L. M. Baumann1,2, O. Yerokun10, P. Jani5, N. Wetzig6, L. Samad9, K. Park7, K. Nguyen8, M. Meheš4, B. Allen4, F. Abdullah1,2, A. Latif3 4G4 Alliance,New York, NY, USA 5The College Of Surgeons Of East, Central And Southern Africa,Arusha, ARUSHA, Tanzania 6HEAL Africa,Gisenyi, WESTERN PROVINCE, Rwanda 7World Federation Of Neurosurgical Societies,Phnom Penh, PHNOM PENH, Cambodia 8Mending Kids,Burbank, CA, USA 9Indus Hospital,Pediatric Surgery,Karachi, SINDH, Pakistan 10Johns Hopkins Bloomberg School Of Public Health,General Preventative Medicine,Baltimore, MD, USA 1Northwestern University,Department Of Surgery,Chicago, IL, USA 2Ann & Robert H. Lurie Children’s Hospital,Division Of Pediatric Surgery,Chicago, IL, USA 3Johns Hopkins University School Of Medicine,Anesthesiology And Critical Care Medicine,Baltimore, MD, USA
Introduction:
Emergency and essential surgical and anesthesia care are a core component of universal health coverage. The Global Alliance for Surgical, Obstetric, Trauma and Anesthesia Care (G4 Alliance) is a coalition of >80 organizations advocating for access to safe surgical and anesthesia care for all. A critical part of this mission is the development of a minimum operative case log tool that can be used to build a robust global surgical registry. Accurate data is essential for the evaluation and improvement of surgical outcomes, health infrastructure, and operating room processes. This pilot study aimed to assess the utility of the G4 Alliance operative case log in a global setting.
Methods:
A multidisciplinary and multinational team of experts was assembled from amongst G4 member organizations. A review of potential data measures was conducted with development of a 38 variable minimum operative data set over three rounds of a modified Delphi approach from March to December 2016. The tool was piloted by members at 6 sites in low- and middle-income countries (LMICs) across 4 WHO regions from March to June 2017. Data was collected for up to 6 weeks, and the tool was available in paper, electronic PDF, and Microsoft Access formats to facilitate collection according to local resources.
Results:
A total of 534 cases were logged between 3 local hospitals (89%) and 3 medical missions (11%). The majority of cases were financed through donation/aid (56%) followed by self-pay (31%). Compliance with data collection for individual variables ranged from 25-100% across all sites (Table 1). The largest variability in compliance was seen with date of birth, which was recorded for 97% of cases during mission trips, but for only 16% of cases at local hospitals. Similarly, weight was recorded for 92% of cases during mission trips but only 68% of cases at local hospitals. In feedback from local staff, >90% were satisfied with the information collected and 100% would like to continue using the tool. Less than 50% of sites currently had an operative data collection system in place.
Conclusion:
Most key operative variables were easily collected across a variety of global settings. Predictably, there was poorer compliance with data that need to be collected at a separate time point such as discharge. Surprisingly, basic demographic data was amongst the most difficult to collect. These results may be reflective of systematic differences in the culture regarding data in LMICs as evidenced by the disparity between locally staffed hospitals and foreign medical missions. Successful integration of a global data system must utilize a locally feasible tool with an emphasis on accurate collection and reporting of data in order to improve surgical care.
