• Author
    Ruvimbo Dzvurumi
  • Discovery PI

    Daniel DeUgarte, MD

  • Project Co-Author

    Massada da Rocha, MD, Whitney Orji, MD, MS, Tarcisio Osorio, Vanda Amado, MD

  • Abstract Title

    Evaluating the Impact of a Dedicated Pediatric Operating Room on Surgical Capacity in Mozambique

  • Discovery AOC Petal or Dual Degree Program

    Global Health

  • Abstract

    Background: Substantial gaps remain in access to surgical care, particularly for pediatric patients in Low- and Middle-Income Countries (LMICs). We previously identified limited block time as a barrier to expanding pediatric operative capacity at the Hospital Central Maputo (HCM), the country's main pediatric training center.  In 2023, a dedicated pediatric operating room (OR) was installed in collaboration with Kids Operating Room (KidsOR), a global health charity organization focused on improving access to safe surgical care for children worldwide. This study evaluates the impact of installing a dedicated pediatric OR on pediatric surgical block time, case volumes, and the spectrum of surgical procedures performed. 

     

    Methods: This was a single-center retrospective study examining the spectrum of surgical cases and changes in case volumes before and after the installation of KidsOR, which became fully functional in March 2023. Surgery logbook data were compared between two periods: March-December 2022 (pre-installation) and March-December 2024 (post-installation). Surgical volume data for 2023 were excluded due to significant disruptions from a natural disaster and personnel issues that could affect the intervention effect. The province-of-origin data were mostly complete from August 2023 to May 2024 and were analyzed separately to understand where patients traveled from to access care at HCM.  

       

    Results: Installation of the KidsOR increased block time for the general pediatric surgical services from 1.5 days/week to 3 days/week. However, KidsOR was restricted to only 1 operation at a time (previously, 2 concurrent operations were allowed). Overall, 288 operative cases were performed during the pre-installation period and 512 during the post-installation period. Male patients comprised most of all surgical cases (73.4%), with hernia repairs (inguinal and umbilical) as the most common procedure. There was a significantly higher median monthly surgical case volume in 2024 compared with 2022 (54 vs. 29.5; p=0.0071).  Case volume during the installation year (2023) fluctuated greatly, given major disruptions in the health system, including Cyclone Freddy and a prolonged national physician strike. Most patients who underwent surgical procedures between August 2023 and May 2024 (n=288) originated from Maputo (55.2%) or Maputo City (29.5%), with the remainder coming from nearby provinces (11.2%) or distant provinces (3.4%).     

     

    Conclusions: Median case volume increased significantly after KidsOR installation, reflecting an increase in pediatric surgical capacity and potential to train more perioperative personnel. Despite these improvements, the variability of case volume throughout 2023 suggests that global surgical systems strengthening must also address natural disaster preparedness, health system personnel challenges, and capacity-building specifically targeted to meet the needs of patients in distant provinces. 

     

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