title: Nicaraguan surgical and anesthesia infrastructure: survey of Ministry of Health hospitals.
abstract: BACKGROUND
  Developing countries have surgical and anesthesia needs that are unique and disparate compared to those of developed countries. However, the extent of these disparities and the specific country-based needs are, for the most part, unknown. The goal of this study was to assess the surgical capacity of Nicaragua's public hospitals as part of a multinational study.
  
  
  METHODS
  A survey adapted from the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical care was used to study 28 primary, departmental, regional, and national referral hospitals within the Ministry of Health system. Data were obtained at the national and hospital levels via interviews with administrators and surgical and anesthesia chiefs of services.
  
  
  RESULTS
  There are 580 obstetrician/gynecologists (OB/GYN), 1,040 non-OB/GYN surgeons, and 250 anesthesiologists in Nicaragua. Primary, departmental, regional, and national referral hospitals perform an annual average of 374, 4,610, 7,270, and 7,776 surgeries, respectively. All but six primary hospitals were able to perform surgeries. Four hospitals reported routine water shortages. Routine medication shortages were reported in 11 hospitals. Eight primary hospitals lacked blood banks on site. Of 28 hospitals, 22 reported visits from short-term surgical brigades within the past 2 years. Measurement of surgical outcomes was inconsistent across hospitals.
  
  
  CONCLUSIONS
  Surgical capacity varies by hospital type, with primary hospitals having the least surgical capacity and surgical volume. Departmental, regional, and national referral hospitals have adequate surgical capacity. Surgical subspecialty care appears to be insufficient, as evidenced by the large presence of NGOs and other surgical brigade teams filling this gap.
authors.affiliation: Department of Surgery, Duke University Medical Center, Hubert Yeargan Center for Global Health, Durham, NC 27710, USA. carolina.solis@post.harvard.edu
authors.forename: Carolina
authors.initials: C
authors.lastname: Solis
authors.forename: Pablo
authors.initials: P
authors.lastname: León
authors.forename: Nora
authors.initials: N
authors.lastname: Sanchez
authors.forename: Mackenzie
authors.initials: M
authors.lastname: Burdic
authors.forename: Logan
authors.initials: L
authors.lastname: Johnson
authors.forename: Hannah
authors.initials: H
authors.lastname: Warren
authors.forename: Adam
authors.initials: A
authors.lastname: Iddriss
authors.forename: Kelly
authors.initials: K
authors.lastname: McQueen
mesh_terms: D000776:Anesthesiology; D013502:General Surgery; D006176:Gynecology; D006297:Health Services Accessibility; D006761:Hospitals / Q000145:classification / Q000592:standards; D006801:Humans; D009527:Nicaragua; D009774:Obstetrics; D013503:Surgery Department, Hospital / Q000592:standards*; D000078329:Workforce