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

Christophe Mpirimbanyi; Egide Abahuje; Aime D. Hirwa; Miguel Gasakure; Elisee Rwagahirima; Christian Niyonzima; Adolphe N. Hakizimana; Epiphanie Ishimwe; Faustin Ntirenganya; Jennifer Rickard

Christophe Mpirimbanyi
Egide Abahuje
Aime D. Hirwa
Miguel Gasakure
Elisee Rwagahirima
Christian Niyonzima
Adolphe N. Hakizimana
Epiphanie Ishimwe
Faustin Ntirenganya
Jennifer Rickard

Keywords: emergency surgery, referral, district hospitals, tertiary care centres, Rwanda

Abstract

Background: The aim of this study was to assess the spectrum of referred emergency general surgery (EGS) conditions in Rwanda and compare to the existing Ministry of Health (MOH) surgical package.

Methods: We performed a retrospective chart review of all EGS patients referred from DH to University Teaching Hospital of Kigali (CHUK), Rwanda to define the spectrum of referred EGS conditions. Data were collected on patients’ demographics, clinical course, and reasons for transfer. Descriptive statistics were used to compare referred patients with operations indicated in the Ministry of Health surgical package. Logistic regression was used to determine patient factors associated with mortality in the transferred EGS patients.

Results: Over a one-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%). Common operations performed were laparotomy (n=21, 24%), bowel resection (n=20, 23%), and debridement (n=9, 11%). Based on MOH recommendations, 455 (81%) patients had conditions that could be managed at the DH.

The median symptom duration was 4 days (IQR: 2, 7). The mortality rate was 12%, re-operation was 7% and the intensive care unit admission rate was 4.8%. The median length of hospital stay was 7 days (IQR: 3, 13).

Conclusions: EGS remains a public health challenge in Rwanda. Re-defining the surgical package of each health facility level,training and staffing at the DH, and addressing gaps in infrastructure would help in early diagnosis and management of patients near their home.