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A dedicated quality improvement programme can increase access to paediatric minimal access surgery in South Africa
Insights
Minimal access paediatric surgery (MAPS) is feasible in resource-limited settings, showing a skills transfer to junior staff. A quality improvement strategy yielded a 3% morbidity rate with no mortalities.
Area of Science:
- Pediatric Surgery
- Surgical Innovation
- Healthcare Access
Background:
- Review of a decade of minimal access paediatric surgery (MAPS) experience at Greys Hospital.
- Identify areas for strengthening surgical services and training programs.
Approach:
- Retrospective review of 1,328 MAPS procedures on 994 patients (aged 0-18 years) from 2012-2021.
- Data collected: demographics, surgery type, organ system, surgeon (trainee/consultant), morbidities, and mortalities.
- Statistical analysis: linear regression and ANOVA using Jamovi software.
Key Points:
- A steady increase in MAPS cases performed annually.
- Strong collective correlation (r=0.87, p=0.014) between cases, consultant numbers, and MAPS procedures.
- Progressive increase in cases performed by trainees, indicating successful skills transfer.
Conclusions:
- MAPS is feasible in resource-limited environments.
- A comprehensive quality improvement strategy led to positive outcomes.
- Ongoing support for MAPS in pediatric care is recommended.
Background:
In this project, we reviewed our experience in minimal access paediatric surgery (MAPS) at Greys Hospital over the last decade. This information would provide an overview of our experience and would enable us to identify areas where we can strengthen our surgical service and our training programme.
Methods:
All surgical patients are captured in the hybrid electronic medical registry (HEMR). All patients aged 18 years or less who underwent a MAPS procedure between 2012 and 2021 were reviewed. Data collected included demographic information, type of surgery, nature of the surgery (elective or emergency), organ system operated on, whether trainees or consultants performed the surgeries and the morbidities and mortalities experienced. Statistical analysis included linear regression and ANOVA, which was performed using Jamovi software.
Results:
A total of 1 328 MAPS procedures were performed on 994 patients over nine years. There were 359 female and 635 male patients. There was a steady increase in the number of cases performed per year. The age of the patients ranged from one day of life to 18 years, with a median of 8 years. The multiple linear regression results indicated a very strong collective significant effect between the courses performed, the number of consultants, and the MAPS cases performed. The ANOVA test for the individual factors was not statistically significant, but there was a very strong combined correlation with an r-value of 0.87 and a p-value of 0.014 using the overall model test. The consultants' training also directly impacted on the teaching and training of registrars, with progressively more cases being performed by trainees over the years. Postoperative morbidity was reported in 40 patients. The morbidity rate was three per cent. There were no mortalities.
Conclusion:
It is feasible to deliver MAPS to children in our environment. A comprehensive quality improvement strategy has yielded satisfying results. The increased use of MAPS has resulted in a general transfer of skills to junior staff. Ongoing efforts to support the rollout of MAPS in children are warranted.
