Skip to main content
Erschienen in: World Journal of Surgery 2/2017

22.09.2016 | Original Scientific Report with Video

The Quality and Utility of Surgical and Anesthetic Data at a Ugandan Regional Referral Hospital

verfasst von: G. Tumusiime, A. Was, M. A. Preston, J. N. Riesel, S. S. Ttendo, P. G. Firth

Erschienen in: World Journal of Surgery | Ausgabe 2/2017

Einloggen, um Zugang zu erhalten

Abstract

Background

There are little primary data available on the delivery or quality of surgical treatment in rural sub-Saharan African hospitals. To initiate a quality improvement system, we characterized the existing data capture at a Ugandan Regional Referral Hospital.

Methods

We examined the surgical ward admission (January 2008–December/2011) and operating theater logbooks (January 2010–July 2011) at Mbarara Regional Referral Hospital.

Results

There were 6346 admissions recorded over three years. The mean patient age was 31.4 ± 22.3 years; 29.8 % (n = 1888) of admissions were children. Leading causes of admission were general surgical problems (n = 3050, 48.1 %), trauma (n = 2041, 32.2 %), oncology (n = 718, 11.3 %) and congenital condition (n = 193, 3.0 %). Laparotomy (n = 468, 35.3 %), incision and drainage (n = 188, 14.2 %) and hernia repair (n = 90, 6.8 %) were the most common surgical procedures. Of 1325 operative patients, 994 (75 %) had an ASA I–II score. Of patients undergoing 810 procedures booked as non-elective, 583 (72 %) had an ASA “E” rating. Records of 41.3 % (n-403/975) of patients age 5 years or older undergoing non-obstetric operations were missing from the ward logbook. Missing patients were younger (25 [13,40] versus 30 [18,46] years, p = 0.002) and had higher ASA scores (ASA III-V 29.0 % versus 18.9 %, p < 0.001) than patients recorded in the logbbook; there was no diffence in gender (male 62.8 % versus 67.0 %, p = 0.20).

