Burden of Emergency Pediatric Surgical Procedures in Uganda: A possible new metric for health system performance in resource-limited settings
*David F Grabski1, *Maija Cheung2, *Nasser Kakembo3, *Anne Shikanda4, *Phyllis Kisa3, *Arlene Muzira3, *Martin Situma4, *John Sekabira3, *Doruk Ozgediz2
1University of Virginia, Charlottesville, VA;2Yale University, New Haven, CT;3Makerere University, Mulago Hospital, Kampala, Uganda4Mbarara University of Science and Technology, Mbarara Hospital, Mbarara, Uganda
Objective: The significant burden of emergent operations in low and middle-income countries (LMICs) may overwhelm surgical capacity. This can lead to backlogs of elective surgical cases with an associated increase in morbidity.
Design: Retrospective review of two independent and prospectively collected databases on pediatric surgical admissions.
Setting: Mulago National Referral Hospital and the Mbarara Regional Referral Hospital in Uganda.
Patients: Patients (age < 14 years) admitted to the pediatric surgical service of either hospital between October 2015 - June 2017.
Main Outcome Measures: Ratio of elective to emergent operations
Results: 1,930 patients with sufficient clinical information were treated at both hospitals. 1,110 surgical procedures occurred over the time period (627 at Mulago and 483 at Mbarara). There were 564 emergent cases (50.9%), 113 urgent cases (10.2%) and 431 elective cases (38.9%). 62.7% of cases were emergent or urgent. By hospital site, Mulago had 396 emergent (63.2%), 58 urgent (9.3%) and 172 elective (27.5%) cases. Comparatively, Mbarara had 168 emergent (34.9%), 55 urgent (11.4%) and 259 elective (53.7%) cases. There was a statistically significant difference in the ratio of emergent and urgent to elective cases between the hospitals (Fisher’s Exact p<0.0001). Most common cases include- intussusception (n=112) and colostomy creation for anorectal malformations (n=106) (emergent operations); sacrococcygeal teratomas (n=28) and Wilms tumor (n=18) (urgent operations); inguinal hernia repair (n=104) and umbilical hernia repair (n=48) (elective operations). 47/151 (31.3%) of inguinal hernias were treated as incarcerated or strangulated. Conclusions: The appropriate ratio of elective to emergent surgical cases in LMICs is unknown. However, emergent and urgent operations utilize the majority of operative resources. Pediatric surgical capacity should be increased to prevent backlogs of elective cases.
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