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Muncner S, Dell AJ, Mwita C, Bigam D, Saleh A. Examining need and capacity for the development of a pediatric liver transplantation program in Kenya. Pediatr Transplant 2023; 27:e14462. [PMID: 36604852 DOI: 10.1111/petr.14462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 10/02/2022] [Accepted: 12/09/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND In Africa, pediatric liver transplantation (PLT) is currently only performed in Egypt and South Africa, leaving those who require treatment in Kenya to travel abroad. The aim of this study was to determine whether sufficient capacity and need exists in Kenya to establish a safe and sustainable PLT program. METHODS A descriptive analysis of the intensive care unit (ICU) beds, surgical workforce, current hepatobiliary volume, and estimated prevalence of pediatric liver disease (PLD) was conducted across 17 hospitals in Kenya between July and September 2020. Data were collected from medical superintendents, directors of surgical departments, or nominated proxies at Kenyan Level 5 and 6 hospitals via a web-based survey. RESULTS A total of 165 ICU beds were reported at 17 facilities, with 15 facilities reporting five or more beds. About 39% of general surgeons at responding hospitals performed hepatobiliary procedures, and 30% performed pediatric surgeries. Only 10% of surgeons had pediatric training. Over half (57%) of hospitals performed hepatobiliary procedures; at the maximum, 1-5 cases were performed per week including cholecystectomy to Kasai portoenterostomy and hepatectomy. Across 13 hospitals, there were an estimated 192-570 cases of PLD seen per month. The most common PLDs were hepatitis B, neonatal hepatitis, cirrhosis, and acute hepatic failure. Overall, two hospitals possessed the minimum workforce and resources to attempt PLT. CONCLUSIONS In Kenya, ICU bed availability, pediatric surgical training, and hepatobiliary volume are limited. However, the high prevalence of PLD demonstrated a significant need for PLT across all Kenyan hospitals.
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Affiliation(s)
- Susan Muncner
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Angela J Dell
- Department of Surgery, University of Cape Town Health Sciences Faculty, Groote Schuur Hospital, Observatory, Cape Town, South Africa
| | - Clifford Mwita
- Afya Research Africa, Nairobi, Kenya.,Department of Surgery, Gatundu Level 5 Hospital, Gatundu, Kenya
| | - David Bigam
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Abdullah Saleh
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.,Office of Global Surgery, University of Alberta, Edmonton, Alberta, Canada
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Benkabbou A, Houssaini K, Majbar MA, Souadka A. Liver resection safety in a developing country: Analysis of a collective learning curve. J Visc Surg 2022; 159:350. [PMID: 35842367 DOI: 10.1016/j.jviscsurg.2022.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- A Benkabbou
- Department of Surgical Oncology, National Institute of Oncology, Rabat, Morocco; Translational Oncology Research Team (EROT), Faculty of Medicine and Pharmacy, Mohammed V Rabat University, Rabat, Morocco
| | | | - M A Majbar
- Department of Surgical Oncology, National Institute of Oncology, Rabat, Morocco; Translational Oncology Research Team (EROT), Faculty of Medicine and Pharmacy, Mohammed V Rabat University, Rabat, Morocco
| | - A Souadka
- Department of Surgical Oncology, National Institute of Oncology, Rabat, Morocco; Translational Oncology Research Team (EROT), Faculty of Medicine and Pharmacy, Mohammed V Rabat University, Rabat, Morocco
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Benkabbou A, Souadka A, Hachim H, Awab A, Alilou M, Serji B, El Malki HO, Mohsine R, Ifrine L, Vibert E, Belkouchi A. Risk factors for major complications after liver resection: A large liver resection study from Morocco and audit of a non-Eastern/non-Western experience. Arab J Gastroenterol 2021; 22:229-235. [PMID: 34538587 DOI: 10.1016/j.ajg.2021.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 05/11/2021] [Accepted: 05/31/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND STUDY AIMS In developing countries, endemic indications, blood shortages, and the scarcity of liver surgeons and intensive care providers can affect liver resection (LR) outcomes, but these have been rarely addressed in the literature. Therefore, in this study we determined risk factors for major complications after LR in a North African general surgery and teaching department. PATIENTS AND METHODS From January 2010 to December 2015, 213 consecutive LRs were performed on 203 patients. All patients underwent a postoperative follow-up of >90 days. Postoperative complications were assessed according to the Clavien-Dindo (CD) classification of surgical complications. A score of CD ≥III is considered as major postoperative complications. In this study, we analyzed the variables assumed to affect these complications. RESULTS The overall 90-day complication rate was 35.7% (n = 76), including a CD ≥III of 14% (n = 30) and a mortality rate of 6.1% (n = 14). According to the multivariate analysis, a preoperative performance status (PS) of ≥2 (P = 0.011; odds ratios [OR], 6.8; 95% confidence intervals [CI], 1.55-29.8), an estimated intraoperative blood loss of >500 ml (P = 0.002; OR, 3.71; 95% CI, 1.23-11.20), and bilioenteric anastomosis (P < 0.004; OR, 7.76; 95% CI, 1.5-3.89) were independent risk factors for major complications after LR. CONCLUSION We recommend that, in the setting of a non-Eastern/non-Western general surgery and teaching department, patients with a PS of ≥2 should undergo a specific selection and preoperative optimization protocol; intermittent clamping indications should be extended; and special attention should paid to patients undergoing LR associated with biliary reconstruction, such as for perihilar cholangiocarcinoma.
