• Evan G Wong, Georges Ntakiyiruta, Mathieu C Rousseau, Landouald Ruhungande, Adam L Kushner, Alexander S Liberman, Kosar Khwaja, Marc Dakermandji, Marnie Wilson, Tarek Razek, Patrick Kyamanywa, and Dan L Deckelbaum.
• Department of Surgery, McGill University, Montreal, Quebec, Canada; Centre for Global Surgery, McGill University Health Centre, Montreal, Quebec, Canada; Surgeons Overseas, New York, NY. Electronic address: evan.wong@mail.mcgill.ca.
• Surgery. 2015 Jul 1; 158 (1): 37-43.

BackgroundSurgical management of emergent, life-threatening diseases is an important public health priority. The objectives of this study were to (1) describe acute care general surgery procedures performed at the largest referral hospital in Rwanda and (2) understand the geographic distribution of disease presentations and referral patterns.MethodsWe performed a retrospective review of prospectively collected acute care surgery cases performed at the Centre Hospitalier Universitaire de Kigali (CHUK) in Rwanda between June 1 and December 1, 2011. Using Pearson's χ(2) test and the Fisher exact test, we compared cases originating from within Kigali and transfers from other provinces. Geospatial analyses also were used to further describe transfer patterns.ResultsDuring the study period, 2,758 surgical interventions were performed, of which 25.6% (707/2,758) were general surgery operations. Of these, 45.4% (321/707) met the definition of acute care surgery. Only about one-third-32.3% (92/285)-of patients resided within Kigali, whereas about two-thirds-67.7% (193/285)-were transferred from other provinces. Most patients transferred from other provinces were younger than 18 years of age (40.4%; 78/193), and 83.0% (39/47) of patients older than 50 years of age originated from outside of Kigali. Specific operative indications and surgical procedures varied substantially between patients from Kigali and patients transferred from other provinces.ConclusionEmergency surgical conditions remain important contributors to the global burden of disease, particularly in low- and middle-income countries. Geographic variations exist in terms of operative diagnoses and procedures, which implies a need for improved access to surgical care at the district level with defined transfer mechanisms to greater-level care facilities when needed.Copyright © 2015 Elsevier Inc. All rights reserved.

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