Key Concepts for Estimating the Burden of Surgical Conditions and the Unmet Need for Surgical Care

Introduction: There is a paucity of published data on the type of surgical conditions that affect the UN personnel of different countries setup and the spectrum of surgical operations performed for these patients. Such information are necessary for assessing the impact of surgical conditions, both elective and emergency, on the health of UN peacekeepers from different races and nationalities and for setting priority to improve the surgical care. Objectives: To ascertain highest possible standard of surgical care to be ensured in an international arena for optimal outcome. Materials and methods: Five years retrospective study was carried out in Bangladesh level II hospital (BANMED), UNMIL located at Suakoko district of Liberia from April 2007 to April 2012 comprising of all major and minor surgical cases with different types of dressings done. Results: A total 83 major, 567 minor and 3924 dressings were done. The majority of operations were emergency cases of which 73.49% were of major and 78.30% were minor surgery. While 26.50% of major and 21.69% of minor surgery were elective cases. All were male patients in cases of major operations and 93.29% for minor cases as most of the peacekeepers were male personnel. The most frequent cases were acute appendicitis, inguinal hernia and polytrauma cases. Highest number of patients was 28 (33.73%) from 26-30 years age group. There were 3 minor postoperative complications with nil mortality rates. Conclusion: The surgical unit of a level-II hospital has to work in an adverse situation of a conflict area with various limitations. So it is very important to provide highest possible standard of surgical care to be ensured in terms of staff, equipments, logistic support and with a motivated surgical team in an international arena for optimal outcome. DOI: http://dx.doi.org/10.3329/jafmc.v9i1.18720 Journal of Armed Forces Medical College Bangladesh Vol.9(1) 2013: 14-19

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The burden of surgical conditions and access to surgical care in low- and middle-income countries

Bulletin of the World Health Organization ◽

10.2471/blt.07.050435 ◽

2008 ◽

Vol 86 (8) ◽

pp. 646-647 ◽

Cited By ~ 147

Author(s):

Kelly McQueen

Keyword(s):

Surgical Care ◽

Middle Income ◽

Middle Income Countries ◽

Surgical Conditions ◽

Low And Middle Income

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Nonsyndromic craniosynostosis in Vietnam: initial surgical outcomes of subspecialty mentorship

Journal of Neurosurgery Pediatrics ◽

10.3171/2021.5.peds20932 ◽

2021 ◽

pp. 1-8

Author(s):

Dang Do Thanh Can ◽

Jacob R. Lepard ◽

Nguyen Minh Anh ◽

Pham Anh Tuan ◽

Tran Diep Tuan ◽

...

Keyword(s):

Scale Up ◽

Unmet Need ◽

Case Series ◽

Surgical Care ◽

Cranial Vault ◽

Female Ratio ◽

Estimated Blood Loss ◽

Common Diagnosis ◽

Cranial Vault Remodeling

OBJECTIVE There is a global deficit of pediatric neurosurgical care, and the epidemiology and overall surgical care for craniosynostosis is not well characterized at the global level. This study serves to highlight the details and early surgical results of a neurosurgical educational partnership and subsequent local scale-up in craniosynostosis correction. METHODS A prospective case series was performed with inclusion of all patients undergoing correction of craniosynostosis by extensive cranial vault remodeling at Children’s Hospital 2, Ho Chi Minh City, Vietnam, between January 1, 2015, and December 31, 2019. RESULTS A total of 76 patients were included in the study. The group was predominantly male, with a male-to-female ratio of 3.3:1. Sagittal synostosis was the most common diagnosis (50%, 38/76), followed by unilateral coronal (11.8%, 9/76), bicoronal (11.8%, 9/76), and metopic (7.9%, 6/76). The most common corrective technique was anterior cranial vault remodeling (30/76, 39.4%) followed by frontoorbital advancement (34.2%, 26/76). The overall mean operative time was 205.8 ± 38.6 minutes, and the estimated blood loss was 176 ± 89.4 mL. Eleven procedures were complicated by intraoperative durotomy (14.5%, 11/76) without any damage of dural venous sinuses or brain tissue. Postoperatively, 4 procedures were complicated by wound infection (5.3%, 4/76), all of which required operative wound debridement. There were no neurological complications or postoperative deaths. One patient required repeat reconstruction due to delayed intracranial hypertension. There was no loss to follow-up. All patients were followed at outpatient clinic, and the mean follow-up period was 32.3 ± 18.8 months postoperatively. CONCLUSIONS Surgical care for pediatric craniosynostosis can be taught and sustained in the setting of collegial educational partnerships with early capability for high surgical volume and safe outcomes. In the setting of the significant deficit in worldwide pediatric neurosurgical care, this study provides an example of the feasibility of such relationships in addressing this unmet need.

