Our Work

Evaluation of Surgical Outcomes in Nicaragua

Project Objectives

Evaluation of surgical outcomes in Surgical Departments in Leon and Matagalpa in order to understands barriers to surgical health care and resource allocation in Nicaragua.

Project Outcomes

Delayed presentations and post-operative outcomes in patients undergoing emergency abdominal surgery: a 1-year prospective study in León and Matagalpa, Nicaragua

Carolina V. Solis, MD, MPHa, Javier Pastor, MDb, Santos Calderwood, MDc, Rosemary Duda, MDd, Nathan Thielman, MDa, Sandhya Lagoo, MD, PhDa

Presented as a poster at the 6th annual ASAP meeting, Durham, NC
September 2013

A Duke University Medical Center, Durham, NC
B Hospital Escuela Oscar Danilo Rosales Arguello, León, Nicaragua
C Hospital Regional Augusto Cesar Molina, Matagalpa, Nicaragua
D Beth Israel Medical Center, Boston, MA

Background: Access to surgical care can vary based on differences in geography and lead to differences in severity of initial presentation, especially in lower and middle income countries such as Nicaragua. The goal of this study was to determine factors leading to delayed presentations in patients undergoing emergency abdominal surgery in two Nicaraguan ministry of health hospitals located in León and Matagalpa, Nicaragua. Additionally, post-operative outcomes were tracked and measured.

Methods: A 1-year (October 2012-2013) prospective study comparing access to surgical care, delayed presentations and surgical outcomes in patients undergoing emergency abdominal surgery in León and Matagalpa, Nicaragua. Data regarding sociodemographic factors, transportation barriers, intra-operative findings, initial presentations, baseline co-morbidities, and post-operative outcomes was collected via patient interviews, review of the medical record and intra-hospital follow-up.

Results:
Preliminary analysis was performed on 495 patients. 190 patients were from León (38.3%) and 305 (61.2%) patients were from Matagalpa. Median presentation time was 19 hrs in Matagalpa vs. 16 hrs in León (p<0.0001). Mean travel time to the hospital was also greater in Matagalpa than León (0.75 hrs vs.0.5 hrs, p<0.0159). However, median travel distance in km was not different (p<0.07).

Conclusion:
Most likely because of geographical barriers and differences in socioeconomic status, the time from onset of symptoms to hospital presentation is longer in patients in Matagalpa. Additionally, patients in Matagalpa travel longer times to get to the hospital despite similar distances to patients in León.

Project Policy Impact Description

This project will help policy regarding allocation of resources to Departments of Surgery in Leon and Matagalpa.

Department & School

Surgery
School of Medicine

Locations

Sponsors

  • Duke Global Health Institute

Collaborators

  • León Teaching Hospitall
  • UNAN-León Medical School
  • Matagalpa Regional Hospital

Project Status

Ongoing

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