Abstract
BackgroundLittle is known about operative volume, distribution of cases, or capacity of the public sector to deliver essential surgical services in Uganda.MethodsA 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.ResultsA 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, R2 = 0·94) when controlling for confounders. Notably, operative volume was not correlated with availability of electricity, oxygen, light source, suction, blood, instruments, suture, gloves, intravenous fluid, or antibiotics.ConclusionAn 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.
Highlights
Little is known about operative volume, distribution of cases, or capacity of the public sector to deliver essential surgical services in Uganda
There was a significant difference between general hospitals (GHs), which had an average of 1·38 operating rooms (ORs) per facility, and referral hospitals (RRHs), which had 3·88 ORs per facility (p = 0.003)
In this study, we report an annual surgical volume of 144·5 cases per 100,000 people per year in the Ugandan public sector
Summary
Little is known about operative volume, distribution of cases, or capacity of the public sector to deliver essential surgical services in Uganda. The LCoGS established that a minimum threshold of surgical volume of 5000 procedures per 100,000 population per year is associated with improved health outcomes [1, 3]. Low operative volumes are known to be Albutt et al BMC Health Services Research (2019) 19:104 associated with high mortality and morbidity from common, treatable surgical conditions [1]. Of the 313 million surgical procedures performed worldwide every year, only 6% were performed in countries home to the poorest 40% of the world’s population [1, 2, 4]. In LMICs, the best available estimates suggest that 143 million additional surgical procedures are needed each year to save lives and prevent disability [1, 5]. Minimum need has been shown to be geographically variable, with the greatest unmet need estimated to be in eastern, western, and central sub-Saharan Africa, and south Asia [1]
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