Cargando…

Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes

BACKGROUND: Management of emergency general surgical conditions remains a challenge in rural sub-Saharan Africa due to issues such as insufficient human capacity and infrastructure. This study describes the burden of emergency general surgical conditions and the ability to provide care for these con...

Descripción completa

Detalles Bibliográficos
Autores principales: Mpirimbanyi, Christophe, Nyirimodoka, Alexandre, Lin, Yihan, Hedt-Gauthier, Bethany L., Odhiambo, Jackline, Nkurunziza, Theoneste, Havens, Joaquim M., Omondi, Jack, Rwamasirabo, Emile, Ntirenganya, Faustin, Toma, Gabriel, Mubiligi, Joel, Bayitondere, Scheilla, Riviello, Robert
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709982/
https://www.ncbi.nlm.nih.gov/pubmed/29191200
http://dx.doi.org/10.1186/s12893-017-0323-x
_version_ 1783282891226087424
author Mpirimbanyi, Christophe
Nyirimodoka, Alexandre
Lin, Yihan
Hedt-Gauthier, Bethany L.
Odhiambo, Jackline
Nkurunziza, Theoneste
Havens, Joaquim M.
Omondi, Jack
Rwamasirabo, Emile
Ntirenganya, Faustin
Toma, Gabriel
Mubiligi, Joel
Bayitondere, Scheilla
Riviello, Robert
author_facet Mpirimbanyi, Christophe
Nyirimodoka, Alexandre
Lin, Yihan
Hedt-Gauthier, Bethany L.
Odhiambo, Jackline
Nkurunziza, Theoneste
Havens, Joaquim M.
Omondi, Jack
Rwamasirabo, Emile
Ntirenganya, Faustin
Toma, Gabriel
Mubiligi, Joel
Bayitondere, Scheilla
Riviello, Robert
author_sort Mpirimbanyi, Christophe
collection PubMed
description BACKGROUND: Management of emergency general surgical conditions remains a challenge in rural sub-Saharan Africa due to issues such as insufficient human capacity and infrastructure. This study describes the burden of emergency general surgical conditions and the ability to provide care for these conditions at three rural district hospitals in Rwanda. METHODS: This retrospective cross-sectional study included all patients presenting to Butaro, Kirehe and Rwinkwavu District Hospitals between January 1st 2015 and December 31st 2015 with emergency general surgical conditions, defined as non-traumatic, non-obstetric acute care surgical conditions. We describe patient demographics, clinical characteristics, management and outcomes. RESULTS: In 2015, 356 patients presented with emergency general surgical conditions. The majority were male (57.2%) and adults aged 15–60 years (54.5%). The most common diagnostic group was soft tissue infections (71.6%), followed by acute abdominal conditions (14.3%). The median length of symptoms prior to diagnosis differed significantly by diagnosis type (p < 0.001), with the shortest being urological emergencies at 1.5 days (interquartile range (IQR):1, 6) and the longest being complicated hernia at 17.5 days (IQR: 1, 208). Of all patients, 54% were operated on at the district hospital, either by a general surgeon or general practitioner. Patients were more likely to receive surgery if they presented to a hospital with a general surgeon compared to a hospital with only general practitioners (75% vs 43%, p < 0.001). In addition, the general surgeon was more likely to treat patients with complex diagnoses such as acute abdominal conditions (33.3% vs 4.1%, p < 0.001) compared to general practitioners. For patients who received surgery, 73.3% had no postoperative complications and 3.2% died. CONCLUSION: While acute abdominal conditions are often considered the most common emergency general surgical condition in sub-Saharan Africa, soft tissue infections were the most common in our setting. This could represent a true difference in epidemiology in rural settings compared to referral facilities in urban settings. Patients were more likely to receive an operation in a hospital with a general surgeon as opposed to a general practitioner. This provides evidence to support increasing the surgical workforce in district hospitals in order to increase surgical availability for patients.
format Online
Article
Text
id pubmed-5709982
institution National Center for Biotechnology Information
language English
publishDate 2017
publisher BioMed Central
record_format MEDLINE/PubMed
spelling pubmed-57099822017-12-06 Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes Mpirimbanyi, Christophe Nyirimodoka, Alexandre Lin, Yihan Hedt-Gauthier, Bethany L. Odhiambo, Jackline Nkurunziza, Theoneste Havens, Joaquim M. Omondi, Jack Rwamasirabo, Emile Ntirenganya, Faustin Toma, Gabriel Mubiligi, Joel Bayitondere, Scheilla Riviello, Robert BMC Surg Research Article BACKGROUND: Management of emergency general surgical conditions remains a challenge in rural sub-Saharan Africa due to issues such as insufficient human capacity and infrastructure. This study describes the burden of emergency general surgical conditions and the ability to provide care for these conditions at three rural district hospitals in Rwanda. METHODS: This retrospective cross-sectional study included all patients