Epidemiology of surgical admissions to a children's disability hospital in Nepal.
BACKGROUND
The goal of this retrospective review was to characterize the spectrum of surgical admissions to a tertiary hospital specializing in musculoskeletal conditions in children and adolescents in Nepal.


METHODS
We reviewed hospital records from 1996 to 2006 to categorize all major surgical procedures. Additional information collected included diagnosis, patient age, gender, and home district.


RESULTS
Of 7,556 major surgical procedures performed from 1996 to 2006, 91% could be placed within the following categories: congenital (n = 2,984; 38%), burn contracture (n = 1,400; 19%), posttraumatic (n = 1,047; 14%), neuromuscular (n = 750; 10%), and infection (n = 731; 10%). The most common diagnosis was congenital clubfoot, which accounted for 2,348 cases (31%). Thirty-three percent of cases (n = 2,447) involved injuries (burns, fractures, dislocations). While burns most commonly involved the upper extremity, fractures in the elbow region were the most frequent posttraumatic problem. The most common neuromuscular diagnosis was poliomyelitis. The sequelae of musculoskeletal sepsis represented 731 cases (10%), most commonly chronic osteomyelitis. Other diagnoses termed miscellaneous included angular deformities of the lower extremities, scoliosis and other spinal deformities, hip dysplasia, and tumors.


CONCLUSIONS
The majority of surgical pathology involved injuries and congenital problems (mainly clubfoot). The presentation was delayed in most patients, and in such cases, the treatment is more complex and costly, and the desired functional outcome is difficult to achieve. In addition to preventive measures, morbidity cases could have been reduced by the timely provision of services at the primary referral level. Strengthening the delivery of basic orthopedic services at primary health care facilities may eliminate or reduce the need for complex reconstructive procedures and diminish the likelihood of permanent disability in our population.
Spiegel
David A
DA
Division of Orthopaedic Surgery, Children's Hospital of Philadelphia and the University of Pennsylvania School of Medicine, 2nd Floor Wood Building, 34th Street and Civic Center Blvd, Philadelphia, PA, 19104, USA. spiegeld@email.chop.edu
Shrestha
Om P
OP
Rajbhandary
Tarun
T
Bijukachhe
Binod
B
Sitoula
Prakash
P
Banskota
Bibek
B
Banskota
Ashok
A
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D019988:Children with Disabilities; D006233:Persons with Disabilities / Q000534:rehabilitation / Q000706:statistics & numerical data*; D005260:Female; D006776:Hospitals, Pediatric / Q000706:statistics & numerical data*; D006782:Hospitals, Special / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D009140:Musculoskeletal Diseases / Q000628:therapy*; D009390:Nepal; D012047:Rehabilitation Centers / Q000706:statistics & numerical data; D012189:Retrospective Studies; D055815:Young Adult