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Article Commentary: Rural Pediatric Surgery

The American Surgeon ◽

10.1177/000313481508100321 ◽

2015 ◽

Vol 81 (3) ◽

pp. 223-228 ◽

Cited By ~ 4

Author(s):

Don K. Nakayama

Keyword(s):

Pediatric Surgery ◽

Local Community ◽

Surgical Care ◽

Older Children ◽

Surgical Disease ◽

Appropriate Treatment ◽

Telemedicine Consultation ◽

Surgical Conditions ◽

Training And Support ◽

Community Facilities

Published outcome studies support regionalization of pediatric surgery, in which all children suspected of having surgical disease are transferred to a specialty center. Transfer to specialty centers, however, is an expensive approach to quality, both in direct costs of hospitalization and the expense incurred by families. A related question is the role of well-trained rural surgeons in an adequately resourced facility in the surgical care of infants and children. Local community facilities provide measurably equivalent results for straightforward emergencies in older children such as appendicitis. With education, training, and support such as telemedicine consultation, rural surgeons and hospitals may be able to care for many more children such as single-system trauma and other cases for which they have training such as pyloric stenosis. They can recognize surgical disease at earlier stages and initiate appropriate treatment before transfer so that patients are in better shape for surgery when they arrive for definitive care. Rural and community facilities would be linked in a pediatric surgery system that covers the spectrum of pediatric surgical conditions for a geographical region.

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Publicly funded interfacility ambulance transfers for surgical and obstetrical conditions: A cross sectional analysis in an urban middle-income country setting

PLoS ONE ◽

10.1371/journal.pone.0241553 ◽

2020 ◽

Vol 15 (11) ◽

pp. e0241553

Author(s):

Paul Truche ◽

Rachel E. NeMoyer ◽

Sara Patiño-Franco ◽

Juan P. Herrera-Escobar ◽

Myerlandi Torres ◽

...

Keyword(s):

