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World Journal of Surgery
Published in: World Journal of Surgery 1/2017

01-01-2017 | Original Scientific Report

Barriers to Surgical Care and Health Outcomes: A Prospective Study on the Relation Between Wealth, Sex, and Postoperative Complications in the Republic of Congo

Authors: Brian M. Lin, Michelle White, Ana Glover, Greta Peterson Wamah, Davi L. Trotti, Kirstie Randall, Blake C. Alkire, Mack L. Cheney, Gary Parker, Mark G. Shrime

Published in: World Journal of Surgery | Issue 1/2017

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Abstract

Background

Approximately thirty percent of the global burden of disease is comprised of surgical conditions. However, five billion people lack access to surgery, with complex factors acting as barriers. We examined whether patient demographics predict barriers to care, and the relation between these factors and postoperative complications in a prospective cohort.

Methods

Participants included people presenting to a global charity in Republic of Congo with a surgical condition between August 2013 and May 2014. The outcomes were self-reported barrier to care and postoperative complications documented by medical record. Logistic regression was used to adjust for covariates.

Results

Of 1237 patients in our study, 1190 (96.2 %) experienced a barrier to care and 126 (10.2 %) experienced a postoperative complication. The most frequently reported barrier was cost (73 %), followed by lack of provider (8.2 %). Greater wealth was associated with decreased odds of cost as a barrier (OR 0.72 [0.57, 0.90]). Greater wealth (OR 1.52 [1.03, 2.25]) and rural home location (OR 3.35 [1.16, 9.62]) were associated with increased odds of no surgeon being available. Cost as a barrier (OR 2.82 [1.02, 7.77]), female sex (OR 3.45 [1.62, 7.33]), and lack of surgeon (OR 5.62 [1.68, 18.77]) were associated with increased odds of postoperative complication. Patient wealth was not associated with odds of postoperative complication.

Conclusions

Barriers to surgery were common in Republic of Congo. Patient wealth and home location may predict barriers to surgery. Addressing gender disparities, access to providers, and patient perception of barriers in addition to removal of barriers may help maximize patient health benefits.
Appendix
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Metadata
Title
Barriers to Surgical Care and Health Outcomes: A Prospective Study on the Relation Between Wealth, Sex, and Postoperative Complications in the Republic of Congo
Authors
Brian M. Lin
Michelle White
Ana Glover
Greta Peterson Wamah
Davi L. Trotti
Kirstie Randall
Blake C. Alkire
Mack L. Cheney
Gary Parker
Mark G. Shrime
Publication date
01-01-2017
Publisher
Springer International Publishing
Published in
World Journal of Surgery / Issue 1/2017
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI
https://doi.org/10.1007/s00268-016-3676-x

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