Surgery has been considered as essential component of public health. Surgical care is essential for managing diverse health condition such as injury, burn, malignancy, obstructed labor, cataract, infection and cardiovascular diseases1.  About 11% of global burden of disease require surgical care or anesthesia or both. According to lancet Commission for global surgery around 5000 surgeries required to meet the surgical burden of disease of 100000 people in low- and middle-income countries. As per report the surgery rate varies from 295 in low-income country to 23000 in high income per 100000 population [2-3]. This   variation is explained by unavailability of surgeons, anesthetist, obstetrician, lack of infrastructure, poor access to health care facility. India being a developing country with 70 % of population being residing in rural India. Recent figures show that not more than 20% of the population have any access to basic surgical services. This situation can be improved only if there is adequate number of rural surgeons in India where surgery is affordable and available near the patient’s residence. Surgical care is increasingly recognized as an important component contributing to global health, yet data for the burden of surgical disease especially in rural areas is scarce [4-6]. Here we are   doing retrospective observation study to analyze spectrum of various surgery in civil hospital from august 2022 to July 2022 from north India. The Data was collected from OT records to see the pattern of various surgical services provided under spinal and general anesthesia.

This retrospective observation study was conducted at civil hospital Palampur for a period of six month from April 2022 to September 2022.Civil hospital Palampur is a secondary healthcare institution with providing surgical services for all specialties like gynae and obstetric, general surgery, ENT and eye and orthopedics. Three anesthetist, three gynecologist, two general surgeon, one ENT and one eye surgeon were the specialist available in the hospital during study period. There is a single operation theatre (OT) in the hospital with one operating table which is shared by all specialties on day-to-day basis. Both elective as well as emergency procedures are performed in this operation theatre. DATEX OHMEDA anesthesia machine is present in our OT. Most of the ENT and eye surgery performed under local anesthesia. Most of the surgery conducted under spinal anesthesia, while general anesthesia is preferred for laparoscopic surgeries, in case of failure of spinal or contraindication to spinal anesthesia.

A total of 373 surgery performed in six-month duration under spinal or general anesthesia. Out of 373 surgery 207 were performed in emergency accounting for 55% of the total surgery. OBG specialty performed   a total of 258 surgery, 160 emergency and 98 in elective basis.  OBG surgery account for 69% of the total surgery performed in last six month. General surgery specialty performed total 60 surgery, 10 in emergency and 50 in elective basis accounting for 16% of the total surgery performed.  42 cataract surgery were performed by eye specialty accounting for 11% of total surgery in last six month. 17 surgeries performed by ENT specialty accounting for2.9 % of total surgery. Emergency LSCS was the most common emergency surgery while TAH was most common elective gynae surgery performed. Other gynae surgery include vaginal hysterectomy, tubal cannulation and cystectomy. Open cholecystectomy was the most common elective procedure while open appendectomy is the most common emergency procedure performed by general surgeon. Tympanoplasty, and myringoplasty surgery performed by ENT surgeon. While cataract surgery is performed by eye surgeon.

Table: 1 Specialty Wise Spectrum of Surgery

In our study, four surgical specialties performed 373 surgeries in six-month duration in a secondary care institution with single operation theatre. Being a secondary care institution   in a population of 2.5 lakh in rural region of HP, civil hospital Palampur act as the first referral centre for many primary care centres of surrounding region and nearby other district primary healthcare centre. This is first of the kind study conducted at this institution regarding spectrum of surgical services provided, to know about the major surgical cases load of respective department and to know about various limiting factor of specialty and accordingly utilization of the manpower and resources to improve health care delivery at secondary care institution. Despite of secondary care centre with single operation theatre 373 Surgeries were performed in six months out of which caesarean section is the most common surgery performed which account for 51% of the total surgery.  Combining both obstetric and gynae surgery 69% of the total surgery performed by gynae department. This may be explained by the availability of gynecologist andanaesthetist 24X7 for emergency LSCS in institution for better maternity care and less referral to higher centre.  Laparoscopy surgical services also provided for gall stone patient which performed under general anesthesia and having less post-operative pain and less surgical site infection considering its minimum invasive nature.  11% of the total surgery performed by eye and 2.9% ENT surgeon in last six month. None of the orthopedics surgery performed in the institution due to non-availability of orthopedic doctor.

Hence from above study it is clear that this hospital primarily providing   obstetric and gynae surgical services along with other surgical specialty services. Limiting   infrastructure like single OT table for both emergency and elective patient of all specialty limit the no of procedure in total, also emergency LSCS which contribute near 50 % of total procedure let the other specialty to postpone the elective cases. This led to long waiting list for other specialty. There is need to start separate table for maternal services in order to avoid long waiting list for other specialty patient, and need for resource utilization.

1. Meara J.G. et al. "Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development." The Lancet, vol. 386, no. 9993, 2015, pp. 569–624.

2. Liverani M. et al. "Improving access to health care amongst vulnerable populations: a qualitative study of village malaria workers in Kampot, Cambodia." BMC Health Services Research, vol. 17, no. 1, 2017, p. 335.

3. Shrime M.G. et al. "Global burden of surgical disease: an estimation from the provider perspective." The Lancet Global Health, vol. 27, no. 3, 2015, p. S8.

4. Debas H.T. et al. editors. Essential surgery: disease control priorities. 3rd ed., vol. 1, the International Bank for Reconstruction and Development/The World Bank, 2015.

5. Meara J.G. et al. "Global surgery 2030: evidence and solutions for achieving health, welfare, and economic development." The Lancet, vol. 386, no. 9993, 2015, pp. 569–624.

6. Bhandarkar P. et al. "Estimation of the national surgical needs in India by enumerating the surgical procedures in an urban community under universal health coverage." World Journal of Surgery, vol. 45, no. 1, 2021, pp. 33–40. https:/ /doi.org/10.1007/s00268-020-05794-7.