Cost-Effectiveness of Exploratory Laparotomy in a Regional Referral Hospital in Eastern Uganda

Bellamkonda, Nikhil; Motwani, Girish; Wange, Andrew Hyginus; Boer, Christopher De; Kirya, Fred; Juillard, Catherine; Marseille, Elliot; Ajiko, Mary Margaret; Dicker, Rochelle

doi:10.1016/j.jss.2019.07.037

Cited by 7 publications

(8 citation statements)

References 16 publications

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“…A median of 32.5 operations is done monthly. SRRH serves a catchment area of approximately two million people (5% of the Ugandan population) [9]. There are two attending general surgeons, two attending gynecological surgeons, and three nurse anesthetists [9].…”

Section: Study Settingmentioning

confidence: 99%

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The Third Delay in General Surgical Care in a Regional Referral Hospital in Soroti, Uganda

Starr

Kim²,

Oke³

et al. 2022

World j. surg.

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Background Building capacity for surgical care in low-and-middle-income countries is essential for the improvement of global health and economic growth. This study assesses in-hospital delays of surgical services at Soroti Regional Referral Hospital (SRRH), a tertiary healthcare facility in Soroti, Uganda. Methods A prospective general surgical database at SRRH was analyzed. Data on patient demographics, surgical characteristics, delays of care, and adverse clinical outcomes of patients seen between January 2017 and February 2020 were extracted and analyzed. Patient characteristics and surgical outcomes, for those who experienced delays in care, were compared to those who did not. Results Of the 1160 general surgery patients, 263 (22.3%) experienced at least one delay of care. Deficits in infrastructure, particularly lacking operating theater space, were the greatest contributor to delays (n = 192, 73.0%), followed by shortage of equipment (n = 52, 19.8%) and personnel (n = 37, 14.1%). Male sex was associated with less delays of care (OR 0.63) while undergoing emergency surgeries (OR 1.65) and abdominal surgeries (OR 1.44) were associated with more frequent delays. Delays were associated with more adverse events (10.3% vs. 5.0%), including death (4.2% vs. 1.6%). Emergency surgery, unclean wounds, and comorbidities were independent risk factors of adverse events. Discussion Patients at SRRH face significant delays in surgical care from deficits in infrastructure and lack of capacity for emergency surgery. Delays are associated with increased mortality and other adverse events. Investing in solutions to prevent delays is essential to improving surgical care at SRRH.

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Section: Study Settingmentioning

confidence: 99%

“…It is a government-run 250-bed hospital that serves 21,000 inpatients and 103,000 outpatients yearly. It has one operating theater with two operating tables, where two operations can be occurring simultaneously [9]. A median of 32.5 operations is done monthly.…”

Section: Study Settingmentioning

confidence: 99%

The Third Delay in General Surgical Care in a Regional Referral Hospital in Soroti, Uganda

Starr

Kim²,

Oke³

et al. 2022

World j. surg.

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“…SRRH offers the second-highest level of care in the country, having a referral base of eight district hospitals in the region and serving 21,000 inpatients and 103,000 outpatients annually. This 250-bed, government-run facility serves a rural catchment of 5% of the Ugandan population—about two million people [ 7 ]. The obstetrics and gynecology unit is served by a single theater with two operating tables staffed by two obstetricians and a trained anesthetist.…”

Section: Methodsmentioning

confidence: 99%

In‐Hospital Obstetric Delays in Rural Uganda: A Cross‐Sectional Analysis of a Hospital Cohort

et al. 2023

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Background Deaths related to pregnancy and childbirth are extremely high in low-resource countries such as Uganda. Maternal mortality in low- and middle-income countries is related to delays in seeking, reaching, and receiving adequate health care. This study aimed to investigate the in-hospital delays to surgical care for women in labor arriving to Soroti Regional Referral Hospital (SRRH). Methods From January 2017 to August 2020, we collected data on obstetric surgical patients in labor using a locally developed, context-specific obstetrics surgical registry. Data regarding patient demographics, clinical and operative characteristics, as well as delays in care and outcomes were documented. Descriptive and multivariate statistical analyses were conducted. Results A total of 3189 patients were treated during our study period. Median age was 23 years, most gestations were at term (97%) at the time of operation, and nearly all patients underwent Cesarean Section (98.8%). Notably, 61.7% of patients experienced at least one delay in their surgical care at SRRH. Lack of surgical space was the greatest contributor to delay (59.9%), followed by lack of supplies or personnel. The significant independent predictors of delayed care were having a prenatal acquired infection (AOR 1.73, 95% CI 1.43–2.09) and length of symptoms less than 12 h (AOR 0.32, 95% CI 0.26–0.39) or greater than 24 h (AOR 2.61, 95% CI 2.18–3.12). Conclusion In rural Uganda, there is a significant need for financial investment and commitment of resources to expand surgical infrastructure and improve care for mothers and neonates.

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“…The government-run 250-bed facility serves a predominantly rural catchment population of two million people, or roughly 5% of the Ugandan population. On an annual basis, 21,000 inpatients and 103,000 outpatients receive care at the hospital, with a referral base of eight district level hospitals throughout the region [ 9 ]. Representing the second-highest level of care within the national health system, SRRH offers patients their first opportunity to access specialized surgical care at any time of day or night.…”

Section: Methodsmentioning

confidence: 99%

Epidemiology of injured patients in rural Uganda: A prospective trauma registry’s first 1000 days

et al. 2021

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Trauma is a leading cause of morbidity and mortality worldwide. Data characterizing the burden of injury in rural Uganda is limited. Hospital-based trauma registries are a critical tool in illustrating injury patterns and clinical outcomes. This study aims to characterize the traumatic injuries presenting to Soroti Regional Referral Hospital (SRRH) in order to identify opportunities for quality improvement and policy development. From October 2016 to July 2019, we prospectively captured data on injured patients using a locally designed, context-relevant trauma registry instrument. Information regarding patient demographics, injury characteristics, clinical information, and treatment outcomes were recorded. Descriptive, bivariate, and multivariate statistical analyses were conducted. A total of 4109 injured patients were treated during the study period. Median age was 26 years and 63% were male. Students (33%) and peasant farmers (31%) were the most affected occupations. Falls (36%) and road traffic injuries (RTIs, 35%) were the leading causes of injury. Nearly two-thirds of RTIs were motorcycle-related and only 16% involved a pedestrian. Over half (53%) of all patients had a fracture or a sprain. Suffering a burn or a head injury were significant predictors of mortality. The number of trauma patients enrolled in the study declined by five-fold when comparing the final six months and initial six months of the study. Implementation of a context-appropriate trauma registry in a resource-constrained setting is feasible. In rural Uganda, there is a significant need for injury prevention efforts to protect vulnerable populations such as children and women from trauma on roads and in the home. Orthopedic and neurosurgical care are important targets for the strengthening of health systems. The comprehensive data provided by a trauma registry will continue to inform such efforts and provide a way to monitor their progress moving forward.

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Cost-Effectiveness of Exploratory Laparotomy in a Regional Referral Hospital in Eastern Uganda

Cited by 7 publications

References 16 publications

The Third Delay in General Surgical Care in a Regional Referral Hospital in Soroti, Uganda

The Third Delay in General Surgical Care in a Regional Referral Hospital in Soroti, Uganda

In‐Hospital Obstetric Delays in Rural Uganda: A Cross‐Sectional Analysis of a Hospital Cohort

Epidemiology of injured patients in rural Uganda: A prospective trauma registry’s first 1000 days

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