A Systematic Review of the Impact of Focused Trauma Education in Low-resource

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Surgical Volumes at the District Hospital: A Retrospective Review of National Data in Rwanda

Background: Surgical conditions are a significant contributor to global morbidity and mortality, and much of the burden of surgical disease arises in resource-limited settings. There are profound disparities in surgical care worldwide, with only 3.5% of surgical procedures estimated to be performed in the poorest 1/3 of countries. Yet, very little is known regarding the true volume of surgical procedures performed in resource-limited settings. Methods: We conducted a retrospective, descriptive study of aggregate district hospital statistics provided to the Ministry of Health in Rwanda from 40 district hospitals over the period from January 2008-September 2010. Results: The total numbers of major procedures performed at the District Hospital level in Rwanda were 23,621 for 2008, 43,389 for 2009, and 32,944 for the first nine months of 2010. Obstetrics and gynecology procedures comprised 75.5%, 60.8%, and 61.4% of major operations in 2008, 2009 and 2010, respectively. Of those, caesarian sections were 87.3% (2008), 87.7% (2009) and 89.1% (2010). Hernia repairs were the most common general surgery procedure. Reported post-operative infection rates were 0.8%, 0.4% and 0.2% for 2008, 2009 and 2010, respectively. Conclusions: Comparable to the global literature, the majority of procedures performed at the District Hospital level in Rwanda are caesarian sections. As surgical capacity improves, accurate reporting of surgical procedures and outcomes is imperative to planning the training of surgical caregivers, allocation of resources and ensuring patient safety

Inter-facility transfer of surgical emergencies in a developing country: effects on management and surgical outcomes

Objectives: Outcomes of surgical emergencies are associated with promptness of the appropriate surgical intervention. However, delayed presentation of surgical patients is common in most developing countries. Delays commonly occur due to transfer of patients between facilities. The aim of the present study was to assess the effect of delays in treatment caused by inter-facility transfers of patients presenting with surgical emergencies as measured by objective and subjective parameters. Methods: We prospectively collected data on all patients presenting with an acute surgical emergency at Aga Khan University Hospital (AKUH). Information regarding demographics, social class, reason and number of transfers, and distance traveled were collected. Patients were categorized into two groups, those transferred to AKUH from another facility (transferred) and direct arrivals (non-transfers). Differences between presenting physiological parameters, vital statistics, and management were tested between the two groups by the chi square and t tests. Results: Ninety-nine patients were included, 49 (49.5 %) patients having been transferred from another facility. The most common reason for transfer was “lack of satisfactory surgical care.” There were significant differences in presenting pulse, oxygen saturation, respiratory rate, fluid for resuscitation, glasgow coma scale, and revised trauma score (all p values \u3c0.001) between transferred and non-transferred patients. In 56 patients there was a further delay in admission, and the most common reason was bed availability, followed by financial constraints. Three patients were shifted out of the hospital due to lack of ventilator, and 14 patients left against medical advice due to financial limitations. One patient died. Conclusions: Inter-facility transfer of patients with surgical emergencies is common. These patients arrive with deranged physiology which requires complex and prolonged hospital care. Patients who cannot afford treatment are most vulnerable to transfers and delays