Output of major surgery in developing countries. Towards a quantitative evaluation and planning tool

As part of a study of surgical operations in a rural African district, different quantitative output rates were explored. The aim was to develop methods facilitating major surgery output comparison between different hospitals or districts and between different points in time at any given hospital or district. All major surgical operations performed at hospitals in a Kenyan district during 12 months in 1990-1991 were listed on record forms including age, sex, and home address of patients, and type of operation. Totally 3,415 major operations were recorded. We discuss, from a health planning perspective, four possible methods of quantifying the major surgery output: a) the annual number of major operations per 100 hospital beds; b) the number per 1,000 in-patient admissions; c) the number per 10,000 new out-patient consultations; and d) the number per 100,000 catchment area population. The mean number per 100 beds was 310 (range 452-140); the mean number per 1,000 admissions was 69 (range 88-31), the number per 10,000 new out-patient visits was 90 (range 182-55), and the mean number per 100,000 catchment area population was 263 for the entire district with a range from 383 to 119 among the five hospitals. We conclude that option a) and b) are useful and implementable, c) is less useful but implementable, and option d) is potentially very useful but not easily implementable until a catchment area population definition is agreed and applied.