Tyson Anna F, Msiska Nelson, Kiser Michelle, Samuel Jonathan C, Mclean Sean, Varela Carlos, Charles Anthony G
Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi; Department of Surgery, University of North Carolina at Chapel Hill, United States.
Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi.
Int J Surg. 2014;12(5):509-15. doi: 10.1016/j.ijsu.2014.02.009. Epub 2014 Feb 19.
Specialized pediatric surgeons are unavailable in much of sub-Saharan Africa. Delegating some surgical tasks to non-physician clinical officers can mitigate the dependence of a health system on highly skilled clinicians for specific services.
We performed a case-control study examining pediatric surgical cases over a 12 month period. Operating surgeon was categorized as physician or clinical officer. Operative acuity, surgical subspecialty, and outcome were then compared between the two groups, using physicians as the control.
A total of 1186 operations were performed on 1004 pediatric patients. Mean age was 6 years (±5) and 64% of patients were male. Clinical officers performed 40% of the cases. Most general surgery, urology and congenital cases were performed by physicians, while most ENT, neurosurgery, and burn surgery cases were performed by clinical officers. Reoperation rate was higher for patients treated by clinical officers (17%) compared to physicians (7.1%), although this was attributable to multiple burn surgical procedures. Physician and clinical officer cohorts had similar complication rates (4.5% and 4.0%, respectively) and mortality rates (2.5% and 2.1%, respectively).
Fundamental changes in health policy in Africa are imperative as a significant increase in the number of surgeons available in the near future is unlikely. Task-shifting from surgeons to clinical officers may be useful to provide coverage of basic surgical care.
撒哈拉以南非洲的大部分地区没有专业的儿科外科医生。将一些外科手术任务委托给非医师临床干事可以减轻卫生系统对高技能临床医生提供特定服务的依赖。
我们进行了一项病例对照研究，对12个月期间的儿科外科病例进行了检查。将主刀医生分为医师或临床干事。然后以医师为对照，比较两组之间的手术敏锐度、外科亚专业和结果。
共对1004名儿科患者进行了1186例手术。平均年龄为6岁（±5），64%的患者为男性。临床干事实施了40%的病例。大多数普通外科、泌尿外科和先天性病例由医师实施，而大多数耳鼻喉科、神经外科和烧伤外科病例由临床干事实施。临床干事治疗的患者再次手术率（17%）高于医师（7.1%），不过这归因于多次烧伤外科手术。医师和临床干事队列的并发症发生率（分别为4.5%和4.0%）和死亡率（分别为2.5%和2.1%）相似。
由于近期外科医生数量大幅增加的可能性不大，非洲的卫生政策必须进行根本性变革。从外科医生向临床干事的任务转移可能有助于提供基本外科护理服务。
