ABSTRACT
INTRODUCTION: Lack of infrastructure drives a large unmet need in children's surgery in low- and middle-income countries (LMIC). This study examines the impact of upgrading existing pediatric operating rooms (ORs) on surgical volume in a hospital in Ouagadougou, Burkina Faso. METHOD(S): A nongovernmental organization upgraded 3 ORs in September 2019. Surgical volume before and after the upgrade were compared from January 2019 to January 2022 using interrupted time series analysis of a prospective data collection tool. Data from April to May 2020 were omitted owing to COVID-related lockdowns. RESULT(S): After the upgrade, patients were younger (5 vs 3.8 years, p < 0.001) and had lower rate of postoperative sepsis (2.4% vs 0.5%, p < 0.001) and surgical site infection (4.3% vs 2.2%;p = 0.005). Volume increased by 36 cases per month (p = 0.005) from a baseline of 161 cases per month. There was a positive trend of 1 case per month after upgrade and a significant difference between pre- and post- trends in volume (pre-upgrade -8 cases per month vs after upgrade of +1 case per month;p = 0.002). The mortality rate fell from 20% to 4% (p = 0.003) in the month after the upgrade, with a significant difference between pre- and postupgrade mortality rate trends (6.2% vs -1%, p < 0.001). CONCLUSION(S): There was significant improvement in volume and surgical outcomes after the OR upgrade This study supports the investment in surgical infrastructure to strengthen capacity in LMIC. Future work should include risk-adjusted mortality.