Safety, productivity and predicted contribution of a surgical task-sharing programme in Sierra Leone
Safety, productivity and predicted contribution of a surgical task-sharing programme in Sierra Leone
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DOI：
10.1002/bjs.10552
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发表时间：
2017-09-01
影响因子：
9.6
通讯作者：
Wibe, A.
中科院分区：
文献类型：
--
作者：
Bolkan, H. A.;van Duinen, A.;Wibe, A.
背景：手术任务分担对于在资源匮乏的地区扩大手术护理的提供可能至关重要。本文的目的是描述为塞拉利昂的助理临床医生和初级医生建立新的外科任务分担培训计划，评估其生产力和安全性，并估计其未来在手术量方面的作用。方法：这项由 16 家医院组成的联盟进行的前瞻性观察性研究评估了 5 年内的粗住院死亡率以及 3 年外科培训计划期间和完成后进行的手术的生产力。结果：约 48 名受训人员和 9 名毕业的外科助理社区卫生官员2011 年 1 月至 2016 年 7 月期间，SACHO 参与了 27 216 次监督行动。在培训期间，学员参加的中位数为 822 次行动。 SACHO 每年平均进行 173 例手术。剖腹产、疝气修复和剖腹手术是训练期间和训练后最常见的手术。受训人员实施的剖腹产和剖腹产手术后的院内粗死亡率分别为 0.7%（1915 年中的 13 例）和 4.3%（164 例中的 7 例），而 SACHO 实施的手术则分别为 0.4%（1169 例中的 5 例）和 8.0%（137 例中的 11 例）。根据患者性别、手术程序、紧急程度和医院进行调整后，与培训师和督导人员进行的手术相比，受训人员进行的手术（OR 0.47，95% c.i. 0.32 至 0.71；P < 0.001）和 SACHO（OR 0.16，0.07 至 0.41；P < 0.001）的死亡率较低。 结论：SACHO 快速、安全地实现了大幅提高塞拉利昂的手术量。
Background: Surgical task-sharing may be central to expanding the provision of surgical care in low-resource settings. The aims of this paper were to describe the set-up of a new surgical task-sharing training programme for associate clinicians and junior doctors in Sierra Leone, assess its productivity and safety, and estimate its future role in contributing to surgical volume.Methods: This prospective observational study from a consortium of 16 hospitals evaluated crude in-hospital mortality over 5 years and productivity of operations performed during and after completion of a 3-year surgical training programme.Results: Some 48 trainees and nine graduated surgical assistant community health officers (SACHOs) participated in 27 216 supervised operations between January 2011 and July 2016. During training, trainees attended a median of 822 operations. SACHOs performed a median of 173 operations annually. Caesarean section, hernia repair and laparotomy were the most common procedures during and after training. Crude in-hospital mortality rates after caesarean sections and laparotomies were 0.7 per cent (13 of 1915) and 4.3 per cent (7 of 164) respectively for operations performed by trainees, and 0.4 per cent (5 of 1169) and 8.0 per cent (11 of 137) for those carried out by SACHOs. Adjusted for patient sex, surgical procedure, urgency and hospital, mortality was lower for operations performed by trainees (OR 0.47, 95 per cent c.i. 0.32 to 0.71; P < 0.001) and SACHOs (OR 0.16, 0.07 to 0.41; P < 0.001) compared with those conducted by trainers and supervisors.Conclusion: SACHOs rapidly and safely achieved substantial increases in surgical volume in Sierra Leone.