Implementing a Perioperative Registry at Mbale Regional Referral Hospital in Eastern Uganda: Insights and future possibilities

Implementing a Perioperative Registry at Mbale Regional Referral Hospital in Eastern Uganda: Insights and future possibilities | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Implementing a Perioperative Registry at Mbale Regional Referral Hospital in Eastern Uganda: Insights and future possibilities Herbert Kiwalya, Chris Anold Balwanaki, Irene Wanyana, Elvis Amunyo, and 6 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-9253066/v1 This work is licensed under a CC BY 4.0 License Status: Under Review Version 1 posted 7 You are reading this latest preprint version Abstract Background Access to safe surgery is a core component of Universal Health Coverage yet many low- and middle-income countries lack reliable patient-level data to inform quality improvement. In Uganda, surgical data collection has historically relied on fragmented paper-based logbooks, limiting data accessibility and use for decision-making. We describe the iterative development, implementation and early impact of a novel electronic perioperative registry at Mbale Regional Referral Hospital in eastern Uganda. Methods Using a clinician-led, co-design approach, we developed a perioperative registry built on the open-source District Health Information Software 2 (DHIS2) Tracker platform. User requirements were defined through stakeholder engagement with surgical, anaesthesia, nursing and medical records teams. The system was aligned with national Health Management Information System (HMIS) reporting tools to avoid duplication of data entry. After an initial pilot on a standalone computer the registry was migrated to a secure in-country cloud server hosted by the Research and Education Network Uganda (RENU). The registry captured patient-level data across the perioperative pathway including admission details, intraoperative variables and postoperative outcomes as shown in Table 2. Data quality was supported through on the job training, validation rules and a dedicated weekly data validation process. Results Between May 2019 and November 2020, 2,751 surgical procedures were recorded during the pilot phase. Over four years of cloud-based implementation, 11,541 procedures were logged across multiple specialties. Implementation resulted in improved data security, elimination of manual logbook aggregation, automated generation of Ministry of Health reports and near real-time dashboard access for clinical teams. The registry supported data-driven quality improvement initiatives including identification of high-risk emergency laparotomy outcomes and subsequent establishment of enhanced postoperative care pathways. Challenges included unstable internet connectivity and staff turnover mitigated through offline data entry tools and regular training. Conclusion Implementation of a DHIS2-based perioperative registry in a regional referral hospital in Uganda was feasible and associated with improvements in data availability, reporting efficiency and clinical engagement with quality metrics. Embedding the registry within routine workflows and aligning with national reporting requirements enhanced sustainability. This model demonstrates how open-source digital health platforms can strengthen surgical service delivery and health system performance in resource-constrained settings. perioperative registry electronic data collection quality improvement health systems strengthening implementation science DHIS2 tracker Figures Figure 1 Figure 2 Figure 3 Figure 4 Background Surgery is a fundamental component of Universal Health Coverage 1 , with approximately 30% of the global burden of disease requiring surgical care 2 . Despite 90% of the world’s population living in the poorest countries, only 6% of global surgical procedures are conducted here 3 . Efforts to address this unmet need include improving access to surgery 4 , expanding the surgical and anaesthesia workforce 5 , and greater advocacy at local and continental levels 6 . There is however, a risk that focusing on improvements to surgical access, will lead to an increase in the number of post-surgical deaths. Currently, an estimated 4.2 million deaths occur within 30 days of surgery each year, half of which occur in In low- and middle-income countries (LMICs), where mortality rates after surgery are twice as high as the global average 7 . Many countries in Africa have developed national surgical, obstetric and anaesthesia plans to support improvements in surgical care pathways, including Ethiopia 8 , Tanzania 9 and Zambia 10 , focusing on improving both access and quality of care. A core theme across all national plans is the need for improvement strategies to be informed by accurate, timely data. Global collaborative efforts to reach consensus on the most effective ways to expand surgical care pathways, have led to recommendations to use data to inform future priorities, for monitoring and evaluation and to showcase advances in care 11 . There are multiple examples reinforcing this need for accessible and comprehensive patient-level data in modern healthcare. It supports quality improvement initiatives at facility level and enables decision making with valuable insights into patient outcomes and treatment procedures 12 . By facilitating analysis of trends, patient data also plays a key role in pointing out areas for improving clinical practices and optimising resource distribution 13 . In 2019, Uganda, like many other LMICs, relied heavily on paper-based records for managing healthcare data 14 . Paper-based records are inherently limited in their accessibility and capacity to provide real-time information, particularly in critical healthcare settings such as surgical care pathways 15 . The need to transition to electronic healthcare data systems to improve data management and