Determinants of access to emergency surgery according to resident doctors: A cross-sectional study at a teaching hospital in Ibadan, Nigeria

Abstract

[Accepted Research Article]

Background: Morbidity and mortality following emergency surgeries can be reduced with timely access to emergency surgery and five billion people globally, lack access to essential surgery. Data on the determinants of these are still lacking.

Objectives: We studied resident doctors' perspectives of the patient-, healthcare-giver-, and health-institution-related determinants of access to emergency surgery at the University College Hospital, Ibadan, Nigeria.

Methodology: This self-administered, questionnaire-based, cross-sectional survey involved eighty-five resident doctors; recruited using systematic random sampling. Ethical approval (UI/EC/20/0318) and prospective registration (NCT04487496) were gotten.

Results: Major patient-related sources of delays included financial constraints (97.7%), patient's consent (78.8%), guardian's consent (74.1%) and diagnosis denial (70.6%). Anaesthetists (65.9%) and surgeons (61.2%) caused and reduced delays respectively. The healthcare-giver factors were provision of blood (84.7%), optimization of patient (83.5%), unavailable theatre space (82.4%), anaesthesia (67.1%), surgical (43.5%) staff fatigue and time-to-diagnosis (58.8%). Diagnostic delays were mostly from investigations (97.6%) and missed diagnosis (47.1%). Unavailable bedspace (82.4%), delays in arrival (82.4%) and entry (74.1%) into the theatre were major health institution challenges. Establishing diagnosis was delayed by payment for (96.5%) and doing (88.2%) diagnostic investigations, and time-to-review by specialist team (80.0%). Arrival in theatre was affected by theatre trolley conveying patient (70.6%), pre-anaesthesia review (70.6%) and pre-operative nursing logistics (64.7%). Entry into the suite depended on payment/payment deferment (87.06%) and suites being unavailable (75.3%).

Conclusion: Hospital personnel modified access to emergency surgery, from diagnosing, pre-operative optimization, conveyance of patient, and the surgical procedure. The patient factors were poor finances, diagnosis denial and giving of consent for surgery. We encourage (recommend) physician-run point-of-care diagnostics in emergency rooms (ER), with improved health insurance coverage, ER bedspace, and personnel (surgical and anaesthesiological).