T. J. Jaraczewski1, T. Diehl2, Y. Nigussie3, W. Melaku3, T. Esayas3, C. Dodgion1, G. Teferra2, B. Mellese3, S. Zafar2 1Medical College Of Wisconsin, Surgery, Milwaukee, WI, USA 2University Of Wisconsin, Surgery, Madison, WI, USA 3Hawassa University Hospital, Surgery, Hawassa, SIDAMA REGION, Ethiopia
Introduction: Postoperative morbidity and mortality is high in low- and middle- income countries (LMICs). Surgical quality improvement (QI) programs that rely on the systematic and prospective collection of surgical outcome data have been successful at reducing postoperative morbidity and mortality in high income countries (HICs). However, a sustainable system of collecting surgical outcome data in low resource settings remains a challenge. Taking advantage of mobile health technology, we developed and piloted a surgical outcome registry at a single institution in Ethiopia.
Methods: Surgical QI was identified as a key priority for Hawassa University Hospital. A local QI champion was identified and a working group established to set priorities and examine system opportunities for improvement. A review of the literature identified common barriers and challenges to implementing sustainable registries, these were addressed in the planning phase. Variables were selected after an iterative process by key stakeholders that included an extensive literature review to identify common and feasible data elements captured in LMICs during prior cross-sectional outcome studies, reviewing data elements included in HIC registries, and evaluating congruency with local priorities. We addressed feasibility and redundancy in the variables, while ensuring inclusion of data elements required for analyzing risk adjusted outcomes. A data entry form was developed using REDCap and local data collectors were trained in its use.
Results:The surgical registry is cloud-based and completely electronic. Data input is performed utilizing smart phones and transmitted via WIFI and cellular networks. It includes 60 demographic, clinical, operative and postoperative variables. After ethical approval, pilot data acquisition was initiated in May of 2022. Weekly meetings are held to evaluate the validity of the data and trouble shoot issues. Data elements have been collected with high fidelity and low missingness. After 3 months of data acquisition 87 eligible patients have been entered into the database. The most common procedures include exploratory laparotomy (33, 34.0%), appendectomy (12, 12.4%), Urologic (9, 9.3%), non-perirectal incision and drainage (5, 5.2%), and modified radical mastectomy (5, 5.2%). Average patient age is 39.1±16.7 years and the gender distribution is 63.7% male. Postoperative complications include 9.1% surgical site infection (n=2), 9.1 % pneumonia (n=2), 9.1% anastomotic leak (n=2) and 0 mortality.
Conclusion:This pilot demonstrates the feasibility of implementing a surgical registry in an LMIC setting. Using a systematic approach and working in concert with hospital leadership we overcame several technical, behavioral, and organizational barriers. Such a perioperative registry can be used to further surgical outcome research in low resource settings and can be used for quality improvement programs aimed at improving post operative morbidity and mortality.