public hospitals) in scanner at
affordable cost, will contribute to optimize the quality of care of the
patients.
One of the brakes in the care of patients
remains the accessibility of the consumable for surgical interventions. Indeed,
the operative prescription (surgery and anesthesia) is the responsibility of
the patient, who in turn is forced to visit different pharmacies in search of
the desired product, because of the unavailability of many consumables within
the pharmacy of the hospital. The manufacture of low cost surgical kit would be
a major asset to facilitate the exercise of neurosurgery.
It should also be noted that the origin of
patients is a brake on the care. In fact, 74% of our patients come from health
centers near our health center. However, this frequency remains overestimated
because many of them do not live close to these centers of reference. They were
mostly referred to peripheral centers, the first of which is 160km from Pointe Noire.
This relates to their place of residence and their profession. Thus, the
financial means are never available immediately and the care agreement remains
dependent on the head of the family not always present or available. This
partly explains the delays in management that we have observed in neurotraumatological
emergencies.
Traumatic pathology (skull and spine) was the
main reason for hospitalization of our patients, 81.11%. Ekouélé, Doléagbanou
and Rabiu found similar results [4-6]. The difference in frequency is related
to the fact that many patients are initially referred to the Adolphe Sicé
hospital which is the second general hospital in the city and where patients
are wrongly hospitalized in a maxillofacial surgery department where they are
either referred to our service for patients deemed to be serious or released
for their home with or without neurosurgical advice.Cranioencephalic trauma is
a global public health problem in terms of mortality, morbidity and
socio-economic impact [7]. Only 10% of the population has access to basic
neurosurgical management in developing countries [8]. The mortality rate in
relation to head trauma varies from one series to another, but is still
considerable. Indeed, in the same country and comparatively between Brazzaville
and Pointe Noire, this rate is respectively 10% [5] and 4.4%. These results
reflect the realities of many African countries whose mortality rate varies
between 5 and 25% [3,9-11].
Craniocephalic traumas are often
characteristic of young people [12]. The average age of traumatic brain injury
in our study was 32.39 years old with male predominance. Our results are
similar to those found in the literature [4,10,13]. Different facts can explain
these results. This young age is one where our patients are in both social and
professional activities. Most often they are young men with dangerous
activities such as driving and breaking the rules of the road. In addition the
increase in recent years of the fleet of two-wheeled vehicle which almost all
patients do not respect the rules of use that is already wearing protective
helmet. These last facts explain just as well the place occupied by the
accidents of the public way like first cause of TCE in our series all for
Coulibaly, Doléagbenou, Ekoulé Mbaki, Motah which found, respectively 80%,
92,36%, 93,6% and 91.35% [3,13,14].
Spinal injuries accounted for 16.08% of
hospitalized patients with an average age of 40.2 years. Doléagbenou and Motah
found an average age of 32.4 years and 37 respectively [4,14]. The mortality of
26.08% of our series is superimposable to that found in the literature which is
between 5 and 35% [4,5,9,11,15].
The delay in taking care of patients in
traumatic emergencies remains considerable. Indeed, this delay is 9.04 days and
9.66 days, respectively for TCE and spinal trauma. This could be mainly related
to the low income of patients who do not always have health insurance or the
resources needed to cope with a medical and surgical emergency. The payment of
the consumable necessary for the surgery is made by family contribution
following a consultation.
The tumoral pathology represents the second
reason for hospitalization in front of the degenerative affections. The tumors
recorded a significant mortality rate of 3.49%. Our results are superimposable
to some authors who find, respectively 5.56% and 4.58% [4,5].
The degenerative pathology came third (6.29%
of patients). This difference with some authors of the literature could be
related to the small size of our sample but also to the duration of the study
[16-18]. No patient had to be operated on. On the one hand, it was a painful
spine whose drug treatment had been able to improve the symptomatology. On the
other hand, for lack of means, some patients where he had been indicated a
surgical gesture, came out against medical advice.
Postoperatively, the evolution was rather
favorable for our patients. Postoperative mortality is 3.33% for an overall
mortality of 13.81%. It was a patient admitted for cervical spine injury. Also,
there is a patient who has worsened clinically postoperatively operated for
cervical spine trauma. Our results are below those of some authors who found an
overall mortality of 8.9% to 37.4% [2,16-20]. This could be related to the size
of the sample. Nevertheless, these figures are still considerable. Road traffic
awareness should be conducted to reduce road accidents, which are the leading
cause of spinal trauma that is frequently life-threatening and/or functional
depending on the severity of the initial lesions.
CONCLUSION
Neurosurgical conditions remain a major
public health problem. The neuro-traumatological emergencies remain the main
activity of our service followed of the tumoral affections and the pathology of
the degenerative rachis.
The postoperative complications and the
mortality rate are identical to those of many sub-Saharan African countries.
The results are significant for TCEs, hence the interest to reflect on the best
equipment for diagnosis, surgery and resuscitation to significantly reduce the
time of care and diagnosis time.
It would therefore be appropriate to expand
the human resource and reception capacity service, to create a
neuro-resuscitation service and a neurosurgical emergency center.
ICONOGRAPHY
CONFLICT OF INTEREST
None.
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