Surgical Care ◽

Healthcare Facility ◽

Public Hospitals ◽

Public Healthcare ◽

Publicly Funded ◽

Cross Sectional ◽

Middle Income ◽

Healthcare Facilities ◽

Timely Access ◽

Surgical Conditions

Introduction Interfacility transfers may reflect a time delay of definitive surgical care, but few studies have examined the prevalence of interfacility transfers in the urban low- and middle-income (LMIC) setting. The aim of this study was to determine the number of interfacility transfers required for surgical and obstetric conditions in an urban MIC setting to better understand access to definitive surgical care among LMIC patients. Methods A retrospective analysis of public interfacility transfer records was conducted from April 2015 to April 2016 in Cali, Colombia. Data were obtained from the single municipal ambulance agency providing publicly funded ambulance transfers in the city. Interfacility transfers were defined as any patient transfer between two healthcare facilities. We identified the number of transfers for patients with surgical conditions and categorized transfers based on patient ICD-9-CM codes. We compared surgical transfers from public vs. private healthcare facilities by condition type (surgical, obstetric, nonsurgical), transferring physician specialty, and transfer acuity (code blue, emergent, urgent and nonurgent) using logistic regression. Results 31,659 patient transports occurred over the 13-month study period. 22250 (70.2%) of all transfers were interfacility transfers and 7777 (35%) of transfers were for patients with surgical conditions with an additional 2,244 (10.3%) for obstetric conditions. 49% (8660/17675) of interfacility transfers from public hospitals were for surgical and obstetric conditions vs 32% (1466/4580) for private facilities (P<0.001). The most common surgical conditions requiring interfacility transfer were fractures (1,227, 5.4%), appendicitis (913, 4.1%), wounds (871, 3.9%), abdominal pain (818, 3.6%), trauma (652, 2.9%), and acute abdomen (271, 1.2%). Conclusion Surgical and obstetric conditions account for nearly half of all urban interfacility ambulance transfers. The most common reasons for transfer are basic surgical conditions with public healthcare facilities transferring a greater proportion of patient with surgical conditions than private facilities. Timely access to an initial healthcare facility may not be a reliable surrogate of definitive surgical care given the substantial need for interfacility transfers.

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Decentralization and Regionalization of Surgical Care as a Critical Scale-up Strategy in Low- and Middle-Income Countries Comment on "Decentralization and Regionalization of Surgical Care: A Review of Evidence for the Optimal Distribution of Surgical Services in Low- and Middle-Income Countries"

International Journal of Health Policy and Management ◽

10.34172/ijhpm.2020.26 ◽

2020 ◽

Author(s):

Jaymie A. Henry

Keyword(s):

Scale Up ◽

Surgical Care ◽

Lessons Learned ◽

Optimal Distribution ◽

Middle Income ◽

Middle Income Countries ◽

Surgical Services ◽

Obstetric Services ◽

Surgical Conditions ◽

Low And Middle Income

As global attention to improve the quality, safety and access to surgical care in low- and middle-income countries (LMICs) increases, the need for evidence-based strategies to reliably scale-up the quality and quantity of surgical services becomes ever more pertinent. Iversen et al discuss the optimal distribution of surgical services, whether through decentralization or regionalization, and propose a strategy that utilizes the dimensions of acuity, complexity and prevalence of surgical conditions to inform national priorities. Proposed expansion of this strategy to encompass levels of scale-up prioritization is discussed in this commentary. The decentralization of emergency obstetric services in LMICs shows promising results and should be further explored. The dearth of evidence of regionalization in LMICs, on the other hand, limits extrapolation of lessons learned. Nevertheless, principles from the successful regionalization of certain services such as trauma care in high-income countries (HICs) can be adapted to LMIC settings and can provide the backbone for innovation in service delivery and safety.

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Surgical Diseases Management during COVID-19 Crisis at a Tertiary Care Hospital of India: Our Institutional Strategy

The Surgery Journal ◽

10.1055/s-0041-1740452 ◽

2021 ◽

Vol 07 (04) ◽

pp. e366-e373

Author(s):

Sudhir Kumar Singh ◽

Amit Gupta ◽

Harindra Sandhu ◽

Rishit Mani ◽

Jyoti Sharma ◽

...

Keyword(s):