accessibility was a priority for the country and Ministry of Health 16 . In Mbale Regional Referral Hospital (RRH) in eastern Uganda, the need for improvements in surgical care had been previously identified 17 . We describe the iterative development and implementation of an electronic perioperative registry, including its use to support efforts to improve perioperative data management in similar settings. Development and implementation of the perioperative registry Our goal was to improve access to perioperative data for the surgical care teams working on the frontline. Improved access would enable them to understand and improve the quality of surgical care within the hospital. By consolidating and digitising perioperative information through an electronic registry, the hospital aimed to streamline data flow and access, enabling near real-time analysis and response to emerging trends or issues. This approach would enable the team to refine surgical practices and foster a more accountable and evidence-based perioperative environment, where process decisions and improvements are directly driven by reliable, comprehensive data. Methods Setting Mbale RRH is a 470-bed referral and teaching hospital in eastern Uganda, serving over 4.6 million people across 17 districts as shown in Fig. 1 . In 2019 the hospital was the only government hospital in the region providing specialist surgical care in obstetrics, orthopaedics and general surgery. Anaesthesia was provided mainly by non-physician anaesthesia providers with one volunteer anaesthesiologist and intermittent support from one anaesthesiologist employed by the Faculty of Health Sciences of Busitema University. Postoperative care was provided on the wards where nurse to patient ratios reached as high as 1:40 18 . Patient medical records were paper based. For the collation and submission of monthly reports into the National Health Management Information System (HMIS) and mandated by the Ministry of Health (MoH), the hospital relied on fragmented paper logbooks to document surgical information. Data was entered in separate logbooks at multiple points, including initial admissions in the casualty ward, surgical procedure details in the operating theatre and ward admission and outcome data in the postoperative wards. This fragmentation hindered the ability to compile a comprehensive view of a patient's perioperative journey, coordinate care across all stages and track outcomes effectively. The manual tallying of data from these paper logbooks by non-clinical medical records personnel, for entry into the HMIS further compounded inefficiencies, leading to delays, inaccuracies and limited use of surgical data for informing process and improvement at the facility level. Planning and design The first phase of the implementation process involved planning and design. Through a series of collaborative meetings with the surgical, anaesthesia, nursing and medical records teams we generated user requirements and were able to identify challenges with the existing paper-based system that would strengthen the use case for an electronic system. Two examples of frustrations identified included the accurate reporting of facility surgical procedure rates because non-clinical medical records staff had difficulty reading and interpreting the handwriting in the operating theatre logbook and complaints from the surgeons about the time required to manually collate monthly and annual reports of their surgical activity required for their annual appraisals. To avoid double data entry into both paper logbooks and the electronic registry, we ensured that all MoH mandated data points from the paper logbooks were incorporated and that this data would be accessible when teams from the MoH visited the facility and required data. Examples of these MoH HMIS forms included the operating theatre register HMIS SUR 003 and the inpatient monthly report HMIS form 108 19 . During this stage, all existing data collection procedures were examined to help ensure a smooth transition to the electronic registry. Technology and infrastructure For the technology backbone of the perioperative registry, we utilised District Health Information Software 2 (DHIS2), a widely adopted open-source health management data platform 20 . The DHIS2 Tracker programme was employed to capture and manage detailed, patient-level data throughout the perioperative process, allowing for individual patient tracking from admissions to hospital discharge. At the time, this was the first use case of the DHIS2 tracker programme for this purpose that we were aware of. The registry was structured to mirror the organisational logic and reporting hierarchy of Uganda’s HMIS ensuring alignment with the Ministry of Health. DHIS2 Tracker was selected in preference to aggregate data modules because it supports longitudinal patient-level records and enables linkage of multiple events across the perioperative pathway. The system was deployed using a PostgreSQL backend database consistent with DHIS2 architecture 21 . Figure 3 shows the technical architecture of the perioperative registry with role-based user access through web and android interfaces connected securely to a cloud server via SSL encryption. Our first instance of the registry was implemented on a standalone computer in the main operating theatre, which was secured with a lock and had daily backups on a hard drive to ensure data security. This pilot phase enabled us to test the feasibility of transitioning from a paper to an electronic logbook within the context of Mbale RRH. This standalone instance only captured intraoperative data. Visual dashboards using DHIS2 visualisation tools were integrated to automatically display routine monthly reports and generate near real time data analysis to identify trends in caseload distribution of procedures across different surgical specialties. Figure 4 