Rural Health: What can and cannot be done in an isolated rural neurosurgical unit

Area of Science:

• Neurosurgery
• Rural Health
• Global Health

Background:

• Tertiary neurosurgical centers in high-income countries offer advanced infrastructure.
• Isolated rural units face challenges due to limited technological resources.

Purpose of the Study:

• To determine the feasibility and safety of performing neurosurgical procedures in a rural unit.
• To assess the effectiveness of neurosurgical care without advanced technology.

Main Methods:

• Retrospective analysis of 155 neurosurgical procedures performed at the Territorial Hospital of Nouméa, New Caledonia.
• Inclusion of all patients operated between December 1, 2023, and February 1, 2025.
• Primary outcome: composite endpoint including 3-month mortality, reoperation, and secondary transfer due to complications.

Main Results:

• 134 patients underwent 155 procedures (129 cranial, 5 spinal).
• 69% were emergency surgeries (traumatic brain injuries, CSF disorders, infections), 31% planned (tumor resection, cranioplasty).
• Favorable postoperative course for 93.8% of planned surgeries; 13.1% of emergency surgeries required reoperation.

Conclusions:

• The majority of neurosurgical cases can be safely managed in rural units without extensive technology.
• Transferring high-complexity cases to advanced centers is crucial.
• On-site management of complications by a resident neurosurgeon improves rural healthcare quality and reduces transfers.