Surgical Procedures ◽

Tertiary Care Hospital ◽

Multiorgan Failure ◽

Operative Procedure ◽

Tertiary Care ◽

Surgical Care ◽

Care Hospital ◽

Advanced Malignancy ◽

Number Of Patients ◽

Surgical Conditions

Abstract Introduction In response to the national coronavirus disease 2019 (COVID-19) pandemic, all hospitals and medical institutes gave priority to COVID-19 screening and to the management of patients who required hospitalization for COVID-19 infection. Surgical departments postponed all elective operative procedures and provided only essential surgical care to patients who presented with acute surgical conditions or suspected malignancy. Ample literature has emerged during this pandemic regarding the guidelines for safe surgical care. We report our experience during the lockdown period including the surgical procedures performed, the perioperative care provided, and the specific precautions implemented in response to the COVID-19 crisis. Materials and Methods We extracted patient clinical data from the medical records of all surgical patients admitted to our tertiary care hospital between the March 24th, 2020 and May 31st, 2020. Data collected included: patient demographics, surgical diagnoses, surgical procedures, nonoperative management, and patient outcomes. Results Seventy-seven patients were included in this report: 23 patients were managed medically, 28 patients underwent a radiologic intervention, and 23 patients required an operative procedure. In total eight of the 77 patients died due to ongoing sepsis, multiorgan failure, or advanced malignancy. Conclusion During the COVID-19 lockdown period, our surgical team performed many lifesaving surgical procedures and appropriately selected cancer operations. We implemented and standardized essential perioperative measures to reduce the spread of COVID-19 infection. When the lockdown measures were phased out a large number of patients remained in need of delayed elective and semi-elective operative treatment. Hospitals, medical institutes, and surgical leadership must adjust their priorities, foster stewardship of limited surgical care resources, and rapidly implement effective strategies to assure perioperative safety for both patients and operating room staff during periods of crisis.

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Essential Emergency Surgical Care in Remote Hilly Districts of Karnali - A Cross-Sectional Survey

Journal of Karnali Academy of Health Sciences ◽

10.3126/jkahs.v3i2.31384 ◽

2020 ◽

Vol 3 (2) ◽

pp. 116-121

Author(s):

Praveen Kumar Giri ◽

Prem Prasad Panta ◽

Niresh Thapa

Keyword(s):

Human Resources ◽

Electrical Power ◽

Unmet Need ◽

Surgical Care ◽

Situational Analysis ◽

Care Providers ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Running Water ◽

Surgical Interventions

Background: Remote hilly areas of Karnali Province has one in all the very best burdens of surgically treatable conditions within the world and therefore, the highest unmet need. The first objective of our study was to gauge the capacity of first-referral health facilities in remote districts of Karnali Province to perform basic surgical procedures. The aim is to assess the status of Essential Emergency Surgical Care in remote hilly districts of Karnali region of Nepal. Method: The screening Tool was Situational Analysis to Assess Emergency and Essential Surgical Care, to spot the health facility’s capacity to perform basic surgical (including obstetrics and trauma) and anesthetic procedures by investigating four categories of data: human resources, infrastructure, equipment and interventions available. The tool interrogated the supply of eight sorts of care providers, 35 surgical interventions and 67 items of apparatus. Results: on the average, 72.83% of all admissions required either minor or major surgical interventions. Oxygen supplies, electrical power backup, running water, blood bank, hospital guidelines were inconsistent. Only 1 Hospital have trained Surgeons, Anesthesiologist and Obstetrician/Gynecologist. Only 1 hospital can perform around 97.1% of procedures. Conclusion: The capacity for essential surgery is severely limited in Karnali region of Nepal. Limitations was seen in basic equipment, human resources, infrastructure, and supplies.

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Paediatric surgical conditions in Malawi - A cross-sectional nationwide household survey

Malawi Medical Journal ◽

10.4314/mmj.v33i2.2 ◽

2021 ◽

Vol 33 (2) ◽

pp. 73-81

Author(s):

Carlos Varela ◽

Asgaut Viste ◽

Sven Young ◽

Reinou S. Groen ◽

Leonard Banza ◽

...

