Stephens Trina, Mezei Alexander, O'Hara Nathan N, Potter Jeffrey, Mugarura Rodney, Blachut Piotr A, O'Brien Peter J, Beyeza Tito, Slobogean Gerard P
School of Medicine, Queen's University, 99 University Ave, Kingston, ON, K7L 3N6, Canada.
Faculty of Medicine, University of British Columbia, 317 - 2194 Health Sciences Mall, Vancouver, BC, V6T 1Z3, Canada.
World J Surg. 2017 Jun;41(6):1415-1419. doi: 10.1007/s00268-017-3874-1.
In low- and middle-income countries, the volume of traumatic injuries requiring orthopaedic intervention routinely exceeds the capacity of available surgical resources. The objective of this study was to identify predictors of surgical care for lower extremity fracture patients at a high-demand, resource-limited public hospital in Uganda.
Skeletally mature patients admitted with the intention of definitive surgical treatment of an isolated tibia or femur fractures to the national referral hospital in Uganda were recruited to participate in this study. Demographic, socioeconomic, and clinical data were collected through participant interviews at the time of injury and 6 months post-injury. Social capital (use of social networks to gain access to surgery), financial leveraging, and ethnicity were also included as variables in this analysis. A probit estimation model was used to identify independent and interactive predictors of surgical treatment.
Of the 64 patients included in the final analysis, the majority of participants were male (83%), with a mean age of 40.6, and were injured in a motor vehicle accident (77%). Due to resource constraints, only 58% of participants received surgical care. The use of social capital and femur fractures were identified as significant predictors of receiving surgical treatment, with social capital emerging as the strongest predictor of access to surgery (p < 0.05).
Limited infrastructure, trained personnel, and surgical supplies rations access to surgical care. In this environment, participants with advantageous social connections were able to self-advocate for surgery where demand for these services greatly exceeded available resources.
在低收入和中等收入国家，需要骨科干预的创伤性损伤数量通常超过了现有手术资源的承受能力。本研究的目的是确定乌干达一家高需求、资源有限的公立医院中下肢骨折患者接受手术治疗的预测因素。
招募了以明确手术治疗孤立性胫骨或股骨骨折为目的入住乌干达国家转诊医院的骨骼成熟患者参与本研究。通过在受伤时和受伤后6个月对参与者进行访谈，收集人口统计学、社会经济和临床数据。社会资本（利用社交网络获得手术机会）、财务杠杆作用和种族也作为变量纳入本分析。使用概率估计模型来确定手术治疗的独立和交互预测因素。
在最终分析纳入的64例患者中，大多数参与者为男性（83%），平均年龄为40.6岁，且在机动车事故中受伤（77%）。由于资源限制，只有58%的参与者接受了手术治疗。社会资本的利用和股骨骨折被确定为接受手术治疗的重要预测因素，其中社会资本是获得手术机会的最强预测因素（p<0.05）。
基础设施、训练有素的人员和手术用品有限限制了手术治疗机会。在这种环境下，具有有利社会关系的参与者能够在这些服务的需求大大超过可用资源时为自己争取手术机会。
