G. A. Anderson1,5, L. Ilcisin5, L. Abesiga4, R. Mayanja4, N. Portal Benetiz2, J. Ngonzi4, P. Kayima2, M. Shrime5 1Massachusetts General Hospital,Surgery,Boston, MA, USA 2Mbarara University Of Science And Technology,Surgery,Mbarara, WESTERN, Uganda 3Havard Medical School,Global Health And Social Change,Boston, MA, USA 4Mbarara University Of Science And Technology,Obstetrics And Gynecology,Mbarara, WESTERN, Uganda 5Harvard School Of Medicine,Global Health And Social Medicine,Brookline, MA, USA
Introduction: The Lancet Commission on Global Surgery (LCoGS) recently recommended that every country report its surgical volume and post-operative mortality rate. Little is known about the numbers of operations performed and the post-operative mortality rate (POMR) in low and middle-income countries (LMIC’s). Additionally, there is little guidance from the literature regarding the most accurate method for collecting these metrics in low resource settings.
Methods: During two, 2-week periods, every patient who underwent an operation at a medium sized hospital in Western Uganda (MRRH) was observed and recorded. These patients were then followed until discharge or for 30 days. The types of operations were recorded, as were the outcomes of all patients. Prospective data were compared with data obtained by looking at logbooks and patient charts to determine the validity of using retrospective methods for collecting these metrics
Results: Surgical volume at this regional hospital in Uganda is 8,515 operations per year, significantly higher than the 4,000 operations/year reported in the only other paper on volume at a referral hospital in Uganda. The POMR at this hospital is 2.4% (6% for when OBGyn cases are excluded), similar to the 2.1% POMR reported from MSF hospitals (22) and the non-obgyn POMR is nearly identical to the 6% reported at a referral hospital in Rwanda. Finding patient files in the medical records department was time consuming and ultimately yielded only 62% of the needed files. Furthermore, a comparison of missing versus found charts revealed that the missing charts are significantly different from the found charts. Logbooks, on the other hand, found 99% of the operations and 94% of the deaths.
Conclusion: The LCoGS recommends that every country begin annual reporting of surgical volume and POMR. Our results describe a simple, reproducible, accurate and inexpensive method for collection of these variable using logbooks that are already exist in the operating theatres and on the wards of most hospitals in low resource settings. While some have suggested using risk-adjusted POMR as a more equitable variable our data suggests that only a limited amount of risk adjustment is possible given the limited resources in hospitals such as MRRH
