B P Waalewijn1,2,3, A van Duinen4,5,6,7, A P Koroma8, M J Rijken9,10,11, M Elhassein12, H A Bolkan5,6,7. 1. Royal Tropical Institute, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands. bartwaalewijn@gmail.com. 2. CapaCare, Korsgata 17, 7030, Trondheim, Norway. bartwaalewijn@gmail.com. 3. Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands. bartwaalewijn@gmail.com. 4. Royal Tropical Institute, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands. 5. CapaCare, Korsgata 17, 7030, Trondheim, Norway. 6. Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905, 7491, Trondheim, Norway. 7. Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway. 8. Ministry of Health and Sanitation, Princess Christiana Maternity Hospital, Fourah Bay Road, Freetown, Sierra Leone. 9. Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands. 10. Julius Global Health, The Julius Center for Health Sciences and Primary Care, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands. 11. University Medical Center Utrecht, Utrecht, The Netherlands. 12. United Nations Population Found, New Signal Hill Road, Congo Cross, Freetown, Sierra Leone.
Abstract
BACKGROUND: In response to the high maternal mortality ratio, Sierra Leone has adopted an associate clinician postgraduate surgical task-sharing training programme. Little is known about learning curve characteristics for caesarean sections among associate clinicians. The aim of this study is to evaluate the number of caesarean sections needed to be performed by associate clinicians until there is no further significant reduction in operation time. METHODS: This prospective study evaluates the first 50 caesarean sections performed by trainees between January 2011 and June 2016. Primary outcome was total operating time in minutes (incision to suturing time). Secondary outcomes were length of hospital stay, surgical site infections, estimated operative bloodloss and in-hospital postoperative mortality. RESULTS: A total of 1174 caesarean sections performed by 24 trainees were analysed. Total operation time significantly reduced during the first 15 operations from mean (SD) operation time 72 (27)-51 (18) min after 15 procedures (p < 0.001). Estimated bloodloss did not significantly vary among the first 50 caesarean sections. Surgical site infections were reported in 3.7% of the operations, which was higher during the first 15 operations (6.8%) compared to the following 35 operations (2.3%). Length of stay reduced from median (range) 9 (2-39)-6 (2-127) days after 15 operations, but there was no reduction in maternal mortality. CONCLUSION: While gaining experience, the operation time of associate clinicians significantly reduced during the first 15 caesarean sections. Estimated bloodloss is not related to trainees experience.
BACKGROUND: In response to the high maternal mortality ratio, Sierra Leone has adopted an associate clinician postgraduate surgical task-sharing training programme. Little is known about learning curve characteristics for caesarean sections among associate clinicians. The aim of this study is to evaluate the number of caesarean sections needed to be performed by associate clinicians until there is no further significant reduction in operation time. METHODS: This prospective study evaluates the first 50 caesarean sections performed by trainees between January 2011 and June 2016. Primary outcome was total operating time in minutes (incision to suturing time). Secondary outcomes were length of hospital stay, surgical site infections, estimated operative bloodloss and in-hospital postoperative mortality. RESULTS: A total of 1174 caesarean sections performed by 24 trainees were analysed. Total operation time significantly reduced during the first 15 operations from mean (SD) operation time 72 (27)-51 (18) min after 15 procedures (p < 0.001). Estimated bloodloss did not significantly vary among the first 50 caesarean sections. Surgical site infections were reported in 3.7% of the operations, which was higher during the first 15 operations (6.8%) compared to the following 35 operations (2.3%). Length of stay reduced from median (range) 9 (2-39)-6 (2-127) days after 15 operations, but there was no reduction in maternal mortality. CONCLUSION: While gaining experience, the operation time of associate clinicians significantly reduced during the first 15 caesarean sections. Estimated bloodloss is not related to trainees experience.
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