Central Nervous System Tumors in Uganda: Outcomes of Surgical Treatment and Complications Assessed Through Telephone Survey

World Neurosurg. 2019 Sep;129:e866-e880. doi: 10.1016/j.wneu.2019.06.060. Epub 2019 Jun 15.

Abstract

Background: Uganda has one of the largest unmet neurosurgical needs in the world, but has seen major improvements in neurosurgery-largely centered at Mulago National Referral Hospital (MNRH). This study implements the first long-term follow-up and outcomes analysis of central nervous system tumor patients in Uganda.

Methods: Inpatient data were collected using a prospective database of patients presenting to the MNRH neurosurgical ward between 2014 and 2015. Follow-up health care status was assessed in the patient's language using phone surveys. Analysis was performed to identify which factors were associated with patient outcomes.

Results: The MNRH neurosurgical ward saw 112 patients with central nervous system tumors (adult N = 87, female: 70%, median age: 37 years). Meningiomas (21%) comprised the most common tumor diagnosis. In-hospital mortality (18%), 30-day mortality (22%), and 1-year mortality (35%) were high. Thirty percent of patients underwent tumor resection in-patient and had greater median overall survival (66.5 months vs. 5.1 months for nonsurgical patients, P = 0.025). For those with known pathologic diagnoses, patients with glioblastomas had decreased median overall survival (0.83 months vs. 59 months for meningiomas, P = 0.02). Phone interviews yielded an 85% response rate. Of the survivors at the time of follow-up, 55% reported a subjective return to normalcy, and 75% received follow-up care for their tumor with most returning to MNRH.

Conclusions: We show evidence for improved overall survival with surgical care at MNRH. In addition, phone interviews as a method of measuring health outcomes provided an effective means of follow-up, showing that most patients do seek follow-up care.

Keywords: Brain tumor; Long-term follow-up; Low- and middle-income countries; Mulago; Neurosurgery; Phone interview.

MeSH terms

  • Adult
  • Central Nervous System Neoplasms / epidemiology
  • Central Nervous System Neoplasms / pathology
  • Central Nervous System Neoplasms / surgery*
  • Child, Preschool
  • Developing Countries
  • Female
  • Humans
  • Male
  • Neurosurgical Procedures / adverse effects*
  • Neurosurgical Procedures / mortality
  • Postoperative Complications / epidemiology*
  • Surveys and Questionnaires
  • Treatment Outcome
  • Uganda / epidemiology