Building Surgical Capacity Sustainably in Resource-Constrained Ghanaian Hospital: A 7-Year Update on the Creation of an Outpatient Local Anesthetic Operating Room.

BACKGROUND

The Komfo Anokye Teaching Hospital (KATH) in Ghana serves a population of over 5.4 million people. The number of operating rooms creates a bottleneck to accessing surgical care. In a previously published paper, the plastic surgery department at KATH sought to utilize a wide-awake local anesthesia no tourniquet (WALANT) technique to perform hand surgery as a solution to improving surgical capacity. This technique, popularized by Donald H. Lalonde, was first utilized in February 2017 at KATH. We aim to provide an update on the utilization of this procedure room created almost a decade ago.

METHODS

Surgeries from January 1, 2023, to December 31, 2023, were included in this study. Procedures were categorized into elective versus emergent, and information regarding the cost of procedures for the patient was analyzed.

RESULTS

In 2023, a total of 500 surgeries were performed in the WALANT procedure room, with an average of 42 surgeries performed monthly. This represents a 40% increase in surgical volume compared to 2017. The plastic surgery team performed a total of 188 hand surgeries and 249 nonhand reconstructive surgeries. The procedure room has also garnered increased utilization from general surgery and orthopedic surgery, with an 86.4% increase in utilization from 2017. Prices remain comparable to prices in 2017 and remain more cost-effective compared to the same procedure done under general anesthesia in the main operating room. A total cost savings for patients of ₵578,816.30 was achieved for the 2023 year.

CONCLUSIONS

This local anesthesia technique and subsequent procedure room were born out of a necessity to increase surgical capacity at a major tertiary center in Ghana. Over the past 7 years, it has proven to be increasingly productive while remaining cost-effective for both patients and the hospital system alike. The transformation of a storage room into this procedure room shows how easily replicable this setup can be throughout other hospital systems. Finally, WALANT is an accepted practice in many parts of the world, and is easily learned. This model is thus a sustainable and practical solution to the surgical capacity problems facing overburdened medical systems in developing countries.