Factors associated with treatment delays in orthopedic trauma patients attending the accident and emergency department of the University Teaching Hospital of Kigali

Abstract

Background: The delays to surgery are a global health problem, especially in trauma patients, given injuries are currently a major cause of deaths worldwide. However, the status of emergency orthopedic surgical delays in the Rwandan hospitals is not known. This study aims at describing the factors associated surgical treatment delays in emergency trauma patients received at the emergency of CHUK, the largest referral hospital in Rwanda. Methods: This was a single center cross-sectional study, conducted at the CHUK accident and emergency department, in the orthopedic unit. A sample of 112 patients was recruited. We recorded demographic data and injury characteristics. We evaluated the timing status between the injury and surgery, and we analyzed the factors associated with delayed surgery using a logistic regression model made of a full model containing all covariates and a final, reduced model containing only significant independent variables determined using a backward model selection approach. The goodness of fit was assessed using the Hosmer Lemeshow test. The model validation was done using training dataset (70%) and test dataset (30%) through the comparison of conclusions from them. Results: A total number of 112 patients constitutes our study sample size, 60 % of them were from the capital city, and Kigali.72.32% were males while 27.68% were females. 26.79% of selected patients had no insurance. 57% of our patients had open fractures, with the median time from injury to surgery being 2 days; while 48.65 % had closed fractures with the median time from injury to surgery was 4 days. In general, 64.22% of cases were delayed to have surgery. The majority of delayed patients had open fractures (37 patients) while 32 patients had closed fractures. Delays were commonly associated with lack of theater slot, lack of health insurance and other challenges like lack of implants, lack of sterile equipment and lack of experienced surgeon. Conclusion: surgery delay was related to both patient and institutional factors. These included patients lacking a health insurance, lack of theater slots, lack of implants, insufficient staff as well as lack of orthopedic emergency patient flow system. Improved community health insurance sensitization, increasing the infrastructure and personnel, and better usage of available resources would help in decreasing the amount of delays.