Life After the Neurosurgical Ward in Sub-Saharan Africa: Neurosurgical Treatment and Outpatient Outcomes in Uganda

World Neurosurg. 2018 May;113:e153-e160. doi: 10.1016/j.wneu.2018.01.204. Epub 2018 Feb 8.

Abstract

Background: In the past decade, neurosurgery in Uganda experienced increasing surgical volume and a new residency training program. Although research has examined surgical capacity, minimal data exist on the patient population treated by neurosurgery and their eventual outcomes in sub-Saharan Africa.

Methods: Patients admitted to Mulago National Referral Hospital neurosurgical ward over 2 years (2014 and 2015) were documented in a prospective database. In total, 1167 were discharged with documented phone numbers and thus eligible for follow-up. Phone surveys were developed and conducted in the participant's language to assess mortality, neurologic outcomes, and follow-up health care.

Results: During the study period, 2032 patients were admitted to the neurosurgical ward, 80% for traumatic brain injury. A total of 7.8% received surgical intervention. The in-hospital mortality rate was 18%. A total of 870 patients were reached for phone follow-up, a 75% response rate, and 30-day and 1-year mortality were 4% and 8%, respectively. Almost one-half of patients had not had subsequent health care after the initial encounter. Most patients had Glasgow Outcome Scale-Extended scores consistent with good recovery and mild disability, with patients experiencing trauma faring best and patients with tumor faring worst. A total of 85% felt they returned to baseline work performance, and 76% of guardians felt that children returned to baseline school performance.

Conclusions: The neurosurgical service provided health care to a large proportion of nonoperative patients. Phone surveys captured data on patients in whom nearly one-half would be lost to subsequent health care. Although mortality during initial hospitalization was high, more than 90% of those discharged survived at 1-year follow up, and the vast majority returned to work and school.

Keywords: Follow-up; Global neurosurgery; Neurosurgical outcomes; Sub-Saharan Africa; Uganda.

MeSH terms

  • Africa South of the Sahara / epidemiology
  • Aftercare
  • Brain Damage, Chronic / epidemiology
  • Brain Damage, Chronic / etiology
  • Brain Injuries, Traumatic / complications
  • Brain Injuries, Traumatic / surgery
  • Brain Neoplasms / complications
  • Brain Neoplasms / surgery
  • Caregivers
  • Cell Phone
  • Comorbidity
  • Convalescence
  • Developing Countries
  • Follow-Up Studies
  • Humans
  • Inpatients
  • Malaria / epidemiology
  • Neurosurgical Procedures*
  • Outpatients* / psychology
  • Patient Satisfaction
  • Postoperative Complications / mortality
  • Postoperative Complications / psychology
  • Quality of Life
  • Socioeconomic Factors
  • Spinal Dysraphism / surgery
  • Survival Analysis
  • Survivors* / psychology
  • Treatment Outcome
  • Uganda / epidemiology