Neurosurgical Procedures by Neurosurgeons and General Surgeons at a Tertiary Hospital in Ethiopia: A Comparative Analysis of Case-Mix and Early Outcomes

Abstract

BACKGROUND AND OBJECTIVES: Sub-Saharan Africa faces a critical shortage of neurosurgeons (NS). In Ethiopia, general surgeons (GS) frequently manage emergencies, yet comparative outcome data with NS remain limited. This study aims to compare patient characteristics, procedural case-mix, and early outcomes between NS and GS for neurosurgical operations at a referral hospital in Ethiopia. METHODS: In this retrospective review of neurosurgical procedures performed between January 2020 and October 2024, we collected data on patient demographics, travel distance, procedure-specific variables, including operative type and surgical delay (<12 hours). Early postoperative outcomes, including complications and length of stay, were also analyzed. Fisher's exact test and the Mann-Whitney U test were used to compare groups while multivariable regression analysis-adjusted for sex, age, and surgical delay-assessed associations with complications. RESULTS: Among 378 patients, 107 (28.3%) were treated by NS and 271 (71.7%) by GS. GS patients were older (36.9 ± 19.5 vs 26.3 ± 20.6 years; P < .001), more often adults (84.5% vs 59.8%; P < .001), and care was more often delayed (68.3% vs 54.2%; P = .012). NS most often performed elevation (23.4%), burr hole (15.9%), and shunt (15.9%) procedures. GS primarily performed craniotomy (33.6%), burr hole (25.8%), and elevation (20.7%). Complication rates were similar (NS: 19.8%, GS: 23.2%; P = .560); length of stay was longer for NS (5 vs 4 days; P = .018). Adjusted odds of complications were not significantly different (adjusted odds ratio 1.2, 95% CI: 0.68-2.18; P = .539). CONCLUSION: GS performed most procedures-chiefly trauma-and achieved outcomes comparable with NS. Findings support task sharing and skills-based training as strategies to expand timely and safe operations in resource-limited settings.