World Journal of Surgery

, Volume 43, Issue 1, pp 36–43 | Cite as

General Thoracic Surgery in Rwanda: An Assessment of Surgical Volume and of Workforce and Material Resource Deficits

  • Adriana G. RamirezEmail author
  • Nebil Nuradin
  • Fidele Byiringiro
  • Georges Ntakiyiruta
  • Andrew E. Giles
  • Robert Riviello
Original Scientific Report



Benchmarking operative volume and resources is necessary to understand current efforts addressing thoracic surgical need. Our objective was to examine the impact on thoracic surgery volume and patient access in Rwanda following a comprehensive capacity building program, the Human Resources for Health (HRH) Program, and thoracic simulation training.


A retrospective cohort study was conducted of operating room registries between 2011 and 2016 at three Rwandan referral centers: University Teaching Hospital of Kigali, University Teaching Hospital of Butare, and King Faisal Hospital. A facility-based needs assessment of essential surgical and thoracic resources was performed concurrently using modified World Health Organization forms. Baseline patient characteristics at each site were compared using a Pearson Chi-squared test or Kruskal–Wallis test. Comparisons of operative volume were performed using paired parametric statistical methods.


Of 14,130 observed general surgery procedures, 248 (1.76%) major thoracic cases were identified. The most common indications were infection (45.9%), anatomic abnormalities (34.4%), masses (13.7%), and trauma (6%). The proportion of thoracic cases did not increase during the HRH program (2.07 vs 1.78%, respectively, p = 0.22) or following thoracic simulation training (1.95 2013 vs 1.44% 2015; p = 0.15). Both university hospitals suffer from inadequate thoracic surgery supplies and essential anesthetic equipment. The private hospital performed the highest percentage of major thoracic procedures consistent with greater workforce and thoracic-specific material resources (0.89% CHUK, 0.67% CHUB, and 5.42% KFH; p < 0.01).

Conclusions and relevance

Lack of specialist providers and material resources limits thoracic surgical volume in Rwanda despite current interventions. A targeted approach addressing barriers described is necessary for sustainable progress in thoracic surgical care.



We extend special appreciation to Drs. Christian Ngarambe and Emmanuel Kayibanda for their assistance in coordinating data collection on-site at CHUB and KFH, respectively. We also thank Drs. Marcel Durieux and Thomas Daniel for their supplementary feedback on essential surgical and anesthetic equipment for thoracic surgery. We are grateful to the Center for Global Health, the University of Virginia which provided financial support for travel expenses related to the work presented in this manuscript. The National Heart, Lung, and Blood Institute of the National Institutes of Health under Award Numbers T32HL007849 supported research reported in this publication. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

Supplementary material

268_2018_4771_MOESM1_ESM.docx (123 kb)
Supplementary material 1 (DOCX 123 kb)


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Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Adriana G. Ramirez
    • 1
    • 7
    Email author
  • Nebil Nuradin
    • 2
  • Fidele Byiringiro
    • 3
  • Georges Ntakiyiruta
    • 4
  • Andrew E. Giles
    • 5
  • Robert Riviello
    • 6
  1. 1.Department of Surgery, School of MedicineUniversity of VirginiaCharlottesvilleUSA
  2. 2.School of MedicineUniversity of VirginiaCharlottesvilleUSA
  3. 3.Department of Surgery, School of MedicineUniversity of RwandaKigaliRwanda
  4. 4.Ejo Heza Surgical CentreKigaliRwanda
  5. 5.Department of SurgeryMcMaster UniversityHamiltonCanada
  6. 6.Center for Surgery and Public Health, Women and Brigham HospitalHarvard UniversityBostonUSA
  7. 7.University of Virginia Medical CenterCharlottesvilleUSA

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