Department of Surgery, Duke University Medical Center, Hubert Yeargan Center for Global Health, Durham, NC 27710, USA.
World J Surg. 2013 Sep;37(9):2109-21. doi: 10.1007/s00268-013-2112-8.
Developing countries have surgical and anesthesia needs that are unique and disparate compared to those of developed countries. However, the extent of these disparities and the specific country-based needs are, for the most part, unknown. The goal of this study was to assess the surgical capacity of Nicaragua's public hospitals as part of a multinational study.
A survey adapted from the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical care was used to study 28 primary, departmental, regional, and national referral hospitals within the Ministry of Health system. Data were obtained at the national and hospital levels via interviews with administrators and surgical and anesthesia chiefs of services.
There are 580 obstetrician/gynecologists (OB/GYN), 1,040 non-OB/GYN surgeons, and 250 anesthesiologists in Nicaragua. Primary, departmental, regional, and national referral hospitals perform an annual average of 374, 4,610, 7,270, and 7,776 surgeries, respectively. All but six primary hospitals were able to perform surgeries. Four hospitals reported routine water shortages. Routine medication shortages were reported in 11 hospitals. Eight primary hospitals lacked blood banks on site. Of 28 hospitals, 22 reported visits from short-term surgical brigades within the past 2 years. Measurement of surgical outcomes was inconsistent across hospitals.
Surgical capacity varies by hospital type, with primary hospitals having the least surgical capacity and surgical volume. Departmental, regional, and national referral hospitals have adequate surgical capacity. Surgical subspecialty care appears to be insufficient, as evidenced by the large presence of NGOs and other surgical brigade teams filling this gap.
发展中国家的外科和麻醉需求与发达国家相比具有独特性和差异性。然而，这些差异的程度和具体的国家需求在很大程度上是未知的。本研究的目的是评估尼加拉瓜公立医院的外科能力，这是一项多国研究的一部分。
我们使用了一种改编自世界卫生组织情境分析工具的调查方法，该工具用于评估紧急和基本外科护理，以研究卫生部系统内的 28 家初级、部门、区域和国家级转诊医院。通过与管理人员和外科及麻醉服务主任的访谈，在国家和医院层面获取数据。
尼加拉瓜有 580 名妇产科医生、1040 名非妇产科外科医生和 250 名麻醉师。初级、部门、区域和国家级转诊医院每年平均进行 374、4610、7270 和 7776 例手术。除了六家初级医院外，所有医院都能够进行手术。四家医院报告经常出现水资源短缺。11 家医院报告经常出现常规药物短缺。八家初级医院缺乏现场血库。在 28 家医院中，有 22 家报告在过去 2 年内有短期外科医疗队来访。各医院的外科手术结果测量方法不一致。
外科能力因医院类型而异，初级医院的外科能力和手术量最少。部门、区域和国家级转诊医院有足够的外科能力。外科专科护理似乎不足，这表现在非政府组织和其他外科医疗队填补这一空白的大量存在。
