Nationwide enumeration of emergency operations performed in Ghana

PURPOSE: To determine the population-based rate of emergency surgery performed in Ghana, categorized by hospital level. METHODS: Data on operations performed from June 2014 to May 2015 were obtained from a nationally representative sample of hospitals and scaled up to nationwide estimates. Operations were categorized as to: “emergency” or “elective” and as to “essential” (most cost-effective, highest population impact) or “other” according to the World Bank’s Disease Control Priorities project. RESULTS: Of 232,776 (95% UI 178,004–287,549) total operations performed nationally, 48% were emergencies. 112,036 emergency operations (95% UI: 92,105–131,967) were performed and the annual national rate was 416 per 100,000 population (95% UI: 342–489). Most emergency operations (87%) were in the essential category. Of essential emergency procedures, 47% were obstetric and gynecologic, 22% were general surgery, and 31% were trauma. District (first-level) hospitals performed 54%, regional hospitals 10%, and tertiary hospitals 36% of all emergency operations. About half (54%) of district hospitals did not have a fully-trained surgeon, however these hospitals performed 36% of district hospital emergency operations and 20% of all emergency operations. CONCLUSIONS: Emergency operations make up nearly half of all operations performed in Ghana. Most are performed at district hospitals, many of which do not have fully-trained surgeons. Obstetric procedures make up a large portion of emergency operations, indicating a need for improved provision of non-obstetric emergency surgical care. These data are useful for future benchmarking efforts to improve availability of emergency surgical care in Ghana and other low- and middle-income countries.