District-level surgery in Uganda: Indications, interventions and perioperative mortality

Area of Science:

• Global Surgery
• Public Health
• Surgical Outcomes

Background:

• The majority of the world's poorest populations receive minimal access to essential surgical procedures.
• Surgical disease poses a significant burden in Africa, yet prospective data on interventions and outcomes are limited.

Purpose of the Study:

• To prospectively investigate surgical interventions, indications, and perioperative mortality rates (POMR) in rural Uganda.
• To identify high-risk surgical procedures and contributing factors to mortality in a low-resource setting.

Main Methods:

• Prospective data collection via questionnaires at two rural Ugandan hospitals over 4 and 3 months in 2011.
• Inclusion of all major and minor operative procedures, patient demographics, intervention indications, and post-operative outcomes.

Main Results:

• A total of 2,790 operative procedures were recorded on 2,701 patients, with a major operative procedure rate of 225 per 100,000 population annually.
• Pregnancy-related complications and gynecologic conditions accounted for the majority of major surgeries, predominantly in women.
• The overall POMR for major procedures was 1%, with higher rates for exploratory laparotomy (13%) and cesarean delivery (1%); sepsis and hemorrhage were leading causes of death.

Conclusions:

• The volume of surgical procedures was low relative to the population, and the POMR was notably high.
• Exploratory laparotomy and cesarean section were identified as particularly high-risk procedures.
• Recommendations include improving blood availability, perioperative monitoring, and early intervention to reduce surgical mortality.