shows a sample dashboard designed in the perioperative registry providing near real-time visual summaries to support routine monitoring and reporting. Following a successful pilot, in which the operating theatre teams embraced electronic logging of cases, we transitioned to a scalable and more secure cloud-based setup. The perioperative registry's database was then hosted on a cloud server physically located within Uganda managed by the Research and Education Network Uganda (RENU). Automated analytics routines were scheduled to run nightly at 02:00 hours enabling near real-time generation of dashboards and routine reports. With this transition, our DHIS2 Tracker programme was expanded to capture data from the entire perioperative pathway, including basic admission data before surgery and ward admission data after surgery including surgical complications and hospital outcomes. Figure 2 illustrates the workflow within our tracker programme. The hosting arrangement complied with the Data Protection and Privacy Act of 2019 ensuring that all patient information is handled in accordance with national data protection requirements. System access was restricted through role-based user permissions with password-protected accounts assigned to authorised users only. Data was stored on secure servers with controlled access via secure shell (SSH) and all user activity was logged to support audit. In addition, data transmission and storage were protected through encryption-at-rest & transit mechanisms implemented at the server level with restricted administrative access and routine backups performed to safeguard against data loss and ensure system integrity. With future scalability to other facilities and clinical areas in mind, we named our programme Mbale Digital Analytics System (MDAS). Data quality and standards in MDAS The success of MDAS relied heavily on the accuracy, consistency and timeliness of data entry. To standardise data collection, MDAS utilised a set of predefined variables that include patient demographics, detailed surgical procedure information, outcomes and complications. These variables were carefully chosen to ensure they captured all the relevant details of perioperative care needed for the generation of key surgical indicators requested by the local teams and that align with Uganda’s national health reporting standards and international best practices. (Table 1 ) Table 1 Key HMIS surgical procedures monitored by the perioperative registry Category HMIS Code Indicator Obstetrics/Gynaecology SP01 Caesarean sections SP02 Obstetric fistula repair (RVF, VVF, RVVF) SP03 Evacuations (incomplete abortion) SP04 Laparotomy SP05 Hysterectomy Cardiothoracic Surgery CS01 Thoracotomy Plastic/ reconstructive surgery PR01 Skin grafting Paediatric Surgery PS01 Ramsteidts Procedure PS02 Excision of Sacro-coccygeal teratome PS03 PSARP (Posterior Saggital Anorectoplasty) PS04 Pull through PS05 Kasai Procedure PS06 Gastroschisis repair PS07 Diaphragmatic hernia repair PS08 Tracheal-eosophageal fistula repair PS09 Congenital cyst excision PS10 Congenital hernia repair PS11 Cut down Ocular surgery OC01 Cataract Surgery OC02 Glaucoma Surgery OC03 Orbital Surgery OC04 Oculoplasty OC05 Eye lid Operation OC06 Opthalmic laser Interventions OC07 Strabismus Surgery OC08 Trachoma surgery for TT OC09 Other Extra Ocular Surgeries Orthopaedics OR01 Sequestrectomy OR02 Spine surgery OR03 Arthroplasty OR04 Arthrotomy OR05 Limb disarticulation OR06 Bone reconstruction OR07 Amputation OR08 Corrective osteotomies OR09 Arthrodesis OR10 Arthroscopy OR11 Internal fixation OR12 Soft tissue releases Neurosurgery NS01 Craniotomy NS02 Burr Hole NS03 Cranioplasty NS04 Microdiscectomy NS05 ETV/CPC (Endoscopic 3rd Ventriculostomy/choroid plexus cauterization) NS06 Spina-bifida surgery NS07 EVD (External Ventricular Drainage) NS08 Elevation of depressed skull fracture NS09 VP shunts ENT Surgery TS01 Tracheostomy TS02 Adenotonsillectomy TS03 Nasal surgery TS04 Laryngological surgery TS05 Otological surgery TS06 ENT endoscopic surgery TS07 Other ENT surgeries Endocrine Surgery ES01 Thyroidectomy ES02 Mastectomy ES03 Adrenalectomy Urology UR01 Open Prostatectomy UR02 Radical prostatectomy UR03 Endo-urology UR04 Renal surgery (Nephrectomy etc.) UR05 Urinary stone Surgery UR06 Pyeloplasty UR07 Ureteric surgery UR08 Radical cystectomy UR09 Testicular Surgery (Orchidopexy, orchidectomy ,BSO ) UR10 Urine diversion (SPC, Nephrostomy) UR11 Urethroplasty UR12 Penectomy UR13 Genitoplasty UR14 Varicocelectomy UR15 Hypospadias repair UR16 Epispadias repair UR17 Bladder exstrophy UR18 Kidney transplant Gastro-intestinal tract GI01 Cholecystectomy GI02 Gastric Surgery G103 Pancreatic Surgery G104 Splenic Surgery GI05 Liver Surgery GI06 Liver transplant GI07 Colectomy GI08 Laparoscopic Surgery GI09 Endoscopic Surgery GI10 Colostomy GI11 Herniorrhaphy GI12 Appendicectomy Oral surgery OS01 Hemi-Mandibulectomy OS02 Total Mandibulectomy OS03 Segmental Resection of Mandible OS04 Salivary gland Surgery OS05 Neck dissection OS06 Partial-glossectomy OS07 Excision biopsy of tumour Other Un classified Surgical Procedures OT01 Debridement OT02 Incision and drainage of abscesses OT03 Safe Male Circumcision OT04 Others Table 2 Key variables captured by the perioperative registry Section Variable name Description Metadata type Datatype PROFILE Enrolment organizational unit Health facility where data entry is taking place enrolment n/a Enrolment date Date of registration enrolment date Patient System ID* ID number automatically assigned by the system when registering a new patient. Comprises facility code, year, week number and a unique 5-digit number attribute text IPD No.