Institute of Clinical and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
Department of Surgery, St Olav's Hospital, Trondheim University Hospital, Trondheim, Norway.
Br J Surg. 2019 Jan;106(2):e129-e137. doi: 10.1002/bjs.11076.
Many countries lack sufficient medical doctors to provide safe and affordable surgical and emergency obstetric care. Task-sharing with associate clinicians (ACs) has been suggested to fill this gap. The aim of this study was to assess maternal and neonatal outcomes of caesarean sections performed by ACs and doctors.
All nine hospitals in Sierra Leone where both ACs and doctors performed caesarean sections were included in this prospective observational multicentre non-inferiority study. Patients undergoing caesarean section were followed for 30 days. The primary outcome was maternal mortality, and secondary outcomes were perinatal events and maternal morbidity.
Between October 2016 and May 2017, 1282 patients were enrolled in the study. In total, 1161 patients (90·6 per cent) were followed up with a home visit at 30 days. Data for 1274 caesarean sections were analysed, 443 performed by ACs and 831 by doctors. Twin pregnancies were more frequently treated by ACs, whereas doctors performed a higher proportion of operations outside office hours. There was one maternal death in the AC group and 15 in the doctor group (crude odds ratio (OR) 0·12, 90 per cent confidence interval 0·01 to 0·67). There were fewer stillbirths in the AC group (OR 0·74, 0·56 to 0·98), but patients were readmitted twice as often (OR 2·17, 1·08 to 4·42).
Caesarean sections performed by ACs are not inferior to those undertaken by doctors. Task-sharing can be a safe strategy to improve access to emergency surgical care in areas where there is a shortage of doctors.
许多国家缺乏足够的医生来提供安全和负担得起的外科和紧急产科护理。有人建议将任务分担给助理临床医生（ACs）来填补这一空白。本研究旨在评估 ACs 和医生进行剖宫产的产妇和新生儿结局。
本前瞻性观察性多中心非劣效性研究纳入了塞拉利昂的所有 9 家既开展 ACs 剖宫产又开展医生剖宫产的医院。对接受剖宫产的患者进行 30 天随访。主要结局是产妇死亡率，次要结局是围产期事件和产妇发病率。
2016 年 10 月至 2017 年 5 月期间，共有 1282 名患者入组研究。共有 1161 名患者（90.6%）接受了 30 天的家庭随访。共分析了 1274 例剖宫产数据，其中 443 例由 ACs 实施，831 例由医生实施。ACs 更常治疗双胎妊娠，而医生在非办公时间进行的手术比例更高。AC 组有 1 例产妇死亡，医生组有 15 例（粗比值比（OR）0.12，90%置信区间 0.01 至 0.67）。AC 组的死产较少（OR 0.74，0.56 至 0.98），但患者再次入院的频率是其两倍（OR 2.17，1.08 至 4.42）。
ACs 实施的剖宫产术并不逊于医生实施的剖宫产术。任务分担可以是一种安全的策略，可改善在医生短缺地区获得紧急外科护理的机会。
