You are here

Article Text

Article menu

Download PDFPDF

Original article
Development of an acute care surgery service in Rwanda
  1. Egide Abahuje1,
  2. Isaie Sibomana1,
  3. Elisee Rwagahirima1,
  4. Christian Urimubabo2,
  5. Robert Munyaneza1,
  6. Jennifer Rickard2,3
  1. 1Department of Surgery, University of Rwanda College of Medicine and Health Sciences, Kigali, Rwanda
  2. 2Department of Surgery, Centre Hospitalier Universitaire de Kigali, Kigali, Rwanda
  3. 3Department of Surgery, University of Minnesota System, Minneapolis, Minnesota, USA
  1. Correspondence to Dr Jennifer Rickard, Department of Surgery, Centre Hospitalier Universitaire de Kigali, Kigali 0000, Rwanda; gehr0059{at}umn.edu

Abstract

Background Acute care surgery (ACS) encompasses trauma, critical care, and emergency general surgery. Due to high volumes of emergency surgery, an ACS service was developed at a referral hospital in Rwanda. The aim of this study was to evaluate the epidemiology of ACS and understand the impact of an ACS service on patient outcomes.

Methods This is a retrospective observational study of ACS patients before and after introduction of an ACS service. χ2 test and Wilcoxon rank-sum test were used to describe the epidemiology and compare outcomes before (pre-ACS)) and after (post-ACS) implementation of the ACS service.

Results Data were available for 120 patients before ACS and 102 patients after ACS. Diagnoses included: intestinal obstruction (n=80, 36%), trauma (n=38, 17%), appendicitis (n=31, 14%), and soft tissue infection (n=17, 8%) with no difference between groups. The most common operation was midline laparotomy (n=138, 62%) with no difference between groups (p=0.910). High American Society of Anesthesiologists (ASA) score (ASA ≥3) (11% vs. 40%, p<0.001) was more common after ACS. There was no difference in intensive care unit admission (8% vs. 8%, p=0.894), unplanned reoperation (22% vs. 13%, p=0.082), or mortality (10% vs. 11%, p=0.848). The median length of hospital stay was longer (11 days vs. 7 days, p<0.001) before ACS.

Conclusions An ACS service can be implemented in a low-resource setting. In Rwanda, ACS patients are young with few comorbidities, but high rates of mortality and morbidity. In spite of more patients who are critically ill in the post-ACS period, implementation of an ACS service resulted in decreased length of hospital stay with no difference in morbidity and mortality.

Level of evidence Prognostic and epidemiologic study type, level III.

  • acute care surgery
  • emergency
  • RWANDA
  • global health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2019-000332

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Presented at This article was presented as an E-Poster at the American College of Surgeons Clinical Congress on October 22, 2018.

    • Contributors EA: literature search, study design, data collection, data interpretation, writing, critical revision. IS: literature search, study design, data collection, writing. ER: study design, data collection, writing. CU: data interpretation, critical revision. RM: study design, data collection, data interpretation, critical revision. JR: literature search, study design, data analysis, data interpretation, writing, critical revision.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Not required.

    • Ethics approval University of Rwanda College of Medicine and Pharmacy (456/CMHS IRB/2016) and CHUK Ethics Committee (EC/CHUK/390/2017).

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Data availability statement All data relevant to the study are included in the article.