Bina W Kakusa1, Linda W Xu2, Silvia D Vaca1, Juliet Nalwanga3, Joel Kiryabwire3, Hussein Ssenyonjo3, John Mukasa3, Michael Muhumuza3, Michael M Haglund4, Gerald A Grant5. 1. Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Stanford Center for Global Health Innovation, Palo Alto, California, USA. 2. Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Stanford Center for Global Health Innovation, Palo Alto, California, USA; Department of Neurosurgery, Allegheny Health Network, Pittsburgh, Pennsylvania, USA. 3. Department of Neurosurgery, Mulago National Referral Hospital, Kampala, Uganda. 4. Division of Global Neurosurgery and Neurology, Department of Neurosurgery, Duke University, Durham, North Carolina, USA. 5. Department of Neurosurgery, Stanford University School of Medicine, Stanford, California, USA; Stanford Center for Global Health Innovation, Palo Alto, California, USA. Electronic address: ggrant2@stanford.edu.
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.
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 tumorpatients 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.
Authors: Ulrick Sidney Kanmounye; Claire Karekezi; Arsene Daniel Nyalundja; Ahmed K Awad; Tsegazeab Laeke; James A Balogun Journal: Neuro Oncol Date: 2022-10-03 Impact factor: 13.029