Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
Oxford University Hospitals NHS Foundation Trust, Oxford, UK.
BMJ Open. 2021 Mar 25;11(3):e042862. doi: 10.1136/bmjopen-2020-042862.
To provide a general overview of the reported current surgical capacity and delivery in order to advance current knowledge and suggest targets for further development and research within the region of sub-Saharan Africa.
Scoping review.
District hospitals in sub-Saharan Africa.
PubMed and Ovid EMBASE from January 2000 to December 2019.
Studies were included if they contained information about types of surgical procedures performed, number of operations per year, types of anaesthesia delivered, cadres of surgical/anaesthesia providers and/or patients' outcomes.
The 52 articles included in analysis provided information about 16 countries. District hospitals were a group of diverse institutions ranging from 21 to 371 beds. The three most frequently reported procedures were caesarean section, laparotomy and hernia repair, but a wide range of orthopaedics, plastic surgery and neurosurgery procedures were also mentioned. The number of operations performed per year per district hospital ranged from 239 to 5233. The most mentioned anaesthesia providers were non-physician clinicians trained in anaesthesia. They deliver mainly general and spinal anaesthesia. Depending on countries, articles referred to different surgical care providers: specialist surgeons, medical officers and non-physician clinicians. 15 articles reported perioperative complications among which surgical site infection was the most frequent. Fifteen articles reported perioperative deaths of which the leading causes were sepsis, haemorrhage and anaesthesia complications.
District hospitals play a significant role in sub-Saharan Africa, providing both emergency and elective surgeries. Most procedures are done under general or spinal anaesthesia, often administered by non-physician clinicians. Depending on countries, surgical care may be provided by medical officers, specialist surgeons and/or non-physician clinicians. Research on safety, quality and volume of surgical and anaesthesia care in this setting is scarce, and more attention to these questions is required.
提供报告中当前外科能力和手术量的概述，以增进对该地区的了解，并为该地区的进一步发展和研究提出目标。
范围综述。
撒哈拉以南非洲的地区医院。
2000 年 1 月至 2019 年 12 月，PubMed 和 Ovid EMBASE。
如果研究包含手术类型、每年手术量、提供的麻醉类型、外科/麻醉提供者的职级以及/或患者结果等信息，则纳入研究。
纳入分析的 52 篇文章提供了 16 个国家的信息。地区医院是一组多样化的机构，床位从 21 张到 371 张不等。报告中最常见的三种手术是剖宫产术、剖腹术和疝修补术，但也提到了广泛的骨科、整形和神经外科手术。每家地区医院每年的手术量从 239 例到 5233 例不等。最常提到的麻醉提供者是非医师临床医生，他们接受过麻醉培训。他们主要提供全身麻醉和脊髓麻醉。根据国家的不同，文章中提到了不同的外科护理提供者：专科外科医生、医疗官员和非医师临床医生。15 篇文章报告了围手术期并发症，其中手术部位感染最为常见。15 篇文章报告了围手术期死亡，主要原因是脓毒症、出血和麻醉并发症。
地区医院在撒哈拉以南非洲发挥着重要作用，提供急诊和择期手术。大多数手术在全身麻醉或脊髓麻醉下进行，通常由非医师临床医生实施。根据国家的不同，外科护理可能由医疗官员、专科外科医生和/或非医师临床医生提供。在这种情况下，关于手术和麻醉护理的安全性、质量和数量的研究很少，需要更多关注这些问题。
