Comparative outcomes for pediatric cranial procedures by general surgeons and neurosurgeons in a tertiary care hospital in Ethiopia

TL;DR

This study compares the outcomes of pediatric cranial surgeries performed by general surgeons and neurosurgeons in a hospital in Ethiopia, finding similar results with proper training.

Contribution

The study provides evidence that general surgeons can achieve comparable outcomes to neurosurgeons in pediatric cranial procedures with appropriate training.

Findings

General surgeons and neurosurgeons had similar complication rates and lengths of stay for pediatric cranial procedures.

There was no statistically significant difference in outcomes between the two groups after adjusting for factors like age and delay.

The study supports task-sharing and mentorship to expand neurosurgical care in resource-limited settings.

Abstract

In resource-limited hospitals, pediatric neurosurgery is performed by general surgeons (GS) and neurosurgeons (NS), but the provider-specific impact remains unclear. This study compares pediatric neurosurgery cranial cases managed by GS and NS at a regional referral center in Southern Ethiopia.

Cranial operations in patients < 18 years (January 2020–October 2024) were retrospectively reviewed. Data included demographics, travel, delay (> 12 h), procedure type, and early outcomes (complications, length of stay [LOS]). Procedures were classified as routine (elevation, washout/I&D) or complex (shunt, craniotomy). Chi square with Yates and Mann‑Whitney U tests compared groups. Multivariable logistic regression adjusted for age, sex, and delay.

Among the 75 patients, 36 (48%) were treated by NS and 39 (52%) by GS. Routine operations predominated in GS (69.2% vs 55.6%) while complex procedures were more frequent in NS (36.1% vs 5.1%). LOS was comparable (4 days, p = 0.772), as were delays (41.0% GS vs 44.4% NS, p = 0.818) and complications (12.8% GS vs 19.4% NS, χ2 test with Yates p = 0.641). Complication rates for routine procedures were similar between groups (elevation 0% and washout/I&D 40%; p = 1.000), and although unadjusted rates were higher in the NS cohort for complex cases (craniotomy 66.7% vs 30.0%; shunt 23.1% vs 0%), these differences were not statistically significant (p = 0.510 and p = 1.000, respectively), with multivariable adjustment likewise showing no provider effect (aOR 1.25, 95% CI 0.27–5.78; p = 0.773).

With appropriate training, GS achieved early outcomes comparable to NS for routine and complex pediatric cranial operations. The absence of significant differences in complications supports structured task‑sharing and skills-based mentorship to expand neurosurgical care in resource-limited settings.

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