Abstract
Background
The significant burden of emergency operations in low- and middle-income countries
can overwhelm surgical capacity leading to a backlog of elective surgical cases. The
purpose of this investigation was to determine the burden of emergency procedures
on pediatric surgical capacity in Uganda and to determine health metrics that capture
surgical backlog and effective coverage of children’s surgical disease in low- and
middle-income countries.
Methods
We reviewed 2 independent and prospectively collected databases on pediatric surgical
admissions at Mulago National Referral Hospital and Mbarara Regional Referral Hospital
in Uganda. Pediatric surgical patients admitted at either hospital between October
2015 to June 2017 were included. Our primary outcome was the distribution of surgical
acuity and associated mortality.
Results
A combined total of 1,930 patients were treated at the two hospitals, and 1,110 surgical
procedures were performed. There were 571 emergency cases (51.6%), 108 urgent cases
(9.7%), and 429 elective cases (38.6%). Overall mortality correlated with surgical
acuity. Emergency intestinal diversions for colorectal congenital malformations (anorectal
malformations and Hirschsprung’s disease) to elective definitive repair was 3:1. Additionally,
30% of inguinal hernias were incarcerated or strangulated at time of repair.
Conclusion
Emergency and urgent operations utilize the majority of operative resources for pediatric
surgery groups in low- and middle-income countries, leading to a backlog of complex
congenital procedures. We propose the ratio of emergency diversion to elective repair
of colorectal congenital malformations and the ratio of emergency to elective repair
of inguinal hernias as effective health metrics to track this backlog. Surgical capacity
for pediatric conditions should be increased in Uganda to prevent a backlog of elective
cases.
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Article info
Publication history
Published online: January 20, 2020
Accepted:
December 4,
2019
Identification
Copyright
© 2019 Elsevier Inc. All rights reserved.
