Table 1
Surgical oncology capacity assessment tool.
| GENERAL SURGERY INFRASTRUCTURE | HUMAN RESOURCES | ||
|---|---|---|---|
| General Infrastructure | Availability | Surgery | Quantity |
| Electricity/Power Generator Running Water Internet Oxygen # General Surgery Admissions per year # General Surgery Outpatients per year # Hospital Beds # General Surgery Beds # Post‑Op Beds # Surgical ICU Beds # OR ventilators # ICU ventilators Pulse Oximetry General Anesthesia IV Sedation Anesthesia Spinal Anesthesia Regional Anesthesia | Always Always Always Always 2,915 9,926 1600 150 6 4 12 20 Always Always Always Always Always | Total # Surgical Providers # Surgeons # Medical Officers # Asst Medical Officers Ever >1 month without surgeon? Surgical provider availability # Surgical Nurses # Theatre Assistants | 41 12 29 N/A No 24 hours/day 38 150 |
| OR Equipment | Availability | ||
| # Functional ORsb # Anesthesia Machines Surgical Instruments Sterilizer Consumables | 23 23 Always Always Always | ||
| Pharmacy | Availability | Anesthesia | Quantity |
| Post‑Op IV Narcotics Post‑Op Oral Narcotics Antibiotics for Surgery IV Fluids for Surgery | Always Always Always Always | # Anesthesia Providers Ever >1 month without anesthesia provider? Anesthesia provider availability | 16 No 24 hours/day |
| Radiology | Availability | Radiology | Quantity |
| Functional Ultrasound Functional X‑ray machine Functional CT scanner Functional MRI scanner | Always Always Always Always | # Radiologists # Radiology Technicians Ever >1 month without radiologist? | 12 17 No |
| Pathology and Laboratory Medicine | Availability | Pathology | Quantity |
| Laboratory in Facility Able to administer blood transfusions Biopsy services Biopsy approaches Staff who perform biopsies | Yes Always Yes CNB, EB, FNA Radiologists, General Surgeons | # Pathologists # Pathology Technicians Ever >1 month without a pathologist? # CNBs performed # EBs performed | 3 10 No 275 84 |
| Biopsy assessment location Turnaround time for biopsies Complete Blood Counts Chemistry Studies Coagulation Studies Histology Services Cytology Services Immunohistochemistry Services Barriers to the Above Services Annual frequency of equipment down Use of synoptic reporting templates | Onsite + private lab 1 week (private), 4 weeks (onsite) Always Always Always Always Always Sometimes Reagent stock outs None No (private lab uses synoptic reporting) | ||
| Multimodal Care | Availability | ||
| Administration of Chemotherapy Administration of Radiation Therapy | Always Always | ||
[i] Key: Intensive Care Unit (ICU), Operating Room (OR), Intravenous (IV), Complete Blood Count (CBC), core needle biopsy (CNB), excisional biopsy (EB), fine needle aspiration (FNA).
[ii] a ICU ventilators include 4 in surgery ICU, 6 in Medical ICU, and 10 in Pediatric ICU.
[iii] b ORs include First‑floor theatre (7: general surgery, urology, ENT, maxillofacial); pediatric surgery (2); obstetrics (2); gynecology (2); orthopedic (2); trauma (2); plastic surgery (2); cardiothoracic (2); neurosurgery (2).
[iv] c Consumables include sterile gloves, hand wash, skin prep.
[v] d Theater assistants include surgical nurses, technicians, assistants.
