The scope of elective surgical procedures and its implications on postgraduate training at MNH, Dar es Salaam, Tanzania

Abstract

Background: Little is documented on the availability of surgical care both globally and locally. Majority of the countries have no data on surgical volume. Recent years have experienced the epidemiological transition, the multiplicity of surgical disorders among the increasingly noted. The increasing role of surgery therefore has been of paramount importance. Limited access to surgery can undoubtedly lead to significant morbidity and mortality. Training in surgery among other things relies on exposure and hands-on learning by students, on a variety of procedures. The importance of adequate volume of surgeries to that end, cannot be questioned, in line with the level of students’ involvement. Yearly volume of surgery both at surgeon and hospital level, has been found to be among parameters with significant influence on patient outcome as measured by length of hospital stay, mortality and complication rate. Thus an understanding of the quantity and distribution of surgical interventions is essential to guide efforts to improve its safety, address shortages of such services and improve on various aspects of training in surgery. Scope of surgical services is part of the components of quality assurance in general surgery and an important one especially in developing countries where resources are limited. Objectives: The aim of this study was to determine the scope of elective surgical procedures and its implications on postgraduate training at MNH, DSM. Methodology: This hospital based descriptive study looked into the volume of elective surgical procedures and the level of postgraduate involvement at MNH, DSM; from April to December 2013. It cut through general surgery, urology, cardiothoracic surgery, paediatric surgery, as well as plastic and reconstructive surgery. The data were analyzed using SPSS software. Results: A total 2315 procedures were performed on the 2214 studied patients during the 9 months study period at MNH from April to December 2013. Majority of the patients were males, 1414 (63.9%) patients with M: F ratio of 1.76:1. The age ranged from 2 days to 112 years with a mean of 39.5± 26.1 years. The most common age group was over 50 years at 37.1% and the paediatric age group was at 22%. The overall average number of procedures per month was 257.2, and the overall average number of procedures per day was 12.9. The top ten performed procedures in order of occurrence were 290 (13.1%) urethrocystoscopies ± biopsy ± EUA, followed by 161 (7.3%) skin graftings, 108 (4.9%) TURPs, 111 (4.8%) WLEs, 104 (4.5%) mastectomies, 87 (3.9%) BSOs/ orchidectomies, 76 (3.4%) DVUs, 70 (3.2%) open prostatectomies, 68 (2.9%) rigid oesophagoscopies plus exploratory laparotomies respectively, and finally 56 (2.6%) thyroidectomies. Of the 2315 performed surgeries, residents participated in 72.1% of the procedures. The predominant residents’ role was that of first assistant in 1214 (54.8%) procedures, followed by role as surgeon in 561 (25.8%) procedures, and finally the second assistant role in 355 (16%) procedures. Conclusion: The surgical output found at MNH and the overall residents’ participation during this study period were at relatively low levels. Recommendations: It appears important to conduct larger studies and surveys looking into factors associated with the observed surgical output and residents’ participation with the aim of optimizing theatre utilization and increasing surgical output at MNH and increasing residents’ involvement in all aspects of surgery especially for the role as a surgeon, an important aspect in general surgery training.