title: The Quality and Utility of Surgical and Anesthetic Data at a Ugandan Regional Referral Hospital.
abstract: There are little primary data available on the delivery or quality of surgical treatment in rural sub-Saharan African hospitals. To initiate a quality improvement system, we characterized the existing data capture at a Ugandan Regional Referral Hospital.
  
  
  
  We examined the surgical ward admission (January 2008-December/2011) and operating theater logbooks (January 2010-July 2011) at Mbarara Regional Referral Hospital.
  
  
  
  There were 6346 admissions recorded over three years. The mean patient age was 31.4 ± 22.3 years; 29.8 % (n = 1888) of admissions were children. Leading causes of admission were general surgical problems (n = 3050, 48.1 %), trauma (n = 2041, 32.2 %), oncology (n = 718, 11.3 %) and congenital condition (n = 193, 3.0 %). Laparotomy (n = 468, 35.3 %), incision and drainage (n = 188, 14.2 %) and hernia repair (n = 90, 6.8 %) were the most common surgical procedures. Of 1325 operative patients, 994 (75 %) had an ASA I-II score. Of patients undergoing 810 procedures booked as non-elective, 583 (72 %) had an ASA "E" rating. Records of 41.3 % (n-403/975) of patients age 5 years or older undergoing non-obstetric operations were missing from the ward logbook. Missing patients were younger (25 [13,40] versus 30 [18,46] years, p = 0.002) and had higher ASA scores (ASA III-V 29.0 % versus 18.9 %, p < 0.001) than patients recorded in the logbbook; there was no diffence in gender (male 62.8 % versus 67.0 %, p = 0.20).
  
  
  
  The hospital records system measures surgical care, but improved data capture is needed to determine outcomes with sufficient accuracy to guide and record expansion of surgical capacity.
authors.affiliation: Department of Surgery, Mbarara University of Science and Technology, Mbarara Regional Referral Hospital, Mbarara, Uganda.
authors.forename: G
authors.initials: G
authors.lastname: Tumusiime
authors.affiliation: Department of Pediatrics, Lucile Packard Children's Hospital at Stanford, Palo Alto, CA, USA.
authors.forename: A
authors.initials: A
authors.lastname: Was
authors.affiliation: Department of Surgery, Brigham and Woman's Hospital, Boston, MA, USA.|Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
authors.forename: M A
authors.initials: MA
authors.lastname: Preston
authors.affiliation: Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.|Department of Surgery, Massachusetts Geenral Hospital, Boston, MA, USA.
authors.forename: J N
authors.initials: JN
authors.lastname: Riesel
authors.affiliation: Department of Anaesthesia and Critical Care, Mbarara University of Science and Technology, Mbarara Regional Referral Hospital, Mbarara, Uganda.
authors.forename: S S
authors.initials: SS
authors.lastname: Ttendo
authors.affiliation: Program for Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA. pfirth@partners.org.|Department of Anesthesia, Critical Care and Pain Medicine, Masachusetts General Hospital, Boston, MA, USA. pfirth@partners.org.
authors.forename: P G
authors.initials: PG
authors.lastname: Firth
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D003625:Data Collection; D005260:Female; D006780:Hospitals, Rural; D006801:Humans; D008297:Male; D008875:Middle Aged; D058996:Quality Improvement; D012017:Referral and Consultation; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014454:Uganda / Q000453:epidemiology; D014947:Wounds and Injuries / Q000453:epidemiology / Q000601:surgery; D055815:Young Adult