Nationwide enumeration of emergency operations performed in Ghana

  • Elissa K. Butler
  • Adam GyeduEmail author
  • Barclay T. Stewart
  • Robert Quansah
  • Peter Donkor
  • Charles N. Mock
Original Article



To determine the population-based rate of emergency surgery performed in Ghana, categorized by hospital level.


Data on operations performed from June 2014 to May 2015 were obtained from a nationally representative sample of hospitals and scaled up to nationwide estimates. Operations were categorized as to: “emergency” or “elective” and as to “essential” (most cost-effective, highest population impact) or “other” according to the World Bank’s Disease Control Priorities project.


Of 232,776 (95% UI 178,004–287,549) total operations performed nationally, 48% were emergencies. 112,036 emergency operations (95% UI 92,105–131,967) were performed and the annual national rate was 416 per 100,000 population (95% UI 342–489). Most emergency operations (87%) were in the essential category. Of essential emergency procedures, 47% were obstetric and gynecologic, 22% were general surgery, and 31% were trauma. District (first-level) hospitals performed 54%, regional hospitals 10%, and tertiary hospitals 36% of all emergency operations. About half (54%) of district hospitals did not have a fully trained surgeon, however, these hospitals performed 36% of district hospital emergency operations and 20% of all emergency operations.


Emergency operations make up nearly half of all operations performed in Ghana. Most are performed at district hospitals, many of which do not have fully trained surgeons. Obstetric procedures make up a large portion of emergency operations, indicating a need for improved provision of non-obstetric emergency surgical care. These data are useful for future benchmarking efforts to improve availability of emergency surgical care in Ghana and other low- and middle-income countries.


Emergency surgery Operation rate Ghana Low- and middle-income countries Global surgery 



The authors would like to thank the dedicated volunteers for extracting data needed for the study.

Author contributions

AG, BTS, RQ, and CNM developed the study concept and design. All authors contributed to acquisition, analysis, or interpretation of the data. EKB drafted the manuscript. All authors provided critical revision of the manuscript for important intellectual content.


This study was funded by Grants 5T32HD057822, R25-TW009345 and D43-TW007267 from the Fogarty International Center and US National Institutes of Health. The content of this study is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with ethical standards

Conflict of interest

Elissa K. Butler, Adam Gyedu, Barclay Stewart, Robert Quansah, Peter Donkor, and Charles N. Mock declare that they have no conflict of interest.

Ethics approval

The ethical committee of the Kwame Nkrumah University of Science and Technology approved this study and the University of Washington Institutional Review Board determined this study was exempt. No identifying information was collected as part of this study.


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of SurgeryUniversity of WashingtonSeattleUSA
  2. 2.Harborview Injury Prevention and Research CenterUniversity of WashingtonSeattleUSA
  3. 3.Department of Surgery, School of Medicine and DentistryKwame Nkrumah University of Science and TechnologyKumasiGhana
  4. 4.University Hospital, Kwame Nkrumah University of Science and TechnologyKumasiGhana

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