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. 2023 Jan-Mar;27(1):e2022.00081.
doi: 10.4293/JSLS.2022.00081.

An Outcomes-Focused Analysis of Laparoscopic and Open Surgery in a Nigerian Hospital

Katherine E Smiley  1 , Funmilola Wuraola  2 , Bolanle O Mojibola  2 , Adewale Aderounmu  2 , Raymond R Price  1 , Adewale O Adisa  2
Affiliations

An Outcomes-Focused Analysis of Laparoscopic and Open Surgery in a Nigerian Hospital

Katherine E Smiley et al. JSLS. 2023 Jan-Mar.

Abstract

Background/objectives: The benefits of laparoscopic surgery such as swifter recovery and fewer wound complications, elude much of the developing world. Nigeria, a lower middle-income country, is the most populous sub-Saharan nation; an excellent model for studying the impact of laparoscopy in resource-constrained environments. The Department of Surgery at the Obafemi Awolowo University Teaching Hospital and the University of Utah's Center for Global Surgery present a study of laparoscopic surgery cases in sub-Saharan Africa.

Methods: A retrospective chart review of 261 patients compared open and laparoscopic surgical outcomes for three common general surgery procedures: open versus laparoscopic cholecystectomy and appendectomy, and open laparotomy versus diagnostic laparoscopy for biopsy of intra-abdominal mass. The primary outcome was total length of stay (LOS); secondary outcomes included wound complications, analgesia and antibiotic use, time to oral intake, and patient charges.

Results: Total LOS for laparoscopic surgery was significantly shorter compared to analogous open procedures (4.7 vs 11.5 days). Postoperative LOS was also shorter (2.6 vs 8.2 days). There were no differences in wound complications. Median charges to patients were lower for laparoscopic versus open procedures ($184 vs $217 USD).

Conclusions: The introduction of laparoscopy allows for significantly shorter LOS and equivalent wound complications in the context of a sub-Saharan teaching hospital. Concerns regarding higher costs of care for patients do not appear to be a significant issue. Further work is needed to evaluate costs to the hospital system as a whole, including procurement and maintenance of laparoscopic equipment.

Keywords: General surgery; LMIC; Laparoscopy; Outcomes.

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Conflict of interest statement

Conflict of interests: none.

Figures

Figure 1.
Figure 1.
Patient distribution by procedure type.
Figure 2.
Figure 2.
Total case volume by year.
See this image and copyright information in PMC

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