A Comparison of Prospective and Retrospective Methods to Measure Surgical Volume and In-Hospital Post-Operative Mortality in Uganda

Abstract

Purpose: Surgery is increasingly accepted as a necessary part of a functioning health system. In 2015, the Lancet Commission on Global Surgery (LCoGS) recommended that every country report its surgical volume and post-operative mortality rate (POMR) as part of six indicators on the strength of a surgical system. The LCoGS did not make recommendations on the best method to collect these data. This study aimed to collect these metrics at a regional referral hospital in Uganda, and to compare observational prospective data collection with retrospective review of patient charts and ward logbooks. We hypothesized that logbooks would be an efficient method, whereas prospective data collection and patient charts would be too time-consuming for large-scale data collection. Methods: For one month, basic information was taken about every patient who had an operation at a regional referral hospital in Western Uganda. These patients were followed up through daily ward observation and their outcomes were followed until discharge or death. Prospective data were compared with data obtained from logbooks and patient charts to determine the validity of using retrospective methods for collecting these metrics. Results: Surgical volume at this regional hospital in Uganda was projected to be 8,515 operations/year. The POMR at this hospital is 2.4%. Finding patient files in the medical records department was time consuming and yielded only 62% of the files. Furthermore, a comparison of missing versus found charts revealed that the missing charts are significantly different from the found charts. Logbooks, on the other hand, captured 99% of the operations and 94% of the deaths. Conclusion: This regional referral hospital has a large volume of surgery, with a POMR that is equivalent to that reported from similar settings. Logbooks, which are ubiquitous in low-resource settings, represent a good source of data for measuring simple metrics such as POMR and surgical volume.