Non-Obstetric Surgical Care at Three Rural District Hospitals in Rwanda: More Human Capacity and Surgical Equipment May Increase Operative Care
Non-Obstetric Surgical Care at Three Rural District Hospitals in Rwanda: More Human Capacity and Surgical Equipment May Increase Operative Care
复制标题
DOI：
10.1007/s00268-016-3515-0
复制
发表时间：
2016-09-01
影响因子：
2.6
通讯作者：
Riviello, Robert
中科院分区：
文献类型：
--
作者：
Muhirwa, Ernest;Habiyakare, Caste;Riviello, Robert
背景 大多数因外科急症导致的死亡发生在低收入和中等收入国家。地区医院作为撒哈拉以南非洲农村地区的一级外科设施，经常面临手术能力有限的挑战。本研究描述了卢旺达地区医院非产科手术患者的表现、管理和结果。方法本研究包括 2013 年在卢旺达农村三所地区医院寻求非产科手术护理的患者。描述了人口统计、手术条件、患者护理和结果；手术和非手术治疗按医院进行分层，并使用 Fisher 精确检验评估差异。结果 在三家医院寻求手术治疗的 2660 名患者中，大多数为男性（60.7%）。许多人 (42.6%) 受伤，其中 34.7% 的受伤是由于道路交通事故造成的。在就诊的患者中，25.3% 接受了手术，而在布塔罗地区医院就诊的患者接受手术的可能性明显更高 (57.0%，p < 0.001)。 Kirehe 和 Rwinkwavu 地区医院的几乎所有手术均由全科医生进行（分别为 98.0% 和 100.0%），但 Butaro 地区医院的 90.6% 手术由外科医生进行。就结果而言，39.5% 的患者未接受手术就出院，21.1% 的患者接受手术后出院，21.1% 的患者被转诊至三级机构进行手术护理。 结论 在布塔罗（唯一一个配备外科医生且手术基础设施更强大的地点），接受手术的患者数量显着增加。聘请更多能够满足最常见手术需求的外科医生并改善用品和设备可能会改善其他地区的治疗效果。建议将手术任务共享作为临时解决方案。
Background Most mortality attributable to surgical emergencies occurs in low-and middle-income countries. District hospitals, which serve as the first-level surgical facility in rural sub-Saharan Africa, are often challenged with limited surgical capacity. This study describes the presentation, management, and outcomes of non-obstetric surgical patients at district hospitals in Rwanda.Methods This study included patients seeking non-obstetric surgical care at three district hospitals in rural Rwanda in 2013. Demographics, surgical conditions, patient care, and outcomes are described; operative and non-operative management were stratified by hospitals and differences assessed using Fisher's exact test.Results Of the 2660 patients who sought surgical care at the three hospitals, most were males (60.7 %). Many (42.6 %) were injured and 34.7 % of injuries were through road traffic crashes. Of presenting patients, 25.3 % had an operation, with patients presenting to Butaro District Hospital significantly more likely to receive surgery (57.0 %, p < 0.001). General practitioners performed nearly all operations at Kirehe and Rwinkwavu District Hospitals (98.0 and 100.0 %, respectively), but surgeons performed 90.6 % of the operations at Butaro District Hospital. For outcomes, 39.5 % of all patients were discharged without an operation, 21.1 % received surgery and were discharged, and 21.1 % were referred to tertiary facilities for surgical care.Conclusion Significantly more patients in Butaro, the only site with a surgeon on staff and stronger surgical infrastructure, received surgery. Availing more surgeons who can address the most common surgical needs and improving supplies and equipment may improve outcomes at other districts. Surgical task sharing is recommended as a temporary solution.