Description
Introduction:
There are many systemic and operational barriers to providing comprehensive postoperative care in a conflict zone, and tracking complication rates is limited due to poor follow-up, lack of hospital documentation, and many other complex factors. Due to a decade of protracted violent conflict, limited health infrastructure, and large-scale displacement in Syria, postoperative care in northwest Syria (NWS) is severely limited and understudied. This problem is especially concerning for the 2.8 million internally displaced persons (IDPs) in NWS, many of whom live in tented settlements and have reported difficulties accessing healthcare. The aim of this project is to characterize healthcare workers’ attitudes towards postoperative care and to quantify the frequency and nature of postoperative complications in NWS.
Methodology:
We conducted two surveys for this study. The first was distributed to healthcare workers in hospitals in NWS and assessed attitudes towards documentation, postoperative care, and potential barriers towards improving care. The second survey collected data from surgical patients at 12 hospitals in NWS on surgery type, complications, and barriers to follow-up. This survey was administered by phone in Arabic with patients or family members familiar with the patients’ healthcare. Multivariate regression was used to assess odds of complication by surgery type.
Findings:
In the first survey, 466 healthcare workers (38.8% doctors and 37.1% nurses) provided responses. 59% deemed postoperative care important, and 29% viewed it as unimportant with no significant difference between professions (p=0.429). There were many potential sources of postoperative complications noted by respondents, the most prominent being: poor patient compliance (21%), lack of routine follow-up appointments (14%), nonsterile operating room instruments (14%), and poor hospital cleanliness (13%).
In the second survey, of the 261 patients who provided responses, the most common complications included fever (26.8%), total parenteral nutrition (22.2%), wound infections (19.5%), nausea/vomiting (16.5%), and additional surgery (13.8%). Four had died. Over half of respondents (57.5%) reported some barrier to follow-up, with transportation (36.0%), financial barriers (31.8%), appointment availability (20.7%), and distance to facilities (19.9%) being the most common. Patients who had undergone orthopedic or trauma surgeries had increased odds of experiencing complications. Trauma patients had 11.04 higher odds (95% CI: 3.83 – 34.10) of receiving a blood transfusion and 10.65 higher odds (95% CI: 3.71 – 33.54) of wound infection following surgery. Orthopedic patients were 3.23 times more likely (95% CI: 1.23-8.66) to require a blood transfusion.
Innovative contribution:
This study is the first, to our knowledge, to study postoperative complications in NWS and identify barriers specific to this setting. Our study demonstrates that most hospitals lack evidence-based standardized approaches to care following surgery, and patients are ill-prepared to identify warning signs of postoperative complications, which many are experiencing with few interventions in place to track.
Conclusion:
The combined approach of assessing healthcare workers’ attitudes towards postoperative care and characterizing postoperative complications in the region provides a unique opportunity to deliver recommendations tailored to the specific healthcare system in NWS. Future efforts to reduce barriers may improve patient outcomes.
Acknowledgement:
Union of Medical Relief and Cares Organization–Canada
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