Quality assurance in surgery: surgical audit in the developing world

Area of Science:

• Surgical Quality Assurance
• Healthcare Management in Developing Countries

Background:

• Surgical audit is vital for quality assurance, particularly in developing nations facing resource and skill limitations.
• Assessing structure, process, and outcomes of surgical care is essential for improvement.

Purpose of the Study:

• To highlight the importance of surgical audit in developing countries.
• To outline key areas for audit: structure, process, and outcomes of surgical care.

Main Methods:

• Evaluating the structure of care, including resource availability and surgical skill access.
• Auditing processes such as ward rounds, case-note documentation, and the use of investigations for cost-benefit.
• Measuring outcomes through complication and mortality audits, and patient perception surveys.

Main Results:

• Lack of resources and surgical skills significantly impact care delivery in developing countries.
• Auditing investigations ensures cost-effectiveness and patient benefit.
• Mortality audits require illness severity grading (e.g., Glasgow Coma Scale) for reliability.

Conclusions:

• Surgical audit is indispensable for enhancing quality of care in resource-limited settings.
• A comprehensive audit approach, including structure, process, and outcome measures, is necessary.
• Long-term disability follow-up may be a better quality indicator than mortality in low-mortality scenarios.