Skip to main content

Advertisement

SpringerLink
Log in

Learning Curve Characteristics for Caesarean Section Among Associate Clinicians: A Prospective Study from Sierra Leone

  • Original Scientific Report
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

In response to the high maternal mortality ratio, Sierra Leone has adopted an associate clinician postgraduate surgical task-sharing training programme. Little is known about learning curve characteristics for caesarean sections among associate clinicians. The aim of this study is to evaluate the number of caesarean sections needed to be performed by associate clinicians until there is no further significant reduction in operation time.

Methods

This prospective study evaluates the first 50 caesarean sections performed by trainees between January 2011 and June 2016. Primary outcome was total operating time in minutes (incision to suturing time). Secondary outcomes were length of hospital stay, surgical site infections, estimated operative bloodloss and in-hospital postoperative mortality.

Results

A total of 1174 caesarean sections performed by 24 trainees were analysed. Total operation time significantly reduced during the first 15 operations from mean (SD) operation time 72 (27)–51 (18) min after 15 procedures (p < 0.001). Estimated bloodloss did not significantly vary among the first 50 caesarean sections. Surgical site infections were reported in 3.7% of the operations, which was higher during the first 15 operations (6.8%) compared to the following 35 operations (2.3%). Length of stay reduced from median (range) 9 (2–39)–6 (2–127) days after 15 operations, but there was no reduction in maternal mortality.

Conclusion

While gaining experience, the operation time of associate clinicians significantly reduced during the first 15 caesarean sections. Estimated bloodloss is not related to trainees experience.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

References

  1. Meara JG, Leather AJ, Hagander L et al (2016) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. The Lancet 386(9993):569–624

    Article  Google Scholar 

  2. Shrime MG, Bickler SW, Alkire BC et al (2015) Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health 3(S2):S8–S9

    Article  PubMed  Google Scholar 

  3. Grimes CE, Bowman KG, Dodgion CM et al (2011) Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg 35(5):941–950. doi:10.1007/s00268-011-1010-1

    Article  PubMed  Google Scholar 

  4. Bolkan HA, Schreeb J, Samai MM et al (2015) Met and unmet needs for surgery in Sierra Leone: a comprehensive, retrospective, countrywide survey from all health care facilities performing operations in 2012. Surgery 157:992–1001

    Article  PubMed  Google Scholar 

  5. Trends in maternal mortality: 1990 to 2015: estimates by WHO, UNICEF, UNFPA, World Bank Group and the United Nations Population Division. Geneva: World Health Organization; 2015. http://datatopics.worldbank.org/hnp/files/Trends in Maternal Mortality 1990 to 2015 full report.PDF. Accessed Sep 2016

  6. Ribacke KJ, Van Duinen AJ, Nordenstedt H et al (2016) The impact of the West Africa Ebola outbreak on obstetric health care in Sierra Leone. PLoS ONE 11(2):e0150080

    Article  Google Scholar 

  7. World Health Organization Human Reproduction Programme A (2015) WHO Statement on caesarean section rates. Reprod Health Matters 23(45):149–150

    Article  Google Scholar 

  8. Molina G, Weiser TG, Lipsitz SR et al (2015) Relationship between caesarean delivery rate and maternal and neonatal mortality. JAMA 314(21):2263–2270

    Article  CAS  PubMed  Google Scholar 

  9. Ye J, Zhang J, Mikolajczyk R et al (2016) Association between rates of caesarean section and maternal and neonatal mortality in the 21st century: a worldwide population-based ecological study with longitudinal data. BJOG 123:745–753

    Article  CAS  PubMed  Google Scholar 

  10. World Health Organization Global Initiative (2005) Integrated Management for Emergency and Essential Surgical Care (IMEESC). http://www.who.int/surgery/publications/imeesc/en/. Accessed Jan 2017

  11. Bolkan HA, van Duinen A, Waalewijn B, et al (2017) Safety, productivity and predicted contribution of a surgical task-sharing programme in Sierra Leone. Br J Surg. http://onlinelibrary.wiley.com/doi/10.1002/bjs.10552/pdf. Accessed May 2017

  12. Duinen A, Cobb N, Mansaray AF, (2017) Sierra Leone’s Community Health Officers: a resilient, responsive health workforce. Transformative Education for Health Professionals. http://whoeducationguidelines.org/blog/sierra-leone%E2%80%99s-community-health-officers-resilient-responsive-health-workforce. Accessed April 2017

  13. Fok WY, Chan LY, Chung TK (2006) The effect of learning curve on the outcome of caesarean section. BJOG 113(11):1259–1263

    Article  CAS  PubMed  Google Scholar 

  14. Madsen K, Grønbeck L, Larsen CR et al (2013) Educational strategies in performing cesarean section. Acta Obstet Gynecol Scand 92:256–263

    Article  PubMed  Google Scholar 

  15. Müller I, Zimmermann R (2003) Die lernkurve im zusammenhang mit der sectio caesarea. Gynakol Geburtshilfliche Rundsch 43(4):238–244