* Unique serial number given to the client during their inpatient admission attribute text NIN National Identification Number attribute text Surname* Surname of the client attribute text Given Name* Given name of the client attribute text Date of Birth/Age* Client's date of birth or age in years attribute number Age (years) Automatically calculated client's age in years attribute number Sex* Gender of the client attribute text Client Category Client citizenship status attribute text District* Client's district address attribute text Sub-county Client's sub-county address attribute text Parish Client's parish address attribute text Village Client's village address attribute text Referral in? * If the patient was referred in select yes. This will result in the options below. attribute yes/no Referred from If the patient was referred in. Choose the appropriate source of referral attribute text Referring health facility The name of the health facility the client was referred from attribute text Reason for referral Reason client was referred attribute text Reason for referral (Other) Free text box to collect 'other' reasons for referral attribute text Referred by Name of person referring attribute text Client Phone number Client's phone number attribute phone number Tobacco use Indicates whether the patient currently uses tobacco products attribute yes/no Alcohol use Indicates whether the patient currently consumes alcohol attribute yes/no Tobacco exposure Indicates whether the patient is regularly exposed to tobacco smoke attribute yes/no Next of kin surname Next of kin's surname attribute text Next of kin given name Next of kin's given name attribute text Next of kin relationship Next of kin's relationship with the patient attribute text Next of kin phone number 1 Next of kin's phone number attribute phone number Next of kin phone number 2 Next of kin's other phone number attribute phone number PRE-OPERATIVE INFORMATION Report date Automatically generated by system when stage created report date date Date of hospital admission* Date of hospital admission data element date Time of hospital admission* Time of hospital admission data element time Co-morbid disease* Indicates whether the patient has any co-morbid conditions data element yes/no Co-morbid disease List of co-morbid conditions data element text NYHA Classification New York Heart Association Classification - this is a severity of illness score for heart failure data element text Other co-morbid disease Any additional co-morbid diseases not listed in the primary co-morbid disease field data element text Co-morbid disease List of co-morbid conditions data element text Other co-morbid disease Any additional co-morbid diseases not listed in the co-morbid disease field data element text Co-morbid disease List of co-morbid conditions data element text Other co-morbid disease Any additional co-morbid diseases not listed in the co-morbid disease field data element text Haemoglobin (g/dl) Concentration of haemoglobin in the blood data element number INTRA-OPERATIVE INFORMATION Report date Automatically generated by system when stage created Report date date Date of surgery The date on which the surgery was performed data element date ASA physical status classification A classification score that assesses the fitness of patients before surgery data element text ASOS Risk score A score assessing the risk associated with surgery based on preoperative health data element number Surgical specialty Allows selection of specialties with additional data elements e.g. obstetrics data element text Time patient on theatre table data element time Anaesthesia start time data element time Time of skin incision* The time when the surgical incision was made in 24-hour format data element time Surgery end time data element time Time patient off theatre table data element time Re-operation for surgical complication* Indicates whether the patient underwent re-operation due to complications from the initial surgery data element yes/no Operation diagnosis* The medical diagnosis necessitating the surgery data element text Indication for surgery* The primary medical reason for the surgery data element text Urgency of surgery* Describes the urgency of the surgery data element text Operation technique − 1* The primary surgical technique used during the procedure data element text Other procedure Details any additional procedures performed during the surgery data element text Operation technique − 2 Secondary surgical technique used, if applicable data element text Other procedure Details any additional procedures performed during the surgery data element text Surgical procedure category* Categorization of the surgical procedure data element text Severity of surgery* The overall severity of the surgical procedure data element text Did the patient receive blood products? * Indicates whether the patient received a blood transfusion during surgery data element yes/no Did the patient receive whole blood? data element yes/no Number of units of whole blood The number of units of whole blood transfused data element text Did the patient receive packed red cells? data element yes/no Number of units of packed red cells The number of units of packed red cells transfused data element text Did the patient receive platelets? data element yes/no Number of units of platelets The number of units of platelets transfused data element text Did the patient receive FFP? data element yes/no Number of units of FFP The number of units of FFP transfused data element text Did the patient receive other blood products? data element yes/no Other blood products received free text box data element text Lead surgeon category* The professional category of the lead surgeon data element text Lead surgeon Name of the lead surgeon in charge of the procedure data element text Second surgeon category The professional category of the second surgeon, if any data element text Second surgeon Name of the second surgeon, if any data element text Third surgeon category The professional category of the third surgeon, if any data element text Third