Keyword(s):

Congenital Anomalies ◽

Traffic Accidents ◽

Surgical Care ◽

Household Survey ◽

Nationwide Survey ◽

Long Term Effects ◽

Cross Sectional ◽

Middle Income ◽

Surgical Conditions ◽

Surgical Condition

BackgroundUntreated surgical conditions may lead to lifelong disability in children. Treating children with surgical conditions may reduce long-term effects of morbidity and disability. Unfortunately, low- and middle-income countries have limited resources for paediatric surgical care. Malawi, for example, has very few paediatric surgeons. There are also significantly inadequate infrastructures and personnel to treat these children. In order to strengthen resources that could provide such services, we need to begin by quantifying the need.AimTo estimate the approximate prevalence of surgical conditions among children in Malawi, to describe the anatomical locations and diagnoses of the conditions and the presence of injuries.MethodsA cross-sectional, nationwide survey of surgical needs was performed in 28 of 29 districts of Malawi. Villages, households and household members were randomly selected. A total of 1487 households were visited and 2960 persons were interviewed. This paper is a sub analysis of the children in the dataset. Information was obtained from 255 living children and inquiry from household respondents for the 255 children who had died in the past year. The interviews were conducted by medical students over a 60-day period, and the validated SOSAS tool was used for data collection. ResultsThere were 67 out of 255 (26.3%) total children living with a surgical condition at the time of the study, with most of the conditions located in the extremities. Half of the children lived with problems due to injuries. Traffic accidents were the most common cause. Two-thirds of the children living with a surgical condition had some kind of disability, and one-third of them were grossly disabled. There were 255 total deceased children, with 34 who died from a surgical condition. The most prevalent causes of death were congenital anomalies of the abdomen, groin and genital region. ConclusionAn extrapolation of the 26% of children found to be living with a surgical condition indicates that there could be 2 million children living with a condition that needs surgical consultation or treatment in Malawi. Congenital anomalies cause significant numbers of deaths among Malawian children. Children living with surgical conditions had disorders in their extremities, causing severe disability. Many of these disorders could have been corrected by surgical care.

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Deaths from surgical conditions in Malawi - a randomised cross-sectional Nationwide household survey

BMC Public Health ◽

10.1186/s12889-020-09575-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Carlos Varela ◽

Sven Young ◽

Reinou S. Groen ◽

Leonard Banza ◽

Nyengo Mkandawire ◽

...

Keyword(s):

Health Care ◽

Health Facility ◽

Scale Up ◽

Surgical Care ◽

Household Survey ◽

Abdominal Distension ◽

African Countries ◽

Cross Sectional ◽

Middle Income ◽

Surgical Conditions

Abstract Background Relatively little is known about deaths from surgical conditions in low- and middle- income African countries. The prevalence of untreated surgical conditions in Malawi has previously been estimated at 35%, with 24% of the total deaths associated with untreated surgical conditions. In this study, we wished to analyse the causes of deaths related to surgical disease in Malawi and where the deaths took place; at or outside a health facility. Methods The study is based on data collected in a randomised multi-stage cross-sectional national household survey, which was carried out using the Surgeons Overseas Assessment of Surgical Need (SOSAS) tool. Randomisation was done on 48,233 settlements, using 55 villages from each district as data collection sites. Two to four households were randomly selected from each village. Two members from each household were interviewed. A total of 1479 households (2909 interviewees) across the whole country were visited as part of the survey. Results The survey data showed that in 2016, the total number of reported deaths from all causes was 616 in the 1479 households visited. Data related to cause of death were available for 558 persons (52.7% male). Surgical conditions accounted for 26.9% of these deaths. The conditions mostly associated with the 150 surgical deaths were body masses, injuries, and acute abdominal distension (24.3, 21.5 and 18.0% respectively). 12 women died from child delivery complications. Significantly more deaths from surgical conditions or injuries (55.3%) occurred outside a health facility compared to 43.6% of deaths from other medical conditions, (p = 0.0047). 82.3% of people that died sought formal health care and 12.9% visited a traditional healer additionally prior to their death. 17.7% received no health care at all. Of 150 deaths from potentially treatable surgical conditions, only 21.3% received surgical care. Conclusion In Malawi, a large proportion of deaths from possible surgical conditions occur outside a health facility. Conditions associated with surgical death were body masses, acute abdominal distention and injuries. These findings indicate an urgent need for scale up of surgical services at all health care levels in Malawi.

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