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

Area of Science:

• Global Health
• Surgical Outcomes
• Health Systems Research

Background:

• Quantitative assessment of surgical output is crucial for health planning and resource allocation.
• Comparing surgical services across different healthcare facilities or time periods requires standardized metrics.
• Rural African settings present unique challenges for data collection and analysis of surgical activity.

Purpose of the Study:

• To explore and evaluate different quantitative methods for comparing major surgical operation output.
• To identify practical and implementable metrics for assessing surgical services in a rural district.
• To inform health planning by providing reliable data on surgical capacity and utilization.

Main Methods:

• A retrospective analysis of all major surgical operations performed in a Kenyan district over 12 months (1990-1991).
• Data collected included patient demographics (age, sex, home address) and type of operation.
• Four quantitative output rates were calculated: per 100 hospital beds, per 1,000 in-patient admissions, per 10,000 new out-patient consultations, and per 100,000 catchment population.

Main Results:

• A total of 3,415 major operations were recorded.
• Mean rates were: 310 operations per 100 beds, 69 per 1,000 admissions, 90 per 10,000 out-patient visits, and 263 per 100,000 population.
• Significant variation in rates was observed among the five hospitals within the district.

Conclusions:

• Operations per 100 beds and per 1,000 admissions are identified as useful and implementable metrics for surgical output comparison.
• Operations per 10,000 out-patient visits are less useful but still implementable.
• Using catchment population requires a standardized definition for reliable implementation, despite its potential utility.