presenting to Butaro, Kirehe and Rwinkwavu District Hospitals between January 1st 2015 and December 31st 2015 with emergency general surgical conditions, defined as non-traumatic, non-obstetric acute care surgical conditions. We describe patient demographics, clinical characteristics, management and outcomes. RESULTS: In 2015, 356 patients presented with emergency general surgical conditions. The majority were male (57.2%) and adults aged 15–60 years (54.5%). The most common diagnostic group was soft tissue infections (71.6%), followed by acute abdominal conditions (14.3%). The median length of symptoms prior to diagnosis differed significantly by diagnosis type (p < 0.001), with the shortest being urological emergencies at 1.5 days (interquartile range (IQR):1, 6) and the longest being complicated hernia at 17.5 days (IQR: 1, 208). Of all patients, 54% were operated on at the district hospital, either by a general surgeon or general practitioner. Patients were more likely to receive surgery if they presented to a hospital with a general surgeon compared to a hospital with only general practitioners (75% vs 43%, p < 0.001). In addition, the general surgeon was more likely to treat patients with complex diagnoses such as acute abdominal conditions (33.3% vs 4.1%, p < 0.001) compared to general practitioners. For patients who received surgery, 73.3% had no postoperative complications and 3.2% died. CONCLUSION: While acute abdominal conditions are often considered the most common emergency general surgical condition in sub-Saharan Africa, soft tissue infections were the most common in our setting. This could represent a true difference in epidemiology in rural settings compared to referral facilities in urban settings. Patients were more likely to receive an operation in a hospital with a general surgeon as opposed to a general practitioner. This provides evidence to support increasing the surgical workforce in district hospitals in order to increase surgical availability for patients. BioMed Central 2017-12-01 /pmc/articles/PMC5709982/ /pubmed/29191200 http://dx.doi.org/10.1186/s12893-017-0323-x Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Mpirimbanyi, Christophe
Nyirimodoka, Alexandre
Lin, Yihan
Hedt-Gauthier, Bethany L.
Odhiambo, Jackline
Nkurunziza, Theoneste
Havens, Joaquim M.
Omondi, Jack
Rwamasirabo, Emile
Ntirenganya, Faustin
Toma, Gabriel
Mubiligi, Joel
Bayitondere, Scheilla
Riviello, Robert
Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes
title Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes
title_full Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes
title_fullStr Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes
title_full_unstemmed Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes
title_short Emergency general surgery in Rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes
title_sort emergency general surgery in rwandan district hospitals: a cross-sectional study of spectrum, management, and patient outcomes
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5709982/
https://www.ncbi.nlm.nih.gov/pubmed/29191200
http://dx.doi.org/10.1186/s12893-017-0323-x
work_keys_str_mv AT mpirimbanyichristophe emergencygeneralsurgeryinrwandandistricthospitalsacrosssectionalstudyofspectrummanagementandpatientoutcomes
AT nyirimodokaalexandre emergencygeneralsurgeryinrwandandistricthospitalsacrosssectionalstudyofspectrummanagementandpatientoutcomes
AT linyihan emergencygeneralsurgeryinrwandandistricthospitalsacrosssectionalstudyofspectrummanagementandpatientoutcomes
AT hedtgauthierbethanyl emergencygeneralsurgeryinrwandandistricthospitalsacrosssectionalstudyofspectrummanagementandpatientoutcomes
AT odhiambojackline emergencygeneralsurgeryinrwandandistricthospitalsacrosssectionalstudyofspectrummanagementandpatientoutcomes
AT nkurunzizatheoneste emergencygeneralsurgeryinrwandandistricthospitalsacrosssectionalstudyofspectrummanagementandpatientoutcomes
AT havensjoaquimm emergencygeneralsurgeryinrwandandistricthospitalsacrosssectionalstudyofspectrummanagementandpatientoutcomes
AT omondijack emergencygeneralsurgeryinrwandandistricthospitalsacrosssectionalstudyofspectrummanagementandpatientoutcomes
AT rwamasiraboemile emergencygeneralsurgeryinrwandandistricthospitalsacrosssectionalstudyofspectrummanagementandpatientoutcomes
AT ntirenganyafaustin emergencygeneralsurgeryinrwandandistricthospitalsacrosssectionalstudyofspectrummanagementandpatientoutcomes
AT tomagabriel emergencygeneralsurgeryinrwandandistricthospitalsacrosssectionalstudyofspectrummanagementandpatientoutcomes
AT mubiligijoel emergencygeneralsurgeryinrwandandistricthospitalsacrosssectionalstudyofspectrummanagementandpatientoutcomes
AT bayitonderescheilla emergencygeneralsurgeryinrwandandistricthospitalsacrosssectionalstudyofspectrummanagementandpatientoutcomes
AT riviellorobert emergencygeneralsurgeryinrwandandistricthospitalsacrosssectionalstudyofspectrummanagementandpatientoutcomes