Voyaging through the paediatric surgical maze: A multi-centre analysis of inter-hospital referrals to Johannesburg, South Africa

Introduction: Paediatric surgery is a centralised service that is provided at only three public sector hospitals in Johannesburg, South Africa. These centres receive an overwhelming number of referrals from over fifty lower-level hospitals. The aim of this study was to analyse referrals to these specialist centres in order to quantify the unmet referred burden of disease and to identify ways in which paediatric surgical access in the region can be improved. Methods: A prospective descriptive study was conducted over a 1-year period (01/06/21–31/05/22). All inter-hospital referrals from lower-level hospitals to the three Johannesburg-based specialist centres were analysed. Results: 2394 unique referrals to 3 hospitals were recorded. Five main diagnoses were responsible for 68% of all referrals: neonatal surgical conditions, burns, acute abdomen/bowel obstruction, trauma and symptomatic hernias. 59.7% of all referred patients met criteria for emergency transfer to a specialist unit. 26.7% of these patients, however, were unable to be transferred owing to a lack of bedspace at specialist centres. Transferred patients experienced significant time delays between referral and arrival. Four lower-level hospitals have been identified as possible sites for service expansion. Conclusion: A large unmet paediatric surgical burden of disease has been identified. Lower-level hospitals have been identified that may be suitable for the implementation of decentralisation efforts to improve access to paediatric surgery within the region. Level of Evidence: V