surgeon Name of the third surgeon, if any data element text Instrument Nurse The nurse responsible for managing surgical instruments data element text Anaesthesia technique* The primary technique of anaesthesia used during surgery data element text Lead anaesthesia provider category* The professional category of the lead anaesthesia provider data element text Lead anaesthesia provider Name of the primary provider of anaesthesia, other professional category data element text Second anaesthesia provider category The professional category of the second anaesthesia provider data element text Second anaesthesia provider Name of the second anaesthesia provider, other professional category data element text Theatre outcome* Outcome of the surgical procedure data element text Destination after surgery The location to which the patient was moved post-surgery data element text Was the level of care where the patient was admitted postoperatively sufficient for their needs? Evaluates if the postoperative care level was adequate data element yes/no Reason for gap in higher level care Discrepancies in the expected versus received level of care post-surgery data element text Time of death The time of the patient's death, if applicable data element time POST-OPERATIVE INFORMATION Report date Automatically generated by system Report date date Unplanned critical care admission* Did the patient have an unplanned critical care admission? data element yes/no Postoperative complications* Did the patient have any postoperative complications? data element yes/no Morbidity type Specifies the type of morbidity experienced by the patient, if any data element text Infectious complication Specifies the site of postoperative infection data element text Gastrointestinal complication Specifies the type of gastrointestinal issue post-surgery data element text Complication severity Classification of surgical complications by severity data element text Morbidity type − 2 Specifies the second type of morbidity experienced by the patient, if applicable data element text Infectious complication − 2 Identifies a second site of postoperative infection, if another occurs data element text Gastrointestinal complication − 2 Notes a second type of gastrointestinal issue that occurred post-surgery, if applicable data element text Complication severity − 2 Classification of surgical complications by severity data element text Morbidity type − 3 Specifies the third type of morbidity experienced by the patient, if applicable data element text Infectious complication − 3 Identifies a third site of postoperative infection, if another occurs data element text Gastrointestinal complication − 3 Notes a third type of gastrointestinal issue that occurred post-surgery, if applicable data element text Complication severity − 3 Classification of surgical complications by severity data element text Date of hospital outcome* Date on which the hospital outcome was determined post-op data element date Hospital outcome Overall outcome of the hospital stay post-surgery data element text Time of death Patient time of death in the hospital in 24-hour format data element text Length of stay after surgery Number of days in hospital after the date of surgery data element text Implementation of novel data collection tools, whilst recognised to be necessary often require additional human resource for data entry. At Mbale RRH, with central recruitment through the Ministry of Public Service and a limited resource envelope for wages, the employment of additional data entry or medical records staff was not a priority. Paper based records had been completed by existing clinical staff (usually medical interns and students) and it was expected that the transition to an electronic system to replace the paper logbooks would enable this to continue. Staff were trained and given login details to enable access to the system. Despite system design features to improve data quality (for example input validation, drop down menus and normal ranges) data quality remained poor due to inconsistencies and missed entries. To address this, a project funded data validation role was introduced. Data validation was conducted weekly to capture missed entries (these were identified through cross referencing with theatre lists and the nurses report books) and ensure accuracy, thereby improving the overall reliability of the registry. Using the existing workforce for data entry served multiple purposes: it integrated the registry into the hospital’s clinical workflow, ensuring that there was a sustainable team responsible for data entry. It also promoted a culture of responsibility among the future healthcare workforce by integrating data collection standards into the training of intern doctors and students. Results Value and immediate impact of MDAS During the pilot phase of MDAS, between May 2019 and November 2020 implemented on a standalone laptop in the main operating theatres, a total of 2,751 procedures were logged. Over the following four-year period 11,541 procedures were logged in the cloud-based MDAS. This included all elective and emergency general surgery, orthopaedic, gynaecological and ear nose and throat procedures in the hospital. Obstetric procedures were conducted in a separate operating theatre and not included in MDAS during this period. Table 3 shows immediate benefits observed during this period included improved data security (previous paper logbooks were kept out and could be accessed by anyone entering theatres) and longevity (paper logbooks would frequently break before they were full of pages easily becoming detached and going missing). Nursing staff no longer needed to compile weekly and monthly reports by hand and could access their own bespoke automated dashboard including flexibility to change date ranges to fit their needs. Table 3 Summary of immediate benefits observed following the