The State of Thoracic Surgery 2014 Prof Anthony Linegar PhD Thoracic Surgeon Hannes Meyer Registrar Symposium 2015 July. For the development of thoracic surgery in South Africa

Specialist thoracic surgeons Province Unit Pop served (m) CTS TS only TS some TS WTE 1 WTE : pop million GP Wits 6.6 7 1.1 6.0 Pretoria 4 1 0.1 66.0 Medunsa 5 2.5 2.6 KZN Dbn 10.6 9 1.6 WP UCT 2.7 1.5 1.8 US 3 0.5 5.4 FS UFS 2 0.8 5.0 NC KH 2.2 EC PE 6 2.1 2.9 Total 48 46 35 10.7 4.5

Thoracic beds Province Pop served (m) CTS beds TS beds CTS ICU beds Bed : population Beds : million GP 20 92 45 22 444 444 2.3 KZN 10.6 110 72 8 147 222 6.8 WP 5.4 40 19 9 284 211 3.5 FS 4 10 400 000 2.5 NC 1.1 s 55 000 18.2 EC 6 32 272 727 3.7 Total 48 314 188 255 319 3.9

Operation slates Province Unit Pop served (m) Ops 2014 Slates per week Slates per year Ops per slate per year GP Wits 6.6 416 3 144 2.9 Pretoria 68 2 96 0.7 Medunsa 730 5 240 3.0 KZN Dbn 10.6 600 8 384 1.6 WP UCT 2.7 415 US 236 1 48 4.9 FS UFS 4 220 1.5 NC KH 1.1 390 4.1 EC PE 6 670 2.8 Total RSA 3745 32 1536 2.4

By pathology (the big 5) Province Unit Pop served (m) Ops 2014 TB % Inflam % Lung ca % Oes ca % Trauma % Total % GP Wits 6.6 416 35 30 10 15 90 Pretoria 68 1 20 91 Medunsa 730 25 16 21 93 KZN Dbn 10.6 600 27 2.5 100 WP UCT 2.7 415 85 US 236 14 28 5 83 FS UFS 4 220 95 NC KH 1.1 390 EC PE 6 670 23 7 96 Total 48 3745 29 22

Inflammatory lung disease surgery Province Unit Pop served (m) Ops 2014 TB Inflam All Inflam Total Resections GP Wits 6.6 416 35 30 65 270 Pretoria 68 70 48 Medunsa 730 25 16 41 299 150 KZN Dbn 10.6 600 10 40 240 127 WP UCT 2.7 415 20 50 208 19 US 236 14 28 42 99 26 FS UFS 4 220 143 NC KH 1.1 390 45 176 117 EC PE 6 670 23 15 38 255 3745 29 22 53 1985 439

Lung cancer BOD for lung cancer resections = 750 per year Province Unit Pop served (m) Ops 2014 Lung CA % Total cases Resections GP Wits 6.6 416 10 42 Pretoria 68 1 Medunsa 730 21 153 KZN Dbn 10.6 600 27 162 9 WP UCT 2.7 415 8 US 236 5 12 FS UFS 4 220 20 44 3 NC KH 1.1 390 15 59 EC PE 6 670 28 188 Total 48 3745 570 46 BOD for lung cancer resections = 750 per year = 11000 procedures per year

Oesophagus cancer BOD for oesophagus resections = 650 per annum Province Unit Pop served (m) Ops 2014 Oes CA % Total cases Resect GP Wits 6.6 416 Pretoria 68 Medunsa 730 1.5 11 4 KZN Dbn 10.6 600 30 180 9 WP UCT 2.7 415 15 62 8 US 236 35 1 FS UFS 220 NC KH 1.1 390 5 20 EC PE 6 670 23 154 2 Total 48 3745 10 372 28 BOD for oesophagus resections = 650 per annum = 10000 cases per year

Trend operations per annum Province Unit Pop served (m) 2002 2003 2004 2005 2006 Ops 2014 GP Wits 6.6 nda 413 416 Pretoria 68 Medunsa 210 730 KZN Dbn 10.6 1462 1205 1060 1021 1186 600 WP UCT 2.7 549 463 460 176 268 415 US 404 442 236 FS UFS 4 90 132 175 190 220 NC KH 1.1 390 EC PE 6 670 Total 48 2011 2162 1652 1814 2730 3745

Summary 48 million population 46 CTS and 35 do some TS 9 X WTE 48 million population 46 CTS and 35 do some TS 4 beds per million 32 slates per week and 2.4 operations per slate 3745 operations in 2014 Inflammatory 55% Lung ca 15% Oesophagus ca 10% Trauma 15% 10.7 WTE 1 TS per 4.5m population 1TS per 150 000 – 500 000 population 3 x BEDS 1 bed per 250 000 5 -6 beds per 150 000 to 500 000 16 hrs of theatre per TS per week (4 slates) 3 hours endoscopy per week 3 X SLATES Performance gap 1:20 Target ~ 700 per unit or 5400 in total Waiting times 2 weeks referral to consultation and 3-4 weeks to surgery from time of diagnosis 1000 cases

Looking ahead - Few people, small steps, big plan? It is possible, its worthwhile and its do-able right now. It will be to the credit of all role players and the lasting benefit of the patients and the community. How do we make this fit in with healthcare priorities for RSA? How do we get buy in and build teams at all levels? What is the next step? For the development of thoracic surgery in South Africa