C. Mpirimbanyi4,5, A. Nyirimodo4,5, Y. Lin3, B. Hedt1,5, J. Odhiambo5, T. Nkurunziza5, J. Havens1,2, R. Riviello1,2 1Harvard School Of Medicine,Surgery,Brookline, MA, USA 2Brigham And Women’s Hospital,Department Of Surgery,Boston, MA, USA 3University Of Colorado Denver,Department Of Surgery,Aurora, CO, USA 4University Of Rwanda,Department Of Surgery,Kigali, KIGALI, Rwanda 5Partners In Health,Boston, MA, USA
Introduction:
Over 5 billion people do not have access to timely, safe and affordable surgical care. An important way to address this need is to improve the capacity to provide these procedures in district hospitals. Currently, there is limited information on emergency general surgical conditions in district hospitals in Sub-Saharan Africa. Therefore, this study aims to describe clinical presentations, management, and outcomes associated with emergency general surgical conditions presenting at three rural district hospitals in Rwanda.
Methods:
This is a retrospective study conducted in three rural district hospitals in Rwanda. All patients presenting with emergency general surgical conditions, defined as non-traumatic and non-obstetric acute care surgical conditions, between January 1st 2015 to December 31st 2015 were included. Patient demographics, clinical characteristics, management and outcomes were measured and compared between district hospitals.
Results:
During the study period, 356 patients presented with emergency general surgery conditions. The majority of patients were male (57.2%) and adults aged 15-60 years (54.5%). The most common emergency general surgery diagnosis was soft tissue infections (71.6%), followed by acute abdomen (14.3%). Median length of symptoms prior to diagnosis differed by diagnosis type: acute abdomen 4 days (interquartile range (IQR): 2-7), complicated hernia 17.5 days (IQR: 1-208), soft tissue infections 10 days (IQR: 6-21), and urological emergencies 1.5 days (IQR: 1-6). Of patients presenting with emergency general surgery diagnoses, 52.8% benefited from operation by a surgeon or general practitioner at the district hospital. Patients were more likely to receive surgery if they presented to a hospital with a surgeon compared to a hospital with only general practitioners (75% vs. 43%). 73.3% of operated patients did not get any complications. The mortality rate of patients undergoing surgery was 1.7%. The most common postoperative complications were surgical site infections (13.8%) and unplanned reoperation (4.8%).
Conclusion:
In most reports from low and middle income countries, acute abdominal conditions are the majority of presenting diagnoses. Our findings that soft tissue infections are the most common could represent a true difference in epidemiology. Alternatively, this could be due to an under-diagnosis of acute abdominal conditions in rural district hospital, where such conditions are often under-recognized. Patients were more likely to receive an operation in a hospital with a surgeon as opposed to a general practitioner. This suggests a need to increase the surgical workforce in district hospitals in order to increase surgical availability for patients.