# 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.

## Key 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.