Surgical Volumes at the District Hospital: A Retrospective Review of National Data in Rwanda

Background: Surgical conditions are a significant contributor to global morbidity and mortality, and much of the burden of surgical disease arises in resource-limited settings. There are profound disparities in surgical care worldwide, with only 3.5% of surgical procedures estimated to be performed in the poorest 1/3 of countries. Yet, very little is known regarding the true volume of surgical procedures performed in resource-limited settings.
Methods: We conducted a retrospective, descriptive study of aggregate district hospital statistics provided to the Ministry of Health in Rwanda from 40 district hospitals over the period from January 2008-September 2010.
Results: The total numbers of major procedures performed at the District Hospital level in Rwanda were 23,621 for 2008, 43,389 for 2009, and 32,944 for the first nine months of 2010. Obstetrics and gynecology procedures comprised 75.5%, 60.8%, and 61.4% of major operations in 2008, 2009 and 2010, respectively. Of those, caesarian sections were 87.3% (2008), 87.7% (2009) and 89.1% (2010). Hernia repairs were the most common general surgery procedure. Reported post-operative infection rates were 0.8%, 0.4% and 0.2% for 2008, 2009 and 2010, respectively.
Conclusions: Comparable to the global literature, the majority of procedures performed at the District Hospital level in Rwanda are caesarian sections. As surgical capacity improves, accurate reporting of surgical procedures and outcomes is imperative to planning the training of surgical caregivers, allocation of resources and ensuring patient safety.