Details

Autor(en) / Beteiligte

• Joharifard, Shahrzad
• Price, Natalie
• Ipanaqué, Josué Gabriel Yarlequé
• Clarke, Robert Harold
• Nyemah, Emmanuel
• Wallace, Andrew F.
• Dobboh, Charles
• Howe, Christiana
• Kortimai, Lucia Gizzie
• Chukwuemeka, Nnajieneh Stanley
• Mentoe, Sianeh Jackson
• Kabeto, Abdissa Kurkie
• Beste, Jason
• Dunbar, Elizabeth

Titel

The Impact of Implementing a Comprehensive Surgical Program on the Surgical Cohort at a Remote Referral Hospital in Southeastern Liberia

Ist Teil von

• World journal of surgery, 2020-03, Vol.44 (3), p.680-688

Ort / Verlag

Cham: Springer International Publishing

Erscheinungsjahr

2020

Link zum Volltext

Quelle

Wiley Online Library - AutoHoldings Journals

Beschreibungen/Notizen

• Background Liberia has an extreme health workforce shortage, particularly with respect to surgery. JJ Dossen Memorial (JJD) is a public referral hospital supported by Partners in Health. Methods We designed and implemented a comprehensive surgical program at JJD. Using case logs, clinic records, and transfer data between December 2016 and April 2018, we evaluated the impact of this program on the surgical cohort and examined temporal trends in patient origin using GIS. Results The mean number of cases per day increased from 1.7 ± 1.0 to 2.4 ± 1.3 ( p  < 0.001). The proportion of females decreased from 59.8 to 51.2% ( p  = 0.03), and mean age decreased from 32.2 ± 14.2 to 29.8 ± 16.5 years ( p  = 0.05). The proportion of elective procedures, C-sections, and laparotomies did not change, but hernias decreased from 28.9 to 22.3% ( p  = 0.05) and oncologic surgery increased from 0.0 to 5.6% ( p  < 0.001). A smaller proportion of cases were performed under local or general anesthesia, while a larger proportion were performed under spinal and sedation ( p  < 0.001). Outward surgical transfers decreased from 13.1 to 5.4% ( p  < 0.001). The mean distance from patient residence to JJD increased from 24.8 ± 29.0 to 32.3 ± 41.9 km ( p  = 0.01). GIS analysis revealed a broader distribution of patient origins. Conclusions Surgeons are desperately needed in referral hospitals to address the large burden of surgical disease in Liberia. The implementation of a surgical program significantly changed the demographics of the surgical cohort and the surgical case mix. Our data can inform training for health workers in Liberia and elsewhere.