A descriptive retrospective cohort study of thoracic surgery experiences from September 2015 to July 2017 at three referral hospitals in Rwanda

Background
Universal access to safe surgery is still a challenge in low- and middle-income countries. An insufficient surgical workforce is a major barrier for performing surgery in these settings, especially specialized operations, such as cardiac and thoracic surgeries. This article describes the thoracic surgical procedures performed at three referral hospitals in Rwanda.

Methods
We conducted a retrospective cohort study involving patients with various chest pathologies operated by or under the supervision of a thoracic surgeon (faculty from the Human Resources for Health Program), at three teaching hospitals in Rwanda, from September 2015 through July 2017. This study included only major thoracic procedures. Data were collected from the faculty logbook and patient files. The information collected included demographic data, clinical presentation, radiological and intraoperative findings, and outcomes. Ethical approval was obtained from the University of Rwanda College of Medicine and Health Sciences Institutional Review Board.

Results
Thirty-two patients underwent 33 operations during the 23 months of the study (1 patient had 2 procedures). Twenty-one of the patients (66%) were male, and 11 (34%) were female. Patients’ ages ranged between 13 and 77 years, with a mean age of 41 years. Infectious chest pathologies (mostly tuberculosis-related) were common indications for surgery. Sixteen cases (48%) were thoracic empyemas that required either thoracotomy and pulmonary decortication or open thoracostomy (modified Eloesser flap). Other operations performed were anterior mediastinotomy for mediastinal mass (4 cases), biopsy and resection of chest wall mass (3 cases), pericardial window for pericardial tamponade (2 cases), resection of lung aspergilloma (2 cases), resection of a lung tumour (2 cases), and others (4 cases). Mortality was 6% (2 patients), and 3 patients had postoperative complications, which were surgical site infection in 1 patient and ineffective thoracotomy in 2 patients.

Conclusions
With clinical mentorship and dedicated teams, thoracic surgery can be performed in low-resource settings, where infectious pa- thologies predominate, with acceptable morbidity and mortality.

Keywords
thoracic surgery; thoracostomy; tuberculosis; empyema; outcomes; complications; Rwanda