1456. A Descriptive Analysis of spine surgeries performed by the first specialist Spine Surgeon in Botswana.

Authors: Louisa Onyewadume; Louisa Onyewadume; Berje Shammassian; Chukwuamaka Onyewadume; Margareta Nordin; Stefan Eberspaecher; Martha Sajatovic; Tiro Mmopelwa; Alia Hdeib (Cleveland, OH)

Introduction: Addressing global surgical disparities requires careful study of surgical care in low-to-middle income countries. The objective of our retrospective review is to assess patterns in presentation, treatment, and outcomes of patients who underwent spine surgery in Botswana. Methods: In this IRB approved study, charts of patients who underwent spine surgery between July 2016 and January 2018, at Gaborone Private Hospital, Botswana were reviewed for pre-operative demographics, intra-operative characteristics, and post-operative outcomes. Results: Of 83 patients with spine interventions, 44 underwent spine surgeries. For spine surgeries, the mean age was 49.8 years, 52.3% were male, 36.4% had comorbid hypertension, and 29.3% were HIV positive. MRI (54.6%) was the diagnostic procedure of choice, followed by X-Ray (31.8%) and CT (18.2%). Approximately two-thirds (63.6%) of patients lived more than 31 miles from the hospital and 68.2% were transferred from another hospital. Spine pathology mechanism included Trauma (43.2%), Tumor (15.9%), Infection (15.9%), and Degeneration (6.8%). For trauma vs non-trauma patients, mean age was 44.8 years vs 52.7 years, and the most common presenting symptoms were pain (62.5%), lower extremity paresis (43.8%), myelopathy (37.5%) and radiculopathy (18.8%) vs pain (36.8%), fracture and/or ligamentous injury (21.1%), spinal instability (10.5%), and radiculopathy (15.8%), respectively. Non-trauma patients had thoracic (43.8%) and lumbar (37.5%) disease and underwent Decompression & Instrumented Fusion (DIF) (43.8%) while trauma patients had even distributions of cervical, thoracic, and lumbar disease (36.8% each) and underwent DIF (26.3%) and ACDF (21.1%). Mean length of stay for trauma patients was three times greater than non-trauma patients (11.7 vs 4.7 days). On average, non-trauma patients had stable-to-improved status (70%) at post-operation day 2 and greater, vs trauma patients (20%). Conclusion: Spine surgeries are recently being performed by the first spine specialist surgeon in Gaborone, Botswana. It is important to establish baseline characteristics for this underreported population.