implementation of the perioperative registry at Mbale Regional Referral Hospital Category Previous situation Improved outcome with registry Data security Paper logbooks were openly accessible in theatres and could be viewed by anyone Digital registry system restricted access to authorized users, improving confidentiality and data protection Record durability Paper logbooks were prone to wear and tear; pages often got lost or detached. Digital records ensured long-term preservation of data with secure backup and no risk of physical damage. Reporting burden Nurses manually compiled weekly and monthly reports from paper logbooks. Automated dashboards replaced manual summaries, saving time and reducing errors. Data accessibility Limited visibility and inflexible reporting formats Custom dashboards allow nursing staff to view data in real-time and filter by date range as needed. Although MDAS used a custom surgical procedure list to match commonly used procedure names familiar to the surgical teams, these were mapped to the MoH HMIS tool procedures to enable automated monthly reporting accessible to the medical records team immediately at the end of the month and without the previous requirement to enter the clean clinical area of theatres. This improved data accuracy and reduced incidence of late reporting. Additional immediate benefits included the ability for individual surgeons to request individualised procedure lists and statistics to support them in assessment of medical interns and for use during their own annual appraisals. MDAS also enabled data-driven quality improvement efforts. With real-time access to perioperative data, the surgical team was able to identify trends and pinpoint areas that needed improvement. MDAS acted as a trigger for quality improvement. In one such example, ward staff reported seemingly higher mortality rates in patients especially young children undergoing emergency laparotomies. Data from the registry was used to accurately describe outcomes and coincided with an opportunity to establish a high dependency unit and a dedicated nursing team to care for these high-risk patients. Lessons learnt A significant challenge encountered during the implementation of MDAS was unstable internet connectivity. This issue disrupted online real-time data capture on several occasions. As a mitigation strategy, we utilised the DHIS2 mobile application designed to allow offline data entry. This feature allowed medical staff to continue entering data into the system without an internet connection. The data was then synchronised with the DHIS2 server automatically once internet connectivity was restored, ensuring no data loss and maintaining the integrity of the registry’s information. While the DHIS2 mobile application allowed the team to continue data entry offline during periods of unstable internet connectivity, there was a trade-off in its use. The team found the mobile app harder to use compared to the web-based system. After a period, when the hospital internet connectivity stabilised, the app was no longer used. Mbale RRH is a training hospital for intern doctors, medical and nursing students. This high rate of staff turnover especially medical interns led to inconsistencies in data entry. To address this, we endeavoured to have regular training sessions for new and existing staff to ensure everyone was well-versed in the registry operations. Our dedicated data validator also held this training role. When the junior team members were well trained, there was a noticeable reduction in the data validation tasks required to maintaining the accuracy and reliability of the registry data. Discussion Mbale Digital Analytics System was a perioperative registry platform co-designed using an iterative approach in eastern Uganda using open source DHIS2 software. It was successfully implemented in a regional referral hospital with immediate benefits that included improved data workflows, automated reporting with outputs mapped to mandatory MoH reporting tools and more accessible data for frontline surgical teams to use for individual performance appraisals and for data driven quality improvement efforts. Support for research and policy making The data collected through the perioperative registry serves as a valuable resource for clinical research helping to generate new insights into surgical care in low-resource settings 22 . Additionally, this data can inform healthcare policy decisions, advocating for resource allocation and systemic changes that improve surgical care quality and accessibility 23 . By embedding variables within the routinely collected data in the perioperative registry, researchers can seamlessly integrate their research without the need for separate data collection systems or reliance on paper records. Also, the availability of pre-existing data in the registry eliminates the initial burden of data gathering for research, speeding up study processes. This capability not only improves the efficiency of research initiatives but also encourages a culture of evidence-based practice and continuous learning among all healthcare providers. Additionally, the registry's comprehensive dataset provides a fertile ground for medical students to engage in research projects, promoting a deeper understanding of surgical care dynamics and outcomes analysis. Benchmarking and performance evaluation The perioperative registry provides a platform for benchmarking against national and international standards 24 , allowing Mbale Regional Referral Hospital to evaluate its performance in various surgical domains. By comparing our data with that of similar institutions both locally and globally, Mbale Regional Referral Hospital can adopt innovative surgical techniques and care protocols that have proven successful elsewhere. This capability improves the hospital's responsiveness to emerging trends and challenges