An Audit on pediatric surgery services at Sinnar Teaching Hospital: outcome and challenges

Abstract

a valuable data for health authorities. The aim of this study was to reflect the burden and outcomeof one pediatric surgery unit at Sinnar Teaching Hospital (STH). It also throws some light intochallenges and obstacles that face running of pediatric surgery services outside of the capital.Methods: This was a retrospective, descriptive review. It included all the patients who presentedto the Pediatric Surgery Unit at Sinnar Teaching Hospital (STH) and underwent emergency orelective operations during the period from January 2009 to December 2012.Results: A total number of 2400 patients were seen at the unit over four years. About half of them(1210) (50.4%) underwent emergency or elective operations. Inguinoscrotal conditions were themost frequently performed elective operations 450 (37%). Appendectomy was the commonest emergency operation: 169 (14%). Forty four (2%) were referred to Al-Jazeera or KhartoumStates for further work-up or advanced care. The majority of the referred cases were those whorequired more specialized oncological or neurosurgical services, in addition to some patients whoneeded non-invasive interventions (like ESWL for instance) or multidisciplinary management (bladder exostrophy and proximal hypospadias). The overall mortality rate was 2.4% (n=52) withhigher mortality rate noticed among neonatal conditions: 20% of it (n=10) due to lack of trainedanesthetists, pediatric intensive care unit facilities, and delayed presentation.Conclusion: Conduction of a pediatric surgery service outside of the capital is challenging andfaces various obstacles, but it is possible with a reasonable outcome. A wide variety of emergencyand elective pediatric surgical conditions are seen and the majority of them could be managedproperly at a state hospital level. Availability of well-established anesthetic and pediatric intensivecare facilities, with trained nursing staff is the cornerstone for better quality services with minimummorbidity and mortality rates. Establishment of pediatric surgery services in the states wouldinvariably decrease the central congestion and referral to capital hospitals. It can also minimizethe unnecessary, and indeed, costly expenditure on referral,especially for low-and middle- incomefamilies.