ABSTRACT
BACKGROUND: Surgical site infection (SSI) is the most common complication of abdominal surgery, with substantial costs to patients and health systems. Heterogeneity in costing methods in existing SSI studies makes multi-country comparison challenging. The objective of the study was to assess the costs of SSI across middle-income countries. METHODS: Centres from a randomized controlled trial assessing interventions to reduce SSI (FALCON, ClinicalTrials.gov, NCT03700749NCT) were sampled from two upper-middle- (India, Mexico) and two lower-middle- (Ghana, Nigeria) income countries. The Key resource use In Wound Infection (KIWI) study collected data on postoperative resource use and costs from consecutive patients undergoing abdominal surgery with an incision >5 cm (including caesarean section) that were recruited to FALCON between April and October 2020. The overall costs faced by patients with and without SSI were compared by operative field contamination (clean-contaminated vs contaminated-dirty), country and timing (inpatient vs outpatient). FINDINGS: A total of 335 patients were included in KIWI; SSI occurred in 7% of clean-contaminated cases and 27% of contaminated-dirty cases. Overall, SSI was associated with an increase in postoperative healthcare costs by 75.3% (412 international Euros) after clean-contaminated surgery and 66.6% (331) after contaminated-dirty surgery. The highest and lowest cost increases were in India for clean-contaminated cases (517) and contaminated-dirty cases (223), respectively. Overall, inpatient costs accounted for 96.4% of the total healthcare costs after clean-contaminated surgery and 92.5% after contaminated-dirty surgery. CONCLUSION: SSI was associated with substantial additional postoperative costs across a range of settings. Investment in health technologies to reduce SSI may mitigate the financial burden to patients and low-resource health systems.
Subject(s)
Developing Countries , Surgical Wound Infection , Female , Humans , Pregnancy , Cesarean Section/adverse effects , Data Collection , Risk Factors , Surgical Wound Infection/epidemiology , Surgical Wound Infection/prevention & control , Surgical Wound Infection/etiologyABSTRACT
Background: Patient satisfaction is an important quality assurance measure in the delivery of health care. Objectives: The objectives were to assess current patient's degree of satisfaction; to document the main reasons for non-satisfaction and identify potential areas for improvement in surgical care delivered at CHUK. Methods: We conducted a prospective cross sectional survey on patients attending a tertiary surgical unit in Rwanda. For 6 weeks; 10 to 20 patients were randomly included in the study after an informed consent. A pre-established questionnaire was filled and descriptive statistics used to analyze the data using SPSS 16.02 and Excel computer programs. Results: 80 patients have been recruited and accepted to be part of the study. The overall satisfaction was 94. 93.8 have been well oriented.78.8 well received. 90 judged the consultation time enough. 96.87 reported having been respected during consultation. 84.37 of those who underwent surgery reported having received a postoperative fitness check appointment. Asked to mark their surgeon after consultation or on discharge; the patients gave an average note of 9.5 over 10. However 52.5 waited for more than 3hours before seeing a doctor in OPD clinic. For those who underwent surgery; only 58.53 were told indications for surgery; and no patient (0) was told eventual complications. 41.46 were not given appointment for elective surgery; 62.5 patients were not satisfied by information received on their disease and its management. 96.87 patients were not included in the treatment plan decision making. Conclusion: The overall patients 'satisfaction attending CHUK surgical facilities was 94. Clinical and nonclinical factors including waiting time; patient-care provider interactions; patient-centered care concept; and management of Rendez-vous have been identified as areas to be improved
Subject(s)
Data Collection , Delivery of Health Care , Hospitals , Patient Satisfaction , Surgical Procedures, Operative , TeachingABSTRACT
Conjoined twins are identical or monozygotic twins whose bodies are joined in utero. Pygopagus or Iliopagus twins are a type of conjoined twins in which two bodies joined back to back at the buttocks. Surgical separation of conjoined twins is extremely risk of death and life threatening. We report on cases of female pygopagus twins of three months operated and separated at Kigali University Teaching Hospital. For both babies a posterior sagittal anorectoplasty was successfully performed with derivated ileostomy. Despite limited resources to carry out such operation in our settings; no complications occurred during the operation and oral feeding was done at third postoperative day. Ileostomy closure was performed three weeks after and babies were discharged from neonatology unit at 35th postoperative day. In conclusion; adequate preoperative investigation with a well organized and trained team contribute a lot to the success of such conjoined twins separation
Subject(s)
Hospitals , Surgical Procedures, Operative , Teaching , TwinsABSTRACT
Ectopic spleen is rare and its acute torsion may be fatal while its correct and early diagnosis continues to represent a challenge especially in children. We are reporting a case of a 9 year-old female patient with a one month history of colicky intermittent abdominal pain and whose physical examination revealed a diffuse abdominal tenderness with a large peri-umbilical abdominal mass. A preoperative diagnosis of acute torsion of ectopic spleen was suspected and was confirmed at laparotomy as the spleen pedicle was found twisted. The spleen was congested and gangrenous indicating a splenectomy.
