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

Abstract

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.

Gynaecologic oncology surgical cancellations in Zambia

“…In our series, we report a surgical cancellation rate of 16.96%. This number is slightly lower than the cited rates reported in the literature [1][2][3][4][5][6][7][8]. Although our number of cases is similar to other published reports (146 cases [1], 369 cases [7], 243 cases [8]), this lower rate may be a reflection associated with a specific single surgical oncological service analysis, the fact that we had no documented causes of cancellations related to social determinants such as lack of electricity and fewer cases being cancelled related to lack/absence of professional personnel (surgeon or anaesthesiologist), given that this centre is the only major referral centre for gynaecologic oncology in the entire country [1,7,8] The most common identified reason for surgical cancellations was having a low haemoglobin and/or the lack of blood products (40.90%) being available on the date of scheduled surgery.…”

“…Across surgical service lines in LMIC operative cancellations of scheduled surgical cases range from 18% to 31% [1][2][3][4][5][6][7][8]. Most common causes of reported cancellations were surgeons or anaesthesiologist unavailability; lack of operating theatre time, equipment, ancillary surgical personnel and electricity; and improper surgical scheduling.…”

“…Surgical cancellations for elective surgery in low-and middle-income countries (LMIC) are not uncommon. Reports have evaluated this problem on a broad perspective, inclusive of evaluating social determinants and infrastructural challenges while collectively looking across different surgical service lines [1][2][3][4][5][6][7][8]. These cancellations are a major hindrance for patients required to receive needed surgical care.…”

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

“…Reliance on self-recall imparts possible reporting-bias, although the extent of recall-bias has not been assessed in Uganda. Surgical complications were captured from surgical notes, so incomplete surgical notes and limited medical charting may have led to inaccurate record of surgical complications, a similar finding to that of the SRRH trauma surgery registry [ 18 ]. Precise time of arrival, time to decision, and time to surgery were not recorded.…”

Increased Surgical Delays Seen During the COVID‐19 Pandemic in a Regional Referral Hospital in Soroti, Uganda: Perspective from a Low‐Resource Setting

“…Providers then reported which factors caused the delay, which was recorded in our registry. Causes of delays were organized into broad categories to represent deficits in personnel, equipment, and infrastructure [13].…”