Each year, approximately 4 million people die from surgery- or anesthesia-related complications.1 Two-thirds of the related disabilities and premature deaths result from the lack of safe and effective surgical care in low- and middle-income countries (LMICs), and at least half of these deaths and disabilities are preventable.2 Premature disability and death resulting from surgical diseases exceed the global annual deaths from HIV, malaria, and tuberculosis combined.3 Only 6.5% of all surgical procedures occur in the poorest third of the world, yet over half of the deaths and disabilities resulting from surgical procedures and anesthesia occur in LMICs.4 In 2015, a Global Surgery agenda emerged in response to these disparities, compelling the global health community to focus on safe surgery and anesthesia. In 2018, the World Health Organization published a list of essential health metrics, including perioperative mortality and surgical site infection rates.
There is a tremendous need to develop sustainable programs aimed at improving perioperative outcomes in LMICs. High-income countries (HICs), such as the United States, have successfully used evidence-based quality improvement (QI) programs to prevent anesthesia- and surgery-related deaths and disabilities. QI programs in LMICs have the potential to provide impactful changes in relatively short time frames. QI programs also directly impact the population served in the local context. While there have been several successful efforts at QI projects in LMICs, much remains to be done to build capacity for QI in Sub-Saharan Africa. Through ongoing collaborations between the American College of Surgeons Health Outreach Program for Equity (ACS H.O.P.E) and the Global Academic Anesthesia Consortium (GAAC) with Hawassa University Comprehensive Specialized Hospital in Hawassa, Ethiopia, and University Teaching Hospital in Lusaka, Zambia, we identified a specific need to build capacity in perioperative QI through educational programs. Using a cost-sharing model, mostly funded by the University of Wisconsin Ira and Ineva Reilly Baldwin Wisconsin Idea Endowment award, we designed and conducted a perioperative quality improvement training program.
In December 2023, we conducted onsite 2-day workshops on perioperative QI in Lusaka, Zambia, and Hawassa, Ethiopia. The program included a mix of theoretical concepts in QI, practical applications, and hands-on workshopping for QI ideas. We included examples of successful QI projects from local hospitals and the United States. Speakers were from local institutions, ministries of health, and the US. Participants included a mix of trainees and faculty from the disciplines of surgery, anesthesia, and nursing. The was well received, with participant feedback indicating that it was extremely valuable, substantially improved their understanding of QI, and motivated them to take on QI projects in the near future. The workshop was supplemented by ACS online modules based on QI and a longitudinal mentorship program for QI projects.
We intend to run this workshop over the next 3 years and aim to equip a cohort of surgeons, anesthesia providers, and nurses with the basic knowledge and skills of designing, conducting, interpreting, and publishing contextually relevant QI programs.
To enable data-driven QI programs, we are implementing a perioperative registry that will facilitate data generation and analysis. To scale up QI programs in Sub-Saharan Africa, our experiences have identified a need to develop robust, accessible, and region-specific educational programs on perioperative quality improvement.
