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Life After the Neurosurgical Ward in Sub-Saharan Africa: Neurosurgical Treatment and Outpatient Outcomes in Uganda.

Publication ,  Journal Article
Xu, LW; Vaca, SD; Nalwanga, J; Muhumuza, C; Vail, D; Lerman, BJ; Kiryabwire, J; Ssenyonjo, H; Mukasa, J; Muhumuza, M; Haglund, MM; Grant, G
Published in: World Neurosurg
May 2018

BACKGROUND: In the past decade, neurosurgery in Uganda experienced increasing surgical volume and a new residency training program. Although research has examined surgical capacity, minimal data exist on the patient population treated by neurosurgery and their eventual outcomes in sub-Saharan Africa. METHODS: Patients admitted to Mulago National Referral Hospital neurosurgical ward over 2 years (2014 and 2015) were documented in a prospective database. In total, 1167 were discharged with documented phone numbers and thus eligible for follow-up. Phone surveys were developed and conducted in the participant's language to assess mortality, neurologic outcomes, and follow-up health care. RESULTS: During the study period, 2032 patients were admitted to the neurosurgical ward, 80% for traumatic brain injury. A total of 7.8% received surgical intervention. The in-hospital mortality rate was 18%. A total of 870 patients were reached for phone follow-up, a 75% response rate, and 30-day and 1-year mortality were 4% and 8%, respectively. Almost one-half of patients had not had subsequent health care after the initial encounter. Most patients had Glasgow Outcome Scale-Extended scores consistent with good recovery and mild disability, with patients experiencing trauma faring best and patients with tumor faring worst. A total of 85% felt they returned to baseline work performance, and 76% of guardians felt that children returned to baseline school performance. CONCLUSIONS: The neurosurgical service provided health care to a large proportion of nonoperative patients. Phone surveys captured data on patients in whom nearly one-half would be lost to subsequent health care. Although mortality during initial hospitalization was high, more than 90% of those discharged survived at 1-year follow up, and the vast majority returned to work and school.

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Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

May 2018

Volume

113

Start / End Page

e153 / e160

Location

United States

Related Subject Headings

  • Uganda
  • Treatment Outcome
  • Survivors
  • Survival Analysis
  • Spinal Dysraphism
  • Socioeconomic Factors
  • Quality of Life
  • Postoperative Complications
  • Patient Satisfaction
  • Outpatients
 

Citation

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Xu, L. W., Vaca, S. D., Nalwanga, J., Muhumuza, C., Vail, D., Lerman, B. J., … Grant, G. (2018). Life After the Neurosurgical Ward in Sub-Saharan Africa: Neurosurgical Treatment and Outpatient Outcomes in Uganda. World Neurosurg, 113, e153–e160. https://doi.org/10.1016/j.wneu.2018.01.204
Xu, Linda W., Silvia D. Vaca, Juliet Nalwanga, Christine Muhumuza, Daniel Vail, Benjamin J. Lerman, Joel Kiryabwire, et al. “Life After the Neurosurgical Ward in Sub-Saharan Africa: Neurosurgical Treatment and Outpatient Outcomes in Uganda.World Neurosurg 113 (May 2018): e153–60. https://doi.org/10.1016/j.wneu.2018.01.204.
Xu LW, Vaca SD, Nalwanga J, Muhumuza C, Vail D, Lerman BJ, et al. Life After the Neurosurgical Ward in Sub-Saharan Africa: Neurosurgical Treatment and Outpatient Outcomes in Uganda. World Neurosurg. 2018 May;113:e153–60.
Xu, Linda W., et al. “Life After the Neurosurgical Ward in Sub-Saharan Africa: Neurosurgical Treatment and Outpatient Outcomes in Uganda.World Neurosurg, vol. 113, May 2018, pp. e153–60. Pubmed, doi:10.1016/j.wneu.2018.01.204.
Xu LW, Vaca SD, Nalwanga J, Muhumuza C, Vail D, Lerman BJ, Kiryabwire J, Ssenyonjo H, Mukasa J, Muhumuza M, Haglund MM, Grant G. Life After the Neurosurgical Ward in Sub-Saharan Africa: Neurosurgical Treatment and Outpatient Outcomes in Uganda. World Neurosurg. 2018 May;113:e153–e160.
Journal cover image

Published In

World Neurosurg

DOI

EISSN

1878-8769

Publication Date

May 2018

Volume

113

Start / End Page

e153 / e160

Location

United States

Related Subject Headings

  • Uganda
  • Treatment Outcome
  • Survivors
  • Survival Analysis
  • Spinal Dysraphism
  • Socioeconomic Factors
  • Quality of Life
  • Postoperative Complications
  • Patient Satisfaction
  • Outpatients