Joana Grudziak1, Jared Gallaher1, Leonard Banza2, Bruce Cairns1, Carlos Varela2, Sven Young2,3, Anthony Charles4,5. 1. Department of Surgery, UNC School of Medicine, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, USA. 2. Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi. 3. Haukeland University Hospital, Bergen, Norway. 4. Department of Surgery, UNC School of Medicine, University of North Carolina at Chapel Hill, 4008 Burnett Womack Building, CB 7228, Chapel Hill, NC, USA. anthchar@med.unc.edu. 5. Department of Surgery, Kamuzu Central Hospital, Lilongwe, Malawi. anthchar@med.unc.edu.
Abstract
INTRODUCTION: To address the need for more surgical providers in low-resource settings, a collaboration to create a surgical residency-training program for local Malawian physicians was established in 2009. This study sought to describe the short-term independent effect of a surgical residency program on trauma mortality at a tertiary trauma center in sub-Saharan Africa. METHODS: We conducted a retrospective analysis of all patients recorded in the trauma surveillance registry of Kamuzu Central Hospital in Lilongwe, Malawi, from 2009 (three residents) through 2014 (11 residents). Log-binominal regression modeling was used to compare the risk ratio of death compared to the referent year of 2009, when the program was started, after adjusting for relevant covariates. Primary injury type was used as a surrogate for injury severity. RESULTS: In total, 82,534 patients were recorded into the KCH Trauma Registry during the study period. Mean age was 23.1 years (SD 15.7) with a male preponderance (72.1%). Trauma patient volume increased from 8725 patients in 2009 to 15,998 patients in 2014. Each year had a significantly decreased risk of death compared to 2009 when adjusted for primary injury type, age, and gender, with an adjusted risk ratio of 0.73 (95% CI 0.58, 0.90) in 2010 and 0.52 (95% CI 0.43, 0.62) in 2014. CONCLUSION: The global burden of surgical diseases cannot be attenuated in the presence of an inadequate surgical workforce. After institution of a surgery residency program, adjusted injury-associated mortality decreased each year despite substantial increases in trauma patient volume. In low-resource settings, establishment of a surgical residency program significantly improves trauma-associated outcomes.
INTRODUCTION: To address the need for more surgical providers in low-resource settings, a collaboration to create a surgical residency-training program for local Malawian physicians was established in 2009. This study sought to describe the short-term independent effect of a surgical residency program on trauma mortality at a tertiary trauma center in sub-Saharan Africa. METHODS: We conducted a retrospective analysis of all patients recorded in the trauma surveillance registry of Kamuzu Central Hospital in Lilongwe, Malawi, from 2009 (three residents) through 2014 (11 residents). Log-binominal regression modeling was used to compare the risk ratio of death compared to the referent year of 2009, when the program was started, after adjusting for relevant covariates. Primary injury type was used as a surrogate for injury severity. RESULTS: In total, 82,534 patients were recorded into the KCH Trauma Registry during the study period. Mean age was 23.1 years (SD 15.7) with a male preponderance (72.1%). Traumapatient volume increased from 8725 patients in 2009 to 15,998 patients in 2014. Each year had a significantly decreased risk of death compared to 2009 when adjusted for primary injury type, age, and gender, with an adjusted risk ratio of 0.73 (95% CI 0.58, 0.90) in 2010 and 0.52 (95% CI 0.43, 0.62) in 2014. CONCLUSION: The global burden of surgical diseases cannot be attenuated in the presence of an inadequate surgical workforce. After institution of a surgery residency program, adjusted injury-associated mortality decreased each year despite substantial increases in traumapatient volume. In low-resource settings, establishment of a surgical residency program significantly improves trauma-associated outcomes.
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