title: District-level surgery in Uganda: Indications, interventions and perioperative mortality.
abstract: BACKGROUND
  The world's poorest 2 billion people, benefit from no more than about 3.5% of the world's operative procedures. The burden of surgical disease is greatest in Africa, where operations could save many lives. Previous facility-based studies have described operative procedure caseloads, but prospective studies investigating interventions, indications and perioperative mortality rates (POMR), are rare.
  
  
  METHODS
  A prospective, questionnaire-based collection of data on all major and minor operative procedures was undertaken at 2 hospitals in rural Uganda covering 4 and 3 months in 2011, respectively. Data included patient characteristics, indications for the interventions performed, and outcome after surgery.
  
  
  RESULTS
  We recorded 2,790 operative procedures on 2,701 patients. The rate of major operative procedures per 100,000 population per year was 225. Patients undergoing major operative procedures (n = 1,051) were mostly women (n = 923; 88%) because most interventions were performed owing to pregnancy-related complications (n = 747; 67%) or gynecologic conditions (n = 114; 10%). General operative interventions registered included herniorrhaphy (n = 103; 9%), exploratory laparotomy (n = 60; 5%), and appendectomy (n = 31; 3%). The POMR for major operative procedures was 1% (n = 14) and was greatest after exploratory laparotomy (13%; n = 8) and caesarean delivery (1%; n = 4). Most deaths (n = 16) were a result of sepsis (n = 10-11) or hemorrhage (n = 3-5).
  
  
  CONCLUSIONS
  The volume of surgery was low relative to the size of the catchment population. The POMR was high. Exploratory laparotomy and caesarean section were identified as high-risk procedures. Increased availability of blood, improved perioperative monitoring, and early intervention could be part of a solution to reduce the POMR.
authors.affiliation: Department of Surgery and Perioperative Sciences, Umeå University Hospital, Umeå, Sweden. Electronic address: jenny.loefgren@gmail.com.
authors.forename: Jenny
authors.initials: J
authors.lastname: Löfgren
authors.affiliation: School of Public Health, Iganga/Mayuge Health and Demographic Surveillance Site, Iganga, Uganda.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kadobera
authors.affiliation: Department of Public Health Sciences, Karolinska Institute, Solna, Sweden.
authors.forename: Birger C
authors.initials: BC
authors.lastname: Forsberg
authors.affiliation: Iganga General Hospital, Iganga, Uganda.
authors.forename: Jude
authors.initials: J
authors.lastname: Mulowooza
authors.affiliation: Department of Clinical Science and Education (KI SÖS), Södersjukhuset, Karolinska Institute, Stockholm, Sweden.
authors.forename: Andreas
authors.initials: A
authors.lastname: Wladis
authors.affiliation: Department of Surgery and Perioperative Sciences, Umeå University Hospital, Umeå, Sweden.
authors.forename: Pär
authors.initials: P
authors.lastname: Nordin
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D006767:Hospitals, District / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D012424:Rural Population; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires; D014454:Uganda / Q000453:epidemiology; D055815:Young Adult