Neurosurgical Outcomes Following Establishment of a Twinning Program at Mulago Hospital in Uganda

Duke University Medical Center neurosurgeon, Dr. Micheal Haglund, established a twinning program between Duke and Mulago Hospital in Kampala, Uganda back in 2008. While a study was performed in 2011 that showed that the program had increased neurosurgical capacity, there was no study looking at patient outcomes. This study was thus undertaken to explore patient outcomes in an effort to provide information the program could use for evaluating its impact.

This study was carried out in a retrospective fashion including all patients who underwent a neurosurgical procedure at Mulago Hospital from fiscal year 2005 to 2013. Data for this study was extracted from three sources: surgical log books, patient charts, and Mulago Hospital death registry. Information from these sources were collected using electronic data collection tools to determine morality rate (30-day and overall), infection rate (pre-op and post-op), and length of stay (total, pre-op, and post-op). These three outcome measures were then compared pre-program versus post-program.

Peri-operative mortality rate (POMR), or 30-day mortality, was significantly increased from 7.41% pre-program to 13.62% post-program. Overall mortality was also significantly increased from 12.96% pre-program to 19.89% post-program. Relative risk for POMR was 1.85 (1.13, 3.03) and overall mortality was 1.53 (1.06, 2.22). Pre-op infection was significantly decreased from 29.74% pre-program to 22.1% post-program with a relative risk of 0.75 (0.56, 1.00). Mean total length of stay and pre-operative length of stay were both significantly decreased.

The results show that the program has had a generally positive impact, but the mortality increase is an important question to explore. This result may be attributed to complexity and triaging issues, but a prospective analysis would be the only way to make that determination. Additionally, further qualitative and deeper quantitative investigations can provide a fuller evaluation of the program's impact. Overall it is clear that this program is allowing greater access to neurosurgical care to a population that would have otherwise went without care.