A 5-year evaluation of the effect of introduction of subspecialty practices on surgical case loads in the orthopaedic department of Moi Teaching and Referral Hospital

Abstract

Background: Subspecialization within the field of orthopaedic surgery is on the increase in the developing world. Objective: To evaluate the trends in surgical caseloads following introduction of subspecialty practices in the Department of Orthopaedics at Moi Teaching and Referral and Hospital. Methods: Retrospective review of theatre records of all orthopaedic surgeries between 2011 and 2015 was done. The numbers of surgeries were categorized as either trauma or non-trauma. The trends in surgical case loads were documented and analyzed against the changing number of orthopaedic surgeons, theatre time allocation, number of orthopaedic trainees and the number of hospitals offering consistent orthopaedic care in the catchment area. Results: Nine thousand and ninety one cases of orthopaedic surgery were performed from 2011 to 2015; of which 9601 (96.1%) were trauma cases while 390 (3.9%) were non-trauma surgeries. Non-trauma surgery caseloads consistently increased over the five year period from 2.5% to 4.8%. The critical factors in increasing orthopaedic surgery caseloads were theatre time allocation and the restructuring of the orthopaedic department into subspecialties. Conclusion/ Recommendations: Trauma surgeries were predominant during the study period. A restructuring of an orthopaedic department to accommodate subspecialty practices and an increase in the number of surgeons; must be coupled with an increase in theatre allocation time in order to increase orthopaedic non-trauma surgical caseloads.