Albutt Katherine, Punchak Maria, Kayima Peter, Namanya Didacus B, Shrime Mark G
Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Avenue, Boston, MA, 02115, USA.
Department of Surgery, Massachusetts General Hospital, Boston, MA, USA.
BMC Health Serv Res. 2019 Feb 6;19(1):104. doi: 10.1186/s12913-019-3920-9.
Little is known about operative volume, distribution of cases, or capacity of the public sector to deliver essential surgical services in Uganda.
A standardized mixed-methods surgical assessment and retrospective operative logbook review were completed at 16 randomly selected public hospitals serving 64·0% of Uganda's population.
A total of 3014 operations were recorded, annualizing to a surgical volume of 36,670 cases/year or 144·5 operations/100,000people/year. Absolute surgical volume was greater at regional referral than general hospitals (p < 0·001); but, relative surgical volume/catchment population was greater at the general versus regional level (p = 0·03). Most patients undergoing operations were women (78·3%) with a mean age of 26·9 years. The overall case distribution was 69·0% obstetrics/gynecology, 23·7% general surgery, 4·0% orthopedics, and 3·3% other subspecialties. Cesarean sections were the most common operation (55·8%). Monthly operative volume was strongly predicted by number of surgical, anesthetic, and obstetric physician providers (훽=10·72, p = 0·005, R = 0·94) when controlling for confounders. Notably, operative volume was not correlated with availability of electricity, oxygen, light source, suction, blood, instruments, suture, gloves, intravenous fluid, or antibiotics.
An understanding of operative case volume and distribution is essential in facilitating targeted interventions to strengthen surgical capacity. These data suggest that surgical workforce is the critical driver of operative volume in the Ugandan public sector. Investment in the surgical workforce is imperative to ensure access to safe, timely, and affordable surgical and anaesthesia care.
关于乌干达的手术量、病例分布或公共部门提供基本外科服务的能力，人们了解甚少。
在随机选取的16家公立医院完成了标准化的混合方法外科评估和回顾性手术日志审查，这些医院服务于乌干达64.0%的人口。
共记录了3014例手术，按年计算手术量为36,670例/年，即144.5例/10万人/年。区域转诊医院的绝对手术量高于综合医院（p<0.001）；但是，综合医院与区域医院相比，相对手术量/服务人口更高（p=0.03）。大多数接受手术的患者为女性（78.3%），平均年龄为26.9岁。总体病例分布为：妇产科69.0%，普通外科23.7%，骨科4.0%，其他亚专科3.3%。剖宫产是最常见的手术（55.8%）。在控制混杂因素时，手术、麻醉和产科医生提供者的数量可强烈预测每月手术量（β=10.72，p=0.005，R=0.94）。值得注意的是，手术量与电力、氧气、光源、吸引器、血液、器械、缝线、手套、静脉输液或抗生素的可用性无关。
了解手术病例量和分布对于促进有针对性的干预措施以加强手术能力至关重要。这些数据表明，外科劳动力是乌干达公共部门手术量的关键驱动因素。必须投资于外科劳动力，以确保获得安全、及时且负担得起的外科和麻醉护理。
