Surgical emergencies referred from district hospitals to University Teaching Hospital of Kigali and the implications on surgical services in Rwanda: A retrospective study

Abstract

Background

We investigated referred emergency general surgery (EGS) cases in Rwanda in terms of compliance with Ministry of Health (MOH) surgical package specifications.

Methods

This was a retrospective chart review of all EGS patients referred from district hospitals to the University Teaching Hospital of Kigali, Rwanda, to define the range of referred EGS conditions. Data were collected regarding demographics, clinical course, and reasons for transfer. Descriptive statistics were used to compare the diagnoses and implemented interventions for referred patients with specifications indicated in MOH surgical package documentation. Logistic regression was used to determine patient factors asso­ciated with mortality among transferred EGS patients.

Results

Over a 1-year period, there were 563 patients transferred with EGS conditions. The most common diagnoses were bowel ob­struction (n=125, 22%), soft tissue infection (n=113, 20%) and trauma (n=104, 18%). Procedures commonly performed included laparotomy (n=21, 24%), bowel resection (n=20, 23%), and debridement (n=9, 11%). According to the MOH recommendations, 455 patients (81%) had conditions that could be managed at district hospitals.

The median symptom duration was 4 days (interquartile range [IQR], 2-7 days). The mortality rate was 12%, and the rates of reoperation and intensive care unit admission were 7% and 4.8%, respectively. The median duration of hospitalization was 7 days (IQR, 3-13 days).

Conclusions

EGS remains a public health challenge in Rwanda. Redefining the surgical packages of each health facility level, improving training and staffing at district hospitals, and addressing infrastructural gaps would facilitate earlier diagnosis and management of patients nearer to their homes.