1407. Neurosurgery in Western Uganda: An Interrupted Time Series Analysis

Authors: Jihad Abdelgadir, MD; Cyrus Elahi; Jacquelyn Corley, MD; Kevin Wall; Josephine Najjuma; Alex Muhindo, MD; Joao Ricardo Nickenig Vissoci, PhD; Michael Haglund, MD, PhD; David Kitya, MD (Durham, NC)


Despite the rising burden of surgical disease globally, infrastructure and human resources for health remain a great challenge for low-and-middle-income countries, this is especially true in Uganda. In this study, we aim to explore the trends of neurosurgical care at a regional referral hospital in Uganda and assess the long-term impact of the institutional collaboration between Mulago National Referral Hospital and Duke University.


An interrupted time-series is a quasi-experimental design used to evaluate the effects of an intervention on longitudinal data. We applied this design to evaluate the trends in monthly mortality rates for neurosurgery patients at Mbarara Regional Referral Hospital (MRRH) from March 2013 to October 2015. We used segmented regression and auto-regressive integrated moving average models for the analysis.


Over the study timeframe, MRRH experienced significant increases in referrals received (from 117 in 2013 to 211 in 2015), neurosurgery patients treated (from 337 in 2013 to 625 in 2015), and operations performed (from 61 in 2013 to 173 in 2015). Despite increasing patient volumes, the hospital achieved a significant reduction in hospital mortality during 2015 compared to prior years (p-value = 0.0039).


This interrupted time series analysis study shows improving trends of neurosurgical care in Western Uganda. There is a steady increase in volume accompanied by a sharp decrease in mortality through the years. Multiple factors are implicated in the significant increase in volume and decrease in mortality, including; the addition of a part-time neurosurgeon, improvement in infrastructure and experience. Further in-depth prospective studies exploring seasonality and long-term outcomes are warranted.