Table 2
Colorectal service delivery assessment.
| ANORECTAL PROCEDURES | ||||
|---|---|---|---|---|
| CONDITION | PROCEDURE | TOTAL | AVAILABILITY | BARRIERS |
| Anal Dysplasia | Fulguration of condylomas | 4 | Adequate | |
| High‑resolution anoscopy for anal dysplasia | 0 | Unavailable | Absent, Training | |
| Anorectal Mass | Transanal excision (polyp, mass) | 2 | Adequate | |
| Fecal Incontinence | Overlapping sphincteroplasty | 1 | Inadequate | Personnel |
| Fistula | Seton placement for perianal fistula | 0 | Unavailable | Infrastructure |
| Fistulotomy for perianal fistula | 37 | Adequate | ||
| Transsphincteric fistula repair (w/ plug, glues, or ligation of the intersphincteric fistula tract [LIFT], etc.) | 13 | Adequate | ||
| Endorectal advancement flaps | 5 | Adequate | ||
| Rectovaginal fistula repair with transposition flaps | 4 | Inadequate | Training | |
| Fissure | Botox injections | 0 | Unavailable | Absent, Infrastructure |
| Lateral internal sphincterotomy | 7 | Adequate | ||
| Hemorrhoid | Excisional hemorrhoidectomy | 64 | Adequate | |
| Banding of internal hemorrhoids | 0 | Unavailable | Othera | |
| Rectal Prolapse | Perineal rectosigmoidectomy (Altemeier) | 6 | Adequate | |
| Mucosal sleeve resection (Delorme) | 0 | Unavailable | Absent | |
| ABDOMINAL PROCEDURES | ||||
| CONDITION | PROCEDURE | TOTAL | AVAILABILITY | BARRIERS |
| Bowel resection (for cancer/ masses, IBD, diverticulitis, infections, etc.) | Abdominoperineal resection | 6 | Adequate | |
| Intersphincteric resection of the rectum | 16 | Adequate | ||
| Lower anterior resection | 10 | Adequate | ||
| Segmental colectomy | 76 | Adequate | ||
| Crohn’s/Genetic disorder related surgeries | Ileal anal pouch procedures | 2 | Adequate | |
| Strictureplasty | 0 | Unavailable | Otherb | |
| Rectal prolapse | Rectopexy | 0 | Unavailable | Training |
| Stoma | Stoma creation and management of complications | 52 | Adequate | |
| ENDOSCOPIC PROCEDURES | ||||
| PROCEDURE | TOTAL | AVAILABILITY | BARRIERS | |
| Anoscopy | 36 | Adequate | ||
| Colonoscopy | 336 | Adequate | ||
| Rigid/flexible sigmoidoscopy | 720 | Adequate | ||
| Upper endoscopy | 1560 | Adequate | ||
| PELVIC FLOOR EVALUATION | ||||
| PROCEDURE | TOTAL | AVAILABILITY | BARRIERS | |
| Anorectal manometry | 0 | Unavailable | Infrastructure, absent | |
| Balloon expulsion | 0 | Unavailable | Infrastructure, absent | |
| Endorectal ultrasound | 0 | Unavailable | Infrastructure, absent | |
| Defecography | 0 | Unavailable | Infrastructure, absent | |
| Pudendal nerve terminal motor latencies (PNTML) | 0 | Unavailable | Infrastructure, absent | |
| Pelvic floor physical therapy | 0 | Unavailable | Training, Otherc | |
[i] a Tool for banding of internal hemorrhoids was available but not used during the study period.
[ii] b No referrals received from gastroenterology for a patient who required a stricturoplasty during the study period.
[iii] c Pelvic floor physiotherapy is performed through the KBTH Department of Obstetrics and Gynecology.
Table 3
Minimum case numbers for US‑accredited colorectal surgery fellowships (adapted from Accreditation Council for Graduate Medical Education, 2017) [13].
| PROCEDURE CATEGORY | MINIMUM NUMBER | EXAMPLES |
|---|---|---|
| Anorectal Procedures | 60 | Hemorrhoidectomy (10 excisional), fistula surgery (30), internal sphincterotomy (2), transanal excision (10) |
| Abdominal Procedures | 120 | Segmental colectomy (50), laparoscopic resections (30), low anterior resection (20), abdominoperineal resection (5), ileal pouch procedures (5), prolapse repair (6 total: 3 abdominal, 3 perineal), stomas (20 total; 5 for complications) |
| Endoscopy/Pelvic Floor | 185 | Colonoscopy (140 total; 30 interventional), proctoscopy/anoscopy (30), pelvic floor evaluation (15) |