    Article  PubMed  Google Scholar 

  16. Soergel P, Jensen T, Makowski L et al (2012) Characterisation of the learning curve of caesarean section. Arch Gynecol Obstet 286(1):29–33

    Article  CAS  PubMed  Google Scholar 

  17. Zhu JG, Han W, Guo W et al (2015) Learning curve and outcome of laparascopic transcystic common bile duct exploration for choledocholithiasis. BJS 102:1691–1697

    Article  CAS  Google Scholar 

  18. Mán E, Németh T, Géczi T et al (2016) Learning curve after rapid introduction of laparascopic appendectomy: are there any risks in surgical resident participation? World J Emerg Surg 11:17

    Article  PubMed  PubMed Central  Google Scholar 

  19. Horan TC, Gaynes RP, Martone WJ et al (1992) CDC definitions of nosocomial surgical site infections, 1992: a modification of CDC definitions of surgical site infections. Infect Control Hosp Epidemiol 13:606–608

    Article  CAS  PubMed  Google Scholar 

  20. Haynes AB, Regenbogen SE, Weiser TG et al (2011) Surgical outcome measurement for a global patient population: validation of the Surgical Apgar Score in 8 countries. Surgery 149:519–524

    Article  PubMed  Google Scholar 

  21. Chu K, Maine R, Trelles M (2015) Cesarean section surgical site infections in sub-Saharan Africa: a multi-country study from Medecins Sans Frontieres. World J Surg 39:350–355. doi:10.1007/s00268-014-2840-4

    Article  PubMed  Google Scholar 

  22. Mpogoro FJ, Mshana SE, Mirambo MM et al (2014) Incidence and predictors of surgical site infections following caesarean sections at Bugando Medical Centre, Mwanza, Tanzania. Antimicrob Resist Infect Control 3:25

    Article  PubMed  PubMed Central  Google Scholar 

  23. Isik O, Kaya E, Dundar HZ et al (2015) Surgical Site Infection: re-assessment of the risk factors. Chirurgia 110:457–461

    CAS  PubMed  Google Scholar 

  24. Uribe-Leitz T, Jaramillo J, Maurer L et al (2016) Variability in mortality following caesarean delivery, appendectomy, and groin hernia repair in low-income and middle-income countries: a systematic review and analysis of published data. Lancet Glob Health 4:e165–e174

    Article  PubMed  Google Scholar 

  25. Achuthan R, Grover K, Macfie J (2006) A critical evaluation of the electronic surgical logbook. BMC Med Educ 6:15

    Article  CAS  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

We are grateful to H. van der Zaag-Loonen, MD, epidemiologist, Gelre Hospital in Apeldoorn for her help during the data analysis.

Author information

Authors and Affiliations

  1. Royal Tropical Institute, P.O. Box 95001, 1090 HA, Amsterdam, The Netherlands

    B. P. Waalewijn & A. van Duinen

  2. CapaCare, Korsgata 17, 7030, Trondheim, Norway

    B. P. Waalewijn, A. van Duinen & H. A. Bolkan

  3. Gelre Hospital, Albert Schweitzerlaan 31, 7334 DZ, Apeldoorn, The Netherlands

    B. P. Waalewijn & M. J. Rijken

  4. Institute of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology (NTNU), P.O. Box 8905, 7491, Trondheim, Norway

    A. van Duinen & H. A. Bolkan

  5. Department of Surgery, St. Olavs Hospital, Trondheim University Hospital, Trondheim, Norway

    A. van Duinen & H. A. Bolkan

  6. Ministry of Health and Sanitation, Princess Christiana Maternity Hospital, Fourah Bay Road, Freetown, Sierra Leone

    A. P. Koroma

  7. Julius Global Health, The Julius Center for Health Sciences and Primary Care, P.O. Box 85500, 3508 GA, Utrecht, The Netherlands

    M. J. Rijken

  8. University Medical Center Utrecht, Utrecht, The Netherlands

    M. J. Rijken

  9. United Nations Population Found, New Signal Hill Road, Congo Cross, Freetown, Sierra Leone

    M. Elhassein

Authors
  1. B. P. Waalewijn
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. A. van Duinen
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. A. P. Koroma
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. M. J. Rijken
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. M. Elhassein
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. A. Bolkan
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to B. P. Waalewijn.

Ethics declarations

Conflict of interest

BW, AvD, HB are boardmembers of CapaCare, the NGO supporting the surgical training programme in Sierra Leone. APK has acted as local supervisor and trainer and received a honorarium from CapaCare. ME works for UNFPA Sierra Leone, a major technical and financial contributor towards the training programme in Sierra Leone.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (PDF 77 kb)

Supplementary material 2 (PDF 522 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Waalewijn, B.P., van Duinen, A., Koroma, A.P. et al. Learning Curve Characteristics for Caesarean Section Among Associate Clinicians: A Prospective Study from Sierra Leone. World J Surg 41, 2998–3005 (2017). https://doi.org/10.1007/s00268-017-4202-5

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00268-017-4202-5

Search

Navigation