PT  - JOURNAL ARTICLE
AU  - Egide Abahuje
AU  - Isaie Sibomana
AU  - Elisee Rwagahirima
AU  - Christian Urimubabo
AU  - Robert Munyaneza
AU  - Jennifer Rickard
TI  - Development of an acute care surgery service in Rwanda
AID  - 10.1136/tsaco-2019-000332
DP  - 2019 Aug 01
TA  - Trauma Surgery & Acute Care Open
PG  - e000332
VI  - 4
IP  - 1
4099  - http://tsaco.bmj.com/content/4/1/e000332.short
4100  - http://tsaco.bmj.com/content/4/1/e000332.full
SO  - Trauma Surg Acute Care Open2019 Aug 01; 4
AB  - Background Acute care surgery (ACS) encompasses trauma, critical care, and emergency general surgery. Due to high volumes of emergency surgery, an ACS service was developed at a referral hospital in Rwanda. The aim of this study was to evaluate the epidemiology of ACS and understand the impact of an ACS service on patient outcomes.Methods This is a retrospective observational study of ACS patients before and after introduction of an ACS service. χ2 test and Wilcoxon rank-sum test were used to describe the epidemiology and compare outcomes before (pre-ACS)) and after (post-ACS) implementation of the ACS service.Results Data were available for 120 patients before ACS and 102 patients after ACS. Diagnoses included: intestinal obstruction (n=80, 36%), trauma (n=38, 17%), appendicitis (n=31, 14%), and soft tissue infection (n=17, 8%) with no difference between groups. The most common operation was midline laparotomy (n=138, 62%) with no difference between groups (p=0.910). High American Society of Anesthesiologists (ASA) score (ASA ≥3) (11% vs. 40%, p<0.001) was more common after ACS. There was no difference in intensive care unit admission (8% vs. 8%, p=0.894), unplanned reoperation (22% vs. 13%, p=0.082), or mortality (10% vs. 11%, p=0.848). The median length of hospital stay was longer (11 days vs. 7 days, p<0.001) before ACS.Conclusions An ACS service can be implemented in a low-resource setting. In Rwanda, ACS patients are young with few comorbidities, but high rates of mortality and morbidity. In spite of more patients who are critically ill in the post-ACS period, implementation of an ACS service resulted in decreased length of hospital stay with no difference in morbidity and mortality.Level of evidence Prognostic and epidemiologic study type, level III.