in surgical care. In addition, benchmarking through clinical registries has been shown to drive continuous quality improvement by identifying performance gaps and guiding targeted interventions to improve surgical outcomes 25 . Enhanced patient care and safety The registry enables detailed tracking and analysis of perioperative processes, from pre-operative assessments through post-operative recovery thus can be used to measure and report additional quality metrics 26 . By capturing patient-level clinical data, the registry supports continuous monitoring of surgical outcomes. Routine collection and analysis of perioperative indicators has been recommended as a key strategy for strengthening surgical safety and quality of care in health systems globally 27 . Strengths and limitations A key strength of this work is the pragmatic, clinician-led approach used to design and implement the registry within a public hospital setting. The system was developed iteratively with direct input from end users ensuring alignment with existing clinical workflows and minimising disruption to routine care. The use of open-source DHIS2 software enhanced sustainability and facilitated alignment with national digital health strategies. Embedding the registry within routine practice rather than as a parallel research tool strengthened ownership among clinical staff and increased the likelihood of long-term adoption. In addition, the integration of automated dashboards and reporting tools reduced the burden of manual data aggregation and improved access to timely information. However, several limitations should be acknowledged. Data completeness and accuracy were initially affected by staff turnover and competing clinical priorities. Although the introduction of a dedicated data validation role improved data quality, this represents an additional resource requirement that may not be readily available in all settings. Finally, while the registry captures detailed perioperative data, outcome follow-up beyond hospital discharge was not done, restricting longer-term outcome assessment. Conclusion Future perspectives The immediate priority is to achieve seamless interoperability between the perioperative registry and the Ministry of Health’s new electronic medical records system known as eAFYA 28 . This integration aims to allow data entry primarily through eAFYA, while enabling frontline healthcare workers to engage with that data through the perioperative registry to drive quality improvement initiatives. Future efforts will focus on refining this interoperability within the Ministry of Health’s Data Warehouse infrastructure. Additionally, plans are underway to extend the registry’s coverage to other clinical specialties within Mbale Regional Referral Hospital building on successes already seen in the neonatal intensive care unit and eventually scale the registry to other hospitals across the region and nationally. To ensure sustainability, the roles of medical records personnel and data collectors need to be formalised within facility staffing structures. A long-term funding model will combine government support, grants and international partnerships to support ongoing operations, infrastructure development and staff training. This positions the registry as a national model for surgical care improvement. Abbreviations DHIS2 District Health Information Software, version 2 HMIS Health Management Information System LMIC Low-and Middle-Income Country MDAS Mbale Digital Analytics System MOH Ministry of Health RENU Research and Education Network Uganda RRH Regional Referral Hospital SSH Secure Socket Shell Declarations Consent for publication Not applicable Ethics approval and consent to participate This implementation was conducted in accordance with the declaration of Helsinki. Ethics approval for the registry was obtained from the Busitema University Faculty of Health Sciences Research and Ethics Committee, Busitema University Faculty of Health Sciences, Uganda (Approval No. BUFHS-2024-162) and approved by the Uganda National Council of Science and Technology (UNCST) (Ref No. HS4359ES).. As MDAS was implemented as a service improvement initiative replacing paper-based medical records with an electronic system and forming part of routine hospital health records, individual informed consent to participate was not required. Availability of data and materials The datasets generated and/or analysed during the implementation are available from the corresponding author on reasonable request and following review and approval by the research and ethics committee in Uganda. Competing interests None declared Funding The following organisations have provided financial support to enable the development and implementation of the perioperative registry. University of California San Francisco, Partnerships Overseas Networking Trust, and Busitema University. We are grateful for their support. Authors' contributions HK and AHS conceptualised the project and system design. HK led system development, implementation, data curation, and manuscript drafting. CAB and FM contributed to methodology and data analysis oversight. AHS, IW, EA, HN, MK, and RG supported implementation, validation and clinical data interpretation. FM provided statistical guidance. AHS supervised the project and critically revised the manuscript. All authors reviewed and approved the final manuscript. Acknowledgements Our gratitude to all those who contributed to the successful implementation and ongoing operation of the perioperative registry at Mbale Regional Referral Hospital. Special thanks go to the dedicated hospital staff, including surgeons, nurses, anaesthesia providers, and medical interns, whose daily efforts and commitment have been key in the registry's development and integration into the hospital’s workflow. Our appreciation also extends to the IT and administrative teams for their role in managing the technical aspects of the registry, ensuring data integrity, and addressing the challenges of system integration and user training. References Price R, Makasa E, Hollands M, World Health Assembly Resolution WHA68.15. Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage—Addressing the Public Health Gaps Arising from Lack of Safe, Affordable and Accessible Surgical and Anesthetic Services. World J Surg. 2015;39(9):2115–25. 10.1007/s00268-015-3153-y . Shrime MG, Bickler SW, Alkire BC, Mock C. Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health. 2015;3(Suppl 2):S8–9. 10.1016/S2214-109X(14)70384-5 . Meara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569–624. 10.1016/S0140-6736(15)60160-X . Wong EG, Deckelbaum DL, Razek T. Global access to surgical care: moving forward. Lancet Glob Health. 2015;3(6):e298–9. 10.1016/S2214-109X(15)00004-2 . Holmer H, Lantz A, Kunjumen T, et al. Global distribution of surgeons, anaesthesiologists, and obstetricians. Lancet Glob Health. 2015;3(Suppl 2):S9–11. 10.1016/S2214-109X(14)70349-3 . Alayande B, Seyi-Olajide J, Fenta B, et al. The Pan-African Surgical Healthcare Forum: An African qualitative consensus propagating continental national surgical healthcare policies and plans. PLOS Glob Public Health. 2024;4. 10.1371/journal.pgph.0003635 . Biccard BM, Madiba TE, Kluyts HL, et al. Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet Lond Engl. 2018;391(10130):1589–98. 10.1016/S0140-6736(18)30001-1 . Osebo C, Grushka J, Deckelbaum D, Razek T. Assessing Ethiopia’s surgical capacity in light of global surgery 2030 initiatives: Is there progress in the past decade? Surg Open Sci. 2024;19:70–9. 10.1016/j.sopen.2024.03.015 . Citron I, Jumbam D, Dahm J, et al. Towards equitable surgical systems: development and outcomes of a national surgical, obstetric and anaesthesia plan in Tanzania. BMJ Glob Health. 2019;4(2):e001282. 10.1136/bmjgh-2018-001282 . Peters AW, Roa L, Rwamasirabo E, et al. National Surgical, Obstetric, and Anesthesia Plans Supporting the Vision of Universal Health Coverage. Glob Health Sci Pract. 2020;8(1):1–9. 10.9745/GHSP-D-19-00314 . Albutt K, Sonderman K, Citron I, et al. Healthcare Leaders Develop Strategies for Expanding National Surgical, Obstetric, and Anaesthesia Plans in WHO AFRO and EMRO Regions. World J Surg. 2019;43(2):360–7. 10.1007/s00268-018-4819-z . Bhati D, Deogade MS, Kanyal D. Improving Patient Outcomes Through Effective Hospital Administration: A Comprehensive Review. Cureus. 2023;15(10):e47731. 10.7759/cureus.47731 . Raghupathi W, Raghupathi V. Big data analytics in healthcare: promise and potential. Health Inf Sci Syst. 2014;2:3. 10.1186/2047-2501-2-3 . Ssebibubbu S, Ssekamwa F, Muhumuza N, Mulumba M. Reforming Uganda’s digital health data systems: A policy analysis for inclusive, equitable, and decolonised data governance. Digit Health. 2026;12:20552076251408532. 10.1177/20552076251408532 . Boike L, Canala L, Kozminski K, Wynd CA. Development of an outpatient perioperative care record. J Post Anesth Nurs. 1995;10(3):140–50. Ministry of Health (Uganda). Uganda Health Information and Digital Health Strategic Plan 2020/21–2024/25. Ministry of Health; 2020. Hewitt-Smith A, Bulamba F, Olupot C, et al. Surgical outcomes in eastern Uganda: a one-year cohort study. South Afr J Anaesth Analg. 2018;24(5):122–7. 10.1080/22201181.2018.1517476 . Hewitt-Smith A, Bulamba F, Patel A, et al. Family supplemented patient monitoring after surgery (SMARTER): a pilot stepped-wedge cluster-randomised trial. Br J Anaesth. 2024;133(4):846–52. 10.1016/j.bja.2024.06.027 . Ministry of Health (Uganda). Health Management Information System (HMIS) Manual. Ministry of Health; 2010. https://www.gou.go.ug/sites/default/files/media-files/THE%20HEALTH%20MANAGEMENT%20INFORMATION%20SYSTEM_0.pdf . Dehnavieh R, Haghdoost A, Khosravi A, et al. The District Health Information System (DHIS2): A literature review and meta-synthesis of its strengths and operational challenges based on the experiences of 11 countries. Health Inf Manag J Health Inf Manag Assoc Aust. 2019;48(2):62–75. 10.1177/1833358318777713 . Øverland L. September. DHIS 2 to support PostgreSQL only? dhis2 community. 2017. https://community.dhis2.org/t/dhis-2-to-support-postgresql-only/4576 Gazzetta JD, Mutambo PP, Mpabalwani MB, et al. The Implementation of a Perioperative Registry in a Resource-Limited Setting: A Feasibility, Fidelity, and Acceptance Study. Med Res Arch. 2025;13(6):6574. 10.18103/mra.v13i6.6574 . Addressing priorities for surgical research in Africa. : implementation of a multicentre cloud-based peri-operative registry in Ethiopia. Anaesthesia. 2021;76(7):933–9. 10.1111/anae.15394 . Reilly JR, Shulman MA, Gilbert AM, et al. Towards a national perioperative clinical quality registry: The diagnostic accuracy of administrative data in identifying major postoperative complications. Anaesth Intensive Care. 2020;48(3):203–12. 10.1177/0310057X20905606 . Bath MF, Kohler K, Hobbs L, et al. The Impact of Trauma System Implementation on Patient Quality of Life and Economic Burden: A Systematic Review Study Protocol. Int J Surg Protoc. 2023;27(1):84–9. 10.29337/ijsp.187 . Jaraczewski TJ, Abebe BM, Diehl T, et al. Implementation of a perioperative registry in Ethiopia to enhance surgical quality improvement. World J Surg. 2024;48(8):1829–39. 10.1002/wjs.12240 . World Health Organization. World Health Organization. Global Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. Geneva: WHO;. 2009. World Health Organization. Accessed March 15, 2026. https://iris.who.int/handle/10665/44185 Ministry of Health (Uganda). Electronic Medical Records Rollout Transforms Patient Care and Data Management. Community Health. https://health.go.ug/electronic-medical-records-rollout-transforms-patient-care-and-data-management/ Additional Declarations No competing interests reported. Cite Share Download PDF