Assessment of essential surgical and anaesthesia care capacity: a cross-sectional study in five Pacific Island Countries.

Background: Pacific Island Countries (PICs) face unique challenges in providing surgical care. We assessed the surgical care capacity of five PICs to inform the development of National Surgical, Obstetric and Anaesthesia Plans (NSOAP). Methods: We conducted a cross-sectional survey of 26 facilities in Fiji, Tonga, Vanuatu, Cook Islands, and Palau using the World Health Organization - Program in Global Surgery and Social Change Surgical Assessment Tool. Findings: Eight referral and 18 first-level hospitals containing 39 functioning operating theatres, 41 post-anaesthesia care beds, and 44 intensive care unit beds served a population of 1,321,000 across the five countries. Most facilities had uninterrupted access to electricity, water, internet, and oxygen. However, CT was only available in 2/8 referral hospitals, MRI in 1/8, and timely blood transfusions in 4/8. The surgical, obstetric, and anaesthetist specialist density per 100,000 people was the highest in Palau (49.7), followed by Cook Islands (22.9), Tonga (9.9), Fiji (7.1), and Vanuatu (5.0). There were four radiologists and 3.5 pathologists across the five countries. Surgical volume per 100,000 people was the lowest in Vanuatu (860), followed by Fiji (2,247), Tonga (2,864), Cook Islands (6,747), and Palau (8,606). The in-hospital peri-operative mortality rate (POMR) was prospectively monitored in Tonga and Cook Islands but retrospectively measured in other countries. POMR was below 1% in all five countries. Interpretation: Whilst PICs share common challenges in providing specialised tertiary services, there is substantial diversity between the countries. Strategies to strengthen surgical systems should incorporate both local contextualisation within each PIC and regional collaboration between PICs. Funding: None.

Short-term outcomes of laparoscopic resection for colon cancer in a provincial New Zealand hospital.

BACKGROUND: Laparoscopic colectomy is associated with modest short-term benefits compared to equivalent open surgery. However, most published data comes from specialist colorectal units. We aimed to evaluate outcomes of laparoscopic colectomy in a provincial hospital setting. METHODS: Retrospective review of all patients who underwent laparoscopic colectomy at Palmerston North Hospital (a provincial New Zealand hospital) between March 2001 and April 2010 was performed. Demographic data, intraoperative parameters, postoperative outcome data, and pathological data were compared with published results from the Australasian Laparoscopic Colon Cancer Surgical trial (ALCCaS). RESULTS: Of 138 laparoscopic colonic resections performed, 76 satisfied criteria for inclusion. More left sided resections were performed in the PNH group versus the ALCCaS group (55% vs 40%). The intraoperative complication rate was significantly lower in the PNH group (2.6% vs 10.5%, P=0.039), and patients tolerated fluids one day earlier (P=0.0001), but mean days to passage of flatus, passage of bowel motion, and discharge were nearly identical. There were no statistically significant differences in the postoperative complication rate or in-hospital mortality. CONCLUSION: Short-term outcomes of laparoscopic colonic surgery for neoplasia in a secondary level provincial setting are equivalent to those from specialist colorectal units.

Short and long term outcomes of oesophagectomy in a provincial New Zealand hospital.

BACKGROUND: Oesophagectomy is a complex procedure associated with a significant morbidity and mortality rate. There is very little published data from New Zealand, with no published data from a non-Tertiary New Zealand hospital. We aimed to evaluate the outcomes of oesophagectomy at a single provincial hospital in New Zealand. METHOD: Retrospective review of clinical records of all patients who underwent oesophagectomy at Palmerston North Hospital (a level II provincial New Zealand public hospital) between 1993 and 2010 was performed. Demographic data, operative details, postoperative recovery parameters, survival data, pathological data, and details of adjuvant treatment were collected. RESULTS: Data from all 68 patients who underwent oesophagectomy were included. Mean age was 63.6 plus or minus 10.9 years, and 69% of patients were male. Mean operating time was 438.37 plus or minus 101.8 min, and mean intraoperative blood loss was 934.5 plus or minus 790.2 ml. Median intensive care unit stay was 7 (1-29) days, and total day stay was 17.5 (4-60) days. Tracheostomy was performed in 20 patients (29.4%). Anastomotic leak occurred in 7 patients (10.3%), chylothorax in 6 patients (8.8%) and cardiopulmonary complications in 34 patients (50.0%). The all cause in-hospital mortality rate was 4.4%. Overall survival at 30 days was 98.5%, at 1 year was 78.3% and at 5 years was 30.3%. CONCLUSION: Survival outcomes of oesophagectomy in this provincial New Zealand hospital are comparable to published series from national and international tertiary centres.