General surgical services at an urban teaching hospital in Mozambique.
BACKGROUND
As surgery becomes incorporated into global health programs, it will be critical for clinicians to take into account already existing surgical care systems within low-income countries. To inform future efforts to expand the local system and systems in comparable regions of the developing world, we aimed to describe current patterns of surgical care at a major urban teaching hospital in Mozambique.


METHODS
We performed a retrospective review of all general surgery patients treated between August 2012 and August 2013 at the Hospital Central Maputo in Maputo, Mozambique. We reviewed emergency and elective surgical logbooks, inpatient discharge records, and death records to report case volume, disease etiology, and mortality.


RESULTS
There were 1598 operations (910 emergency and 688 elective) and 2606 patient discharges during our study period. The most common emergent surgeries were for nontrauma laparotomy (22%) followed by all trauma procedures (18%), whereas the most common elective surgery was hernia repair (31%). The majority of lower extremity amputations were above knee (69%). The most common diagnostic categories for inpatients were infectious (31%), trauma (18%), hernia (12%), neoplasm (10%), and appendicitis (5%). The mortality rate was 5.6% (146 deaths), approximately half of which were related to sepsis.


CONCLUSIONS
Our data demonstrate the general surgery caseload of a large, academic, urban training and referral center in Mozambique. We describe resource limitations that impact operative capacity, trauma care, and management of amputations and cancer. These findings highlight challenges that are applicable to a broad range of global surgery efforts.
Department of Pediatric Surgery, Stanford University School of Medicine, Stanford, California.
Elizabeth
E
Snyder
Department of Surgery, Hospital Central de Maputo, Universidade Eduardo Mondlane Faculdade de Medicina, Maputo, Mozambique.
Vanda
V
Amado
Department of Surgery, Hospital Central de Maputo, Universidade Eduardo Mondlane Faculdade de Medicina, Maputo, Mozambique.
Mário
M
Jacobe
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California.
Greg D
GD
Sacks
Department of Pediatric Surgery, Stanford University School of Medicine, Stanford, California.
Matias
M
Bruzoni
Department of Surgery, Hospital Central de Maputo, Universidade Eduardo Mondlane Faculdade de Medicina, Maputo, Mozambique.
Domingos
D
Mapasse
Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California. Electronic address: ddeugarte@mednet.ucla.edu.
Daniel A
DA
DeUgarte
D000328:Adult; D003906:Developing Countries / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009073:Mozambique / Q000453:epidemiology; D010351:Patient Discharge / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data; D013514:Surgical Procedures, Operative / Q000401:mortality*
Global; Mozambique; Partnership; Surgery; Trauma