Anderson Geoffrey A, Ilcisin Lenka, Abesiga Lenard, Mayanja Ronald, Portal Benetiz Noralis, Ngonzi Joseph, Kayima Peter, Shrime Mark G
Department of Surgery, Massachusetts General Hospital, Boston, MA; Program in Global Surgery and Social Medicine, Department of Global Health and Social Medicine, Harvard University, Boston, MA.
Program in Global Surgery and Social Medicine, Department of Global Health and Social Medicine, Harvard University, Boston, MA.
Surgery. 2017 Jun;161(6):1710-1719. doi: 10.1016/j.surg.2017.01.009. Epub 2017 Mar 1.
The Lancet Commission on Global Surgery recommends that every country report its surgical volume and postoperative mortality rate. Little is known, however, about the numbers of operations performed and the associated postoperative mortality rate in low-income countries or how to best collect these data.
For one month, every patient who underwent an operation at a referral hospital in western Uganda was observed. These patients and their outcomes were followed until discharge. Prospective data were compared with data obtained from logbooks and patient charts to determine the validity of using retrospective methods for collecting these metrics.
Surgical volume at this regional hospital in Uganda is 8,515 operations/y, compared to 4,000 operations/y reported in the only other published data. The postoperative mortality rate at this hospital is 2.4%, similar to other hospitals in low-income countries. Finding patient files in the medical records department was time consuming and yielded only 62% of the files. Furthermore, a comparison of missing versus found charts revealed that the missing charts were significantly different from the found charts. Logbooks, on the other hand, captured 99% of the operations and 94% of the deaths.
Our results describe a simple, reproducible, accurate, and inexpensive method for collection of the Lancet Commission on Global Surgery variables using logbooks that already exist in most hospitals in low-income countries. While some have suggested using risk-adjusted postoperative mortality rate as a more equitable variable, our data suggest that only a limited amount of risk adjustment is possible given the limited available data.
《柳叶刀》全球外科委员会建议每个国家报告其手术量和术后死亡率。然而，对于低收入国家的手术数量及其相关术后死亡率，或者如何最好地收集这些数据，我们知之甚少。
在一个月的时间里，观察了乌干达西部一家转诊医院的每一位接受手术的患者。对这些患者及其术后结果进行随访直至出院。将前瞻性数据与从日志和患者病历中获得的数据进行比较，以确定使用回顾性方法收集这些指标的有效性。
这家乌干达地区医院的年手术量为8515例，相比之下，仅有的其他已发表数据报告的年手术量为4000例。该医院的术后死亡率为2.4%，与低收入国家的其他医院相似。在病历科查找患者档案耗时较长，且仅找到62%的档案。此外，对缺失病历与找到的病历进行比较发现，两者存在显著差异。另一方面，日志记录了99%的手术和94%的死亡病例。
我们的研究结果描述了一种简单、可重复、准确且廉价的方法，可利用低收入国家大多数医院已有的日志来收集《柳叶刀》全球外科委员会的相关变量。虽然有人建议使用风险调整后的术后死亡率作为更公平的变量，但我们的数据表明，鉴于可用数据有限，只能进行有限的风险调整。
