Overcoming Political Upheaval to Deliver Pediatric Surgical Care in Afghanistan: Prospective Analysis of the First 1,000 Procedures.

Abstract

Background: Pediatric surgical care is limited in Afghanistan. Few details are known about the state of pediatric surgery in Afghanistan. We explore the impact of a newly installed pediatric operating room by a children's charity on the provision of pediatric surgery in Afghanistan.

Study design: After the opening of the new Kids Operating Room at Ataturk Hospital in Kabul, Afghanistan, in March 2023, perioperative clinical data were prospectively collected until December 2023. All children (younger than 14 years of age) undergoing surgical procedures were included in a Research Electronic Data Capture database, and descriptive analyses were performed.

Results: A total of 1,014 operations were performed during the study period. Seventy-three percent of the patients were from Kabul Province, and 80% were male. Thirty-four percent of the operations were emergencies. Mean age was 6.5 years. Patients who received elective surgery were, on average, younger (age 5.2 years) compared with those who received emergency surgery (age 7.6 years [p < 0.0001]). The most common emergent diagnoses were appendicitis (52%), intussusception (9%), genitourinary pathologies (8.7%), and neurosurgical trauma (6.1%). The most common elective cases were hernias 27%, undescended testes (18%), hypospadias/epispadias (9%), urinary tract stones (8%), hydrocele/spermatocele/varicocele (7%), gastrointestinal pathologies (7%), and neurosurgical disorders (6%). The most frequent procedures were appendectomy (18%), inguinal hernia repair (17%), and orchidopexy (13%). The rates of mortality and infectious complication were both 0.3%.

Conclusions: This is the largest study on the provision of pediatric surgical care in Afghanistan, demonstrating the successful implementation of infrastructure for surgical capacity in a low-resource setting with a complex political status. Future efforts to quantify the burden of untreated pediatric surgical disease in this setting should assist advocacy efforts toward resource allocation and public health initiatives.