Stephen Tabiri1, Edwin M T Yenli1, Frank E Gyamfi2, Ali Jalali3, Richard E Nelson4, Raymond R Price5, Micah G Katz6. 1. Department Of Surgery, University for Development Studies, School of Medicine and Health Sciences and Tamale Teaching Hospital, Tamale, Ghana. 2. Department Of Surgery, Holy Family Hospital, Berekum, Brong-Ahafo Region, Ghana. 3. Department of Economics Health Economics Core, Population Health Research Foundation, University of Utah, Salt Lake City, Utah. 4. Department of Internal Medicine, Veterans Affairs, Salt Lake City Health Care System, University of Utah, Salt Lake City, Utah. 5. Department of Surgery, Intermountain Healthcare, Salt Lake City, Utah; Department of Surgery, University Of Utah, Center for Global Surgery, Salt Lake City, Utah. 6. Department of Surgery, University Of Utah, Center for Global Surgery, Salt Lake City, Utah. Electronic address: micah.katz@hsc.utah.edu.
Abstract
BACKGROUND: Despite the recognition that inguinal hernia (IH) repair is cost-effective, repair rates in low- and middle-income countries remain low. Estimated use of mesh in low- and middle-income countries also remains low despite publications about low-cost, noncommercial mesh. The purpose of our study was to assess the current state of IH repair in the northern and transitional zone of Ghana. MATERIALS AND METHODS: A retrospective review of surgical case logs of IH repairs from 2013 to 2017 in 41 hospitals was performed. Multivariate logistic regression was used to determine predictors of mesh use. RESULTS: Eight thousand eighty male patients underwent IH repair. The range of IH repair in each region was 96 to 295 (overall 123) per 100,000 population. Most cases were performed at district hospitals (84%) and repaired nonurgently (93%) by nonsurgeon physicians (66%). Suture repair was most common (85%) although mesh was used in 15%. The strongest predictor of mesh use was when a surgeon performed surgery (odds ratio [OR] 3.13, P <0.001), followed by surgery being performed in a teaching hospital (OR 2.31, P <0.001). Repair at a regional hospital was a negative predictor of mesh use (OR 0.08, P <0.001) as was the use of general anesthesia (OR 0.40, P = 0.001). CONCLUSIONS: Most IH repairs are performed in district hospitals, by nonsurgeon physicians, and without mesh. Rates of repair and the use of mesh are higher than previous estimates in Ghana and Sub-Saharan Africa but not as high as high-income countries.
BACKGROUND: Despite the recognition that inguinal hernia (IH) repair is cost-effective, repair rates in low- and middle-income countries remain low. Estimated use of mesh in low- and middle-income countries also remains low despite publications about low-cost, noncommercial mesh. The purpose of our study was to assess the current state of IH repair in the northern and transitional zone of Ghana. MATERIALS AND METHODS: A retrospective review of surgical case logs of IH repairs from 2013 to 2017 in 41 hospitals was performed. Multivariate logistic regression was used to determine predictors of mesh use. RESULTS: Eight thousand eighty male patients underwent IH repair. The range of IH repair in each region was 96 to 295 (overall 123) per 100,000 population. Most cases were performed at district hospitals (84%) and repaired nonurgently (93%) by nonsurgeon physicians (66%). Suture repair was most common (85%) although mesh was used in 15%. The strongest predictor of mesh use was when a surgeon performed surgery (odds ratio [OR] 3.13, P <0.001), followed by surgery being performed in a teaching hospital (OR 2.31, P <0.001). Repair at a regional hospital was a negative predictor of mesh use (OR 0.08, P <0.001) as was the use of general anesthesia (OR 0.40, P = 0.001). CONCLUSIONS: Most IH repairs are performed in district hospitals, by nonsurgeon physicians, and without mesh. Rates of repair and the use of mesh are higher than previous estimates in Ghana and Sub-Saharan Africa but not as high as high-income countries.
Authors: Jessica H Beard; Michael Ohene-Yeboah; Stephen Tabiri; Joachim K A Amoako; Francis A Abantanga; Carrie A Sims; Pär Nordin; Andreas Wladis; Hobart W Harris; Jenny Löfgren Journal: JAMA Surg Date: 2019-09-01 Impact factor: 14.766