title: Surgical volume and postoperative mortality rate at a referral hospital in Western Uganda: Measuring the Lancet Commission on Global Surgery indicators in low-resource settings.
abstract: The Lancet Commission on Global Surgery recommends that every country report its surgical volume and postoperative mortality rate. Little is known, however, about the numbers of operations performed and the associated postoperative mortality rate in low-income countries or how to best collect these data.
  
  
  
  For one month, every patient who underwent an operation at a referral hospital in western Uganda was observed. These patients and their outcomes were followed until discharge. Prospective data were compared with data obtained from logbooks and patient charts to determine the validity of using retrospective methods for collecting these metrics.
  
  
  
  Surgical volume at this regional hospital in Uganda is 8,515 operations/y, compared to 4,000 operations/y reported in the only other published data. The postoperative mortality rate at this hospital is 2.4%, similar to other hospitals in low-income countries. Finding patient files in the medical records department was time consuming and yielded only 62% of the files. Furthermore, a comparison of missing versus found charts revealed that the missing charts were significantly different from the found charts. Logbooks, on the other hand, captured 99% of the operations and 94% of the deaths.
  
  
  
  Our results describe a simple, reproducible, accurate, and inexpensive method for collection of the Lancet Commission on Global Surgery variables using logbooks that already exist in most hospitals in low-income countries. While some have suggested using risk-adjusted postoperative mortality rate as a more equitable variable, our data suggest that only a limited amount of risk adjustment is possible given the limited available data.
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Boston, MA; Program in Global Surgery and Social Medicine, Department of Global Health and Social Medicine, Harvard University, Boston, MA.
authors.forename: Geoffrey A
authors.initials: GA
authors.lastname: Anderson
authors.affiliation: Program in Global Surgery and Social Medicine, Department of Global Health and Social Medicine, Harvard University, Boston, MA.
authors.forename: Lenka
authors.initials: L
authors.lastname: Ilcisin
authors.affiliation: Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Lenard
authors.initials: L
authors.lastname: Abesiga
authors.affiliation: Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Ronald
authors.initials: R
authors.lastname: Mayanja
authors.affiliation: Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Noralis
authors.initials: N
authors.lastname: Portal Benetiz
authors.affiliation: Department of Obstetrics and Gynaecology, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Joseph
authors.initials: J
authors.lastname: Ngonzi
authors.affiliation: Department of Surgery, Mbarara University of Science and Technology, Mbarara, Uganda.
authors.forename: Peter
authors.initials: P
authors.lastname: Kayima
authors.affiliation: Program in Global Surgery and Social Medicine, Department of Global Health and Social Medicine, Harvard University, Boston, MA. Electronic address: shrime@mail.harvard.edu.
authors.forename: Mark G
authors.initials: MG
authors.lastname: Shrime
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002423:Cause of Death; D002648:Child; D002675:Child, Preschool; D003906:Developing Countries; D005260:Female; D014943:Global Health; D019538:Health Care Surveys; D006295:Health Resources / Q000191:economics*; D017052:Hospital Mortality; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality* / Q000503:physiopathology; D011203:Poverty; D019984:Quality Indicators, Health Care; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D013514:Surgical Procedures, Operative / Q000009:adverse effects* / Q000379:methods / Q000706:statistics & numerical data; D016019:Survival Analysis; D014454:Uganda; D055815:Young Adult