Creating an Outpatient, Local Anesthetic Hand Operating Room in a Resource-Constrained Ghanaian Hospital Builds Surgical Capacity and Financial Stability
Bibliographic record
Abstract
INTRODUCTION: Expanding surgical capacity is very difficult in resource-constrained countries. Financial input and additional physical operating room space are needed. The surgical patient volume exists, but the lack of operating room time causes postponement of cases. Hand surgery is particularly important as it improves patient function and allows for a timely return to the workforce after injury. Some hand surgery cases may be performed under local anesthesia with a very basic instrument set in a procedure room. This arrangement eliminates the need and financial burden of an equipped operating room and the need for an anesthesiologist. We hypothesized that performing hand surgery in a simple procedure room by a surgeon with knowledge of adequate local anesthesia could increase hand surgery capacity significantly in a low-income country. METHODS: This technique has been instituted at Komfo Anokye Teaching Hospital in Kumasi, Ghana, with the use of a single procedure room that was previously used for storage. A surgeon trained in performing wide-awake local anesthesia no tourniquet technique visited Komfo Anokye Teaching Hospital and provided lectures about hand surgery under local anesthesia and evidence-based sterility for 6 years. The number and type of cases performed in the procedure room were recorded for the first 11 months after it opened in 2017. RESULTS: For 11 months, use of this room had increased surgical capacity by 33 cases per month. Patient ages ranged from 2 months to 65 years. There have been 358 total cases performed, 240 of which were hand cases. This included washout of hand wounds (n = 87), tendon repair (n = 54) including a single tendon transfer, fracture pinning (n = 33), amputations (n = 24), trigger finger repair (n = 10), nerve repair (n = 6), congenital hand surgery (n = 4), and other (n = 22). Cost savings per case in the procedure room ranges from 500 cedis (US $100) to 2000 cedis (US $400). CONCLUSIONS: The simple procedure room runs more efficiently and is less costly compared with the main operating rooms. Although the case volume has increased surgical capacity significantly, costs to the hospital and patient have decreased. The hospital is reimbursed in a timely fashion for the procedures directly by the patient using this technique. The creation of a single procedure room for wide-awake local anesthesia no tourniquet hand surgery has helped address the issues of inadequate operating room space, time, and expense in resource-constrained Ghana.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.003 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.001 | 0.001 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.015 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".