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Task-Sharing for Emergency Neurosurgery: A Retrospective Cohort Study in the Philippines
Faith C Robertson1,2, Richard Briones3, Rania A Mekary2,4
1Harvard Medical School, Boston, Massachusetts, USA.
World Neurosurgery: X
|April 21, 2020
Summary
Task-sharing in neurosurgery, delegating care to non-specialists, demonstrated comparable safety and effectiveness. This neurosurgical task-sharing model in the Philippines yielded similar outcomes to neurosurgeons, particularly in emergency settings.
Area of Science:
- Neurosurgery
- Public Health
- Healthcare Workforce Development
Background:
- Neurosurgical workforce shortages are a global challenge, particularly in low- and middle-income countries.
- Task-sharing (TS) models, where non-neurosurgeons perform clinical roles, are proposed to address these deficits.
- The safety and effectiveness of TS in neurosurgery remain incompletely understood, especially in high-burden neurotrauma settings.
Purpose of the Study:
- To evaluate the outcomes of an established task-sharing model for emergency neurosurgery in the Philippines.
- To compare the results of neurosurgery performed by general surgery residents (TS providers) versus neurosurgery consultants.
- To assess the impact of TS on patient mortality, reoperation rates, and length of hospital stay.
Main Methods:
- Retrospective review of medical records for emergency neurosurgical admissions between January 2015 and June 2018.
- Comparison of outcomes between patients treated by TS providers at Bicol Medical Center and neurosurgeons at Mother Seton Hospital.
- Statistical analysis using univariable and multivariable linear and logistic regression to compare provider-associated outcomes.
Main Results:
- TS providers performed 95 of 214 emergency neurosurgery operations.
- TS patients were younger, more often male, and had higher rates of road traffic accidents.
- No significant differences were found in mortality, reoperation, or pneumonia rates between TS and neurosurgeon groups. TS patients had shorter lengths of stay but higher rates of tracheostomy.
Conclusions:
- A strategic task-sharing model for emergency neurosurgery can achieve comparable outcomes to neurosurgeons.
- This study provides evidence supporting the viability and effectiveness of TS in neurosurgery within resource-limited settings.
- Further research is warranted to optimize TS models and expand their application in neurosurgical care.
Keywords:
BMC, Bicol Medical CenterCI, Confidence intervalCT, Computed tomographyGCS, Glasgow Coma ScaleGlobal healthGlobal neurosurgeryHIC, High-income countryICU, Intensive care unitLMICLMIC, Low- and middle-income countryMS, Mother Seton HospitalNeurotraumaOR, Odds ratioTBI, Traumatic brain injuryTS, Task-sharingTS/S, Task-shifting and task-sharingTask-sharingTask-shiftingWorkforce