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Affiliation(s)
- A Benkabbou
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco; Faculty of Medicine, Mohammed V University, and Surgical Oncology Department, National Institute of Oncology, Rabat, Morocco.
| | - A Souadka
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco; Faculty of Medicine, Mohammed V University, and Surgical Oncology Department, National Institute of Oncology, Rabat, Morocco.
| | - H Hachim
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
| | - A Awab
- Faculty of Medicine, Mohammed V University, and Anesthesiology and Intensive Care Department, Ibn Sina Hospital, Rabat, Morocco
| | - M Alilou
- Faculty of Medicine, Mohammed V University, and Anesthesiology and Intensive Care Department, Ibn Sina Hospital, Rabat, Morocco
| | - B Serji
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
| | - H O El Malki
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
| | - R Mohsine
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco; Faculty of Medicine, Mohammed V University, and Surgical Oncology Department, National Institute of Oncology, Rabat, Morocco
| | - L Ifrine
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
| | - E Vibert
- Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France
| | - A Belkouchi
- Faculty of Medicine, Mohammed V University, and Surgical Department A, Ibn Sina Hospital, Rabat, Morocco
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Houssaini K, Majbar MA, Souadka A, Lahnaoui O, El Ahmadi B, Ghannam A, Houssain Belkhadir Z, Mohsine R, Benkabbou A. Liver resection safety in a developing country: Analysis of a collective learning curve. J Visc Surg 2021; 159:5-12. [PMID: 33744246 DOI: 10.1016/j.jviscsurg.2021.02.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM OF THE STUDY To analyze the collective learning curve in the performance of safe liver resections, using the decrease of severe postoperative complications (SPC) as a proxy for overall safety competency. MATERIAL AND METHODS This was a retrospective analysis of a prospective database in the setting of a liver surgery program implementation in a tertiary center in Morocco. The 100 first consecutive cases of elective liver resections starting from January 1st, 2018 were included in the analysis. SPC were defined as CD>IIIa during the first 90 postoperative days. We used a cumulative sum (CUSUM) technique to determine the number of cases required to achieve safety competency. We then compared case characteristics before and after the learning curve completion. RESULTS SPC occurred in 15 cases (15%), including 5 deaths (5%). The CUSUM chart revealed a learning curve completion at the 49th case, marked by an inflection point towards the decrease in SPC (24.5% vs 5.9%; P=0.009). In period 2 (after), cases were associated with less diabetes, less synchronous digestive resection, more cirrhosis, and more prolonged preoperative chemotherapy. The rates of major resection (30.6% vs 29.9%; P=0.89) and biliary reconstruction were comparable, as were the operating time, and estimated blood loss. CONCLUSION Approximately 50 cases were required to complete the learning curve and improve the overall safety of liver resection. In our setting, the learning curve chronology was consistent with collective measures, including team stabilization and protocol development.
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Affiliation(s)
- K Houssaini
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco.
| | - M A Majbar
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - A Souadka
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - O Lahnaoui
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - B El Ahmadi
- Intensive Care Department, National Institute of Oncology, Rabat, Morocco
| | - A Ghannam
- Intensive Care Department, National Institute of Oncology, Rabat, Morocco
| | | | - R Mohsine
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
| | - A Benkabbou
- Surgical oncology Department, National Institute of Oncology, Rabat, Morocco; Équipe de recherche en Oncologie Translationnelle (EROT), Faculty of Medicine and Pharmacy, University Mohammed V, Rabat, Morocco
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