Conclusions

The hospital records system measures surgical care, but improved data capture is needed to determine outcomes with sufficient accuracy to guide and record expansion of surgical capacity.
Literatur
1.
Zurück zum Zitat Meara JG, Leather AJ, Hagander L et al (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386:569–624CrossRefPubMed Meara JG, Leather AJ, Hagander L et al (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386:569–624CrossRefPubMed
2.
Zurück zum Zitat Shrime MG, Bickler SW, Alkire BC et al (2015) Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health 3(Suppl 2):S8–S9CrossRefPubMed Shrime MG, Bickler SW, Alkire BC et al (2015) Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health 3(Suppl 2):S8–S9CrossRefPubMed
3.
Zurück zum Zitat Rose J, Weiser TG, Hider P et al (2015) Estimated need for surgery worldwide based on prevalence of diseases: a modeling strategy for the WHO Global Health Estimate. Lancet Glob Health 3(Suppl 2):S13–S20CrossRefPubMed Rose J, Weiser TG, Hider P et al (2015) Estimated need for surgery worldwide based on prevalence of diseases: a modeling strategy for the WHO Global Health Estimate. Lancet Glob Health 3(Suppl 2):S13–S20CrossRefPubMed
4.
Zurück zum Zitat Bickler SN, Weiser TG, Kassebaum N et al (2015) Chapter 2: Global burden of surgical conditions. In: Debras HT, Donfor P, Gawande A et al (eds) Essential surgery: disease control priorities, 3rd edn., vol 1. World Bank, Washington, DC Bickler SN, Weiser TG, Kassebaum N et al (2015) Chapter 2: Global burden of surgical conditions. In: Debras HT, Donfor P, Gawande A et al (eds) Essential surgery: disease control priorities, 3rd edn., vol 1. World Bank, Washington, DC
6.
Zurück zum Zitat Barnighausen T, Bloom DE, Humair S (2011) Going horizontal—shifts in funding of global health interventions. N Engl J Med 364:2181–2183CrossRefPubMed Barnighausen T, Bloom DE, Humair S (2011) Going horizontal—shifts in funding of global health interventions. N Engl J Med 364:2181–2183CrossRefPubMed
7.
Zurück zum Zitat Wang H, Dwyer-Lindgren L, Lofgren KT et al (2012) Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2071–2094CrossRefPubMed Wang H, Dwyer-Lindgren L, Lofgren KT et al (2012) Age-specific and sex-specific mortality in 187 countries, 1970–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380:2071–2094CrossRefPubMed
8.
Zurück zum Zitat Chan M, Kazatchkine M, Lob-Levyt J et al (2010) Meeting the demand for results and accountability: a call for action on health data from eight global health agencies. PLoS Med 7:e1000223CrossRefPubMedPubMedCentral Chan M, Kazatchkine M, Lob-Levyt J et al (2010) Meeting the demand for results and accountability: a call for action on health data from eight global health agencies. PLoS Med 7:e1000223CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Rottingen JA, Regmi S, Eide M et al (2013) Mapping of available health research and development data: what’s there, what’s missing, and what role is there for a global observatory? Lancet 382:1286–1307CrossRefPubMed Rottingen JA, Regmi S, Eide M et al (2013) Mapping of available health research and development data: what’s there, what’s missing, and what role is there for a global observatory? Lancet 382:1286–1307CrossRefPubMed
10.
Zurück zum Zitat Funk LM, Weiser TG, Berry WR et al (2010) Global operating theatre distribution and pulse oximetry supply: an estimation from reported data. Lancet 376:1055–1061CrossRefPubMed Funk LM, Weiser TG, Berry WR et al (2010) Global operating theatre distribution and pulse oximetry supply: an estimation from reported data. Lancet 376:1055–1061CrossRefPubMed
11.
Zurück zum Zitat Bickler S, Ozgediz D, Gosselin R et al (2010) Key concepts for estimating the burden of surgical conditions and the unmet need for surgical care. World J Surg 34:374–380CrossRefPubMed Bickler S, Ozgediz D, Gosselin R et al (2010) Key concepts for estimating the burden of surgical conditions and the unmet need for surgical care. World J Surg 34:374–380CrossRefPubMed
12.
Zurück zum Zitat Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modeling strategy based on available data. Lancet 372:139–144CrossRefPubMed Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modeling strategy based on available data. Lancet 372:139–144CrossRefPubMed
14.
Zurück zum Zitat Linden AF, Sekidde FS, Galukande M et al (2012) Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda’s public hospitals. World J Surg 36:1056–1065CrossRefPubMed Linden AF, Sekidde FS, Galukande M et al (2012) Challenges of surgery in developing countries: a survey of surgical and anesthesia capacity in Uganda’s public hospitals. World J Surg 36:1056–1065CrossRefPubMed
17.
Zurück zum Zitat Walker IA, Obua AD, Mouton F et al (2010) Paediatric surgery and anaesthesia in south-western Uganda: a cross-sectional survey. Bull World Health Organ 88:897–906CrossRefPubMedPubMedCentral Walker IA, Obua AD, Mouton F et al (2010) Paediatric surgery and anaesthesia in south-western Uganda: a cross-sectional survey. Bull World Health Organ 88:897–906CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Laing GL, Skinner DL, Bruce JL et al (2014) A multi faceted quality improvement programme results in improved outcomes for the selective non-operative management of penetrating abdominal trauma in a developing world trauma centre. Injury 45:327–332CrossRefPubMed Laing GL, Skinner DL, Bruce JL et al (2014) A multi faceted quality improvement programme results in improved outcomes for the selective non-operative management of penetrating abdominal trauma in a developing world trauma centre. Injury 45:327–332CrossRefPubMed
19.
Zurück zum Zitat Ralston ME, Day LT, Slusher TM et al (2013) Global paediatric advanced life support: improving child survival in limited-resource settings. Lancet 381:256–265CrossRefPubMed Ralston ME, Day LT, Slusher TM et al (2013) Global paediatric advanced life support: improving child survival in limited-resource settings. Lancet 381:256–265CrossRefPubMed
20.
Zurück zum Zitat Clarke DL, Kong VY, Handley J et al (2013) A concept paper: using the outcomes of common surgical conditions as quality metrics to benchmark district surgical services in South Africa as part of a systematic quality improvement programme. S Afr J Surg 51:84–86CrossRefPubMed Clarke DL, Kong VY, Handley J et al (2013) A concept paper: using the outcomes of common surgical conditions as quality metrics to benchmark district surgical services in South Africa as part of a systematic quality improvement programme. S Afr J Surg 51:84–86CrossRefPubMed
21.
Zurück zum Zitat Clarke DL, Furlong H, Laing GL et al (2013) Using a structured morbidity and mortality meeting to understand the contribution of human error to adverse surgical events in a South African regional hospital. S Afr J Surg 51:122–126CrossRefPubMed Clarke DL, Furlong H, Laing GL et al (2013) Using a structured morbidity and mortality meeting to understand the contribution of human error to adverse surgical events in a South African regional hospital. S Afr J Surg 51:122–126CrossRefPubMed
22.
Zurück zum Zitat Nwomeh BC, Lowell W, Kable R et al (2006) History and development of trauma registry: lessons from developed to developing countries. World J Emerg Surg 1:32CrossRefPubMedPubMedCentral Nwomeh BC, Lowell W, Kable R et al (2006) History and development of trauma registry: lessons from developed to developing countries. World J Emerg Surg 1:32CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Juillard CJ, Mock C, Goosen J et al (2009) Establishing the evidence base for trauma quality improvement: a collaborative WHO-IATSIC review. World J Surg 33:1075–1086CrossRefPubMed Juillard CJ, Mock C, Goosen J et al (2009) Establishing the evidence base for trauma quality improvement: a collaborative WHO-IATSIC review. World J Surg 33:1075–1086CrossRefPubMed
24.
Zurück zum Zitat Juillard CJ, Stevens KA, Monono ME et al (2014) Analysis of prospective trauma registry data in Francophone Africa: a pilot study from Cameroon. World J Surg 38:2534–2542CrossRefPubMed Juillard CJ, Stevens KA, Monono ME et al (2014) Analysis of prospective trauma registry data in Francophone Africa: a pilot study from Cameroon. World J Surg 38:2534–2542CrossRefPubMed
25.
Zurück zum Zitat Laing GL, Bruce JL, Aldous C et al (2014) The design, construction and implementation of a computerised trauma registry in a developing South African metropolitan trauma service. Injury 45:3–8CrossRefPubMed Laing GL, Bruce JL, Aldous C et al (2014) The design, construction and implementation of a computerised trauma registry in a developing South African metropolitan trauma service. Injury 45:3–8CrossRefPubMed
Metadaten
Titel
The Quality and Utility of Surgical and Anesthetic Data at a Ugandan Regional Referral Hospital
verfasst von
G. Tumusiime
A. Was
M. A. Preston
J. N. Riesel
S. S. Ttendo
P. G. Firth
Publikationsdatum
22.09.2016
Verlag
Springer International Publishing
Erschienen in
World Journal of Surgery / Ausgabe 2/2017
Print ISSN: 0364-2313
Elektronische ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-016-3714-8

Weitere Artikel der Ausgabe 2/2017

World Journal of Surgery 2/2017 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.