Chao Tiffany E, Patel Pratik B, Kikubaire Michael, Niescierenko Michelle, Hagander Lars, Meara John G
Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA,
World J Surg. 2015 Sep;39(9):2140-6. doi: 10.1007/s00268-014-2905-4.
Situational needs of health care facilities inform the optimal allocation of resources and quality improvement efforts. This study examines surgical care delivery metrics at a tertiary care institution in Liberia.
We retrospectively reviewed operative and ward logbooks from January 1 to December 31, 2012. Data parameters included patients' age, diagnosis, procedure, mortality, and perioperative provider information.
In 2012, 1,036 operations were performed. The breakdown of adult surgical cases reveals 452 (45.1%) general surgery operations, 192 (18.5%) orthopedic operations, and 180 (17.4%) ophthalmic operations. Other significant case volume included urologic 53 (5.1%), ENT 36 (3.5%), neurosurgical 31 (3.0%), vascular 24 (2.3%), and plastic 14 (1.4%) operations. Pediatric patients accounted for 24.5% (243) of surgical cases, and 9% of pediatric surgical cases were for hydrocephalus. General, spinal, and total intravenous anesthesia was provided by non-physician personnel, except when surgeons provided their own anesthesia. Ward logs documented 7.4% mortality among all patients admitted to the surgical ward, most of which occurred after exploratory laparotomy (44%), in burn (14%) patients, and in patients with head/neck emergencies (12%).
This operative log review can be used to identify surgical practice patterns, needs, and deficits in order to inform the growth of surgical capacity at Liberia's only tertiary medical institution. Using this data to identify critical areas of high-yield operations (e.g., for pediatric hydrocephalus), or excessively high mortality rates (e.g., in burn care), can focus the direction of limited resources toward areas of need. While the heavy reliance on non-consultant surgeons reflects human capacity shortages and a pressing need for postgraduate training programs, identifying the breadth of surgical expertise demonstrated in these operative logs reveals the proficiencies required of surgeons to provide comprehensive surgical care in this setting.
医疗保健机构的实际需求决定了资源的优化配置和质量改进工作。本研究调查了利比里亚一家三级医疗机构的外科护理指标。
我们回顾性分析了2012年1月1日至12月31日的手术和病房日志。数据参数包括患者年龄、诊断、手术、死亡率以及围手术期医护人员信息。
2012年共进行了1036台手术。成人外科病例分类显示，普通外科手术452例（45.1%），骨科手术192例（18.5%），眼科手术180例（17.4%）。其他手术量较大的科室包括泌尿外科53例（5.1%）、耳鼻喉科36例（3.5%）、神经外科31例（3.0%）、血管外科24例（2.3%）和整形外科14例（1.4%）。儿科患者占手术病例的24.5%（243例），其中9%的儿科手术病例为脑积水手术。除外科医生自行实施麻醉外，非医师人员提供全身麻醉、脊髓麻醉和全静脉麻醉。病房日志记录显示，外科病房所有入院患者的死亡率为7.4%，其中大部分发生在剖腹探查术后（44%）、烧伤患者（14%）以及头颈部急诊患者（12%）。
此次手术日志回顾可用于识别外科手术模式、需求和不足，以便为利比里亚唯一的三级医疗机构的外科手术能力发展提供参考。利用这些数据识别高收益手术的关键领域（如小儿脑积水手术）或过高的死亡率（如烧伤护理），可以将有限资源的投入方向集中到有需求的领域。虽然严重依赖非顾问外科医生反映了人力短缺以及对研究生培训项目的迫切需求，但通过这些手术日志中所展示的外科专业知识广度，可以明确在这种情况下外科医生提供全面外科护理所需具备的专业技能。
