Operative volume and surgical case distribution in Uganda's public sector: a stratified randomized evaluation of nationwide surgical capacity.
Adult
Anesthesiology
/ statistics & numerical data
Female
Hospitals, Public
/ statistics & numerical data
Humans
Male
Orthopedics
/ statistics & numerical data
Physicians
/ statistics & numerical data
Public Sector
/ statistics & numerical data
Referral and Consultation
/ statistics & numerical data
Retrospective Studies
Surgical Procedures, Operative
/ statistics & numerical data
Uganda
/ epidemiology
Workload
/ statistics & numerical data
Case distribution
Global surgery
Operative volume
Surgical workforce
Uganda
Journal
BMC health services research
ISSN: 1472-6963
Titre abrégé: BMC Health Serv Res
Pays: England
ID NLM: 101088677
Informations de publication
Date de publication:
06 Feb 2019
06 Feb 2019
Historique:
received:
24
07
2018
accepted:
22
01
2019
entrez:
8
2
2019
pubmed:
8
2
2019
medline:
26
3
2019
Statut:
epublish
Résumé
Little is known about operative volume, distribution of cases, or capacity of the public sector to deliver essential surgical services in Uganda. A standardized mixed-methods surgical assessment and retrospective operative logbook review were completed at 16 randomly selected public hospitals serving 64·0% of Uganda's population. A total of 3014 operations were recorded, annualizing to a surgical volume of 36,670 cases/year or 144·5 operations/100,000people/year. Absolute surgical volume was greater at regional referral than general hospitals (p < 0·001); but, relative surgical volume/catchment population was greater at the general versus regional level (p = 0·03). Most patients undergoing operations were women (78·3%) with a mean age of 26·9 years. The overall case distribution was 69·0% obstetrics/gynecology, 23·7% general surgery, 4·0% orthopedics, and 3·3% other subspecialties. Cesarean sections were the most common operation (55·8%). Monthly operative volume was strongly predicted by number of surgical, anesthetic, and obstetric physician providers (훽=10·72, p = 0·005, R An understanding of operative case volume and distribution is essential in facilitating targeted interventions to strengthen surgical capacity. These data suggest that surgical workforce is the critical driver of operative volume in the Ugandan public sector. Investment in the surgical workforce is imperative to ensure access to safe, timely, and affordable surgical and anaesthesia care.
Sections du résumé
BACKGROUND
BACKGROUND
Little is known about operative volume, distribution of cases, or capacity of the public sector to deliver essential surgical services in Uganda.
METHODS
METHODS
A standardized mixed-methods surgical assessment and retrospective operative logbook review were completed at 16 randomly selected public hospitals serving 64·0% of Uganda's population.
RESULTS
RESULTS
A total of 3014 operations were recorded, annualizing to a surgical volume of 36,670 cases/year or 144·5 operations/100,000people/year. Absolute surgical volume was greater at regional referral than general hospitals (p < 0·001); but, relative surgical volume/catchment population was greater at the general versus regional level (p = 0·03). Most patients undergoing operations were women (78·3%) with a mean age of 26·9 years. The overall case distribution was 69·0% obstetrics/gynecology, 23·7% general surgery, 4·0% orthopedics, and 3·3% other subspecialties. Cesarean sections were the most common operation (55·8%). Monthly operative volume was strongly predicted by number of surgical, anesthetic, and obstetric physician providers (훽=10·72, p = 0·005, R
CONCLUSION
CONCLUSIONS
An understanding of operative case volume and distribution is essential in facilitating targeted interventions to strengthen surgical capacity. These data suggest that surgical workforce is the critical driver of operative volume in the Ugandan public sector. Investment in the surgical workforce is imperative to ensure access to safe, timely, and affordable surgical and anaesthesia care.
Identifiants
pubmed: 30728037
doi: 10.1186/s12913-019-3920-9
pii: 10.1186/s12913-019-3920-9
pmc: PMC6366061
doi:
Types de publication
Journal Article
Multicenter Study
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
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