ArticleThe western journal of emergency medicine2025
Surgical Disease Burden, Outcomes, and Roles of Non-Physician Clinicians in Ugandan Emergency Departments.
Article in The western journal of emergency medicine, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundDelivery of emergency surgical care remains a challenge in much of Sub-Saharan Africa, with physician shortages in Uganda resulting in only one surgeon per 100,000 people. Emergency units in Uganda receive emergency surgical patients, but it is unknown how great of a burden these emergency surgical patients represent in terms of total number, care required, or outcomes.
methodsWe performed a retrospective review of a quality assurance database for all patients treated at two emergency units in Uganda from 2009-2019. Patients were defined as "surgical" if they were admitted directly to the operating theatre, received a surgical diagnosis, or received an emergency surgical procedure as identified by the Disease Control Priorities 3 (DCP3) group. We generated descriptive statistics.
resultsOf the 109,999 total patients seen, 24,745 (22.5%) were emergency surgical patients. Surgical patients were predominantly male (71.7%) with a mean age of 34.9 years. Most surgical patients (57.0%) were admitted to the hospital, while 38.9% were discharged, and only 1.7% were sent directly to the operating theatre. In total, 12.1% of all patients seen in the emergency unit received a surgical procedure from a non-physician clinician while in the unit. Of the surgical procedures, the most common were suturing of lacerations (51.8%), urinary catheterization (24.5%), fracture management (16.5%), and incision and drainage of abscesses (6.0%). Among surgical patients, the most common surgical diagnoses were for fractures (30.9%), lacerations (29.6%), and abscesses (8.8%). The overall three-day mortality for emergency surgical patients was 2.8%.
conclusionEmergency surgical patients are common in Ugandan emergency units, where emergent surgical procedures are commonly performed by non-physician clinicians. Strengthening system capacity for emergency surgical patients should also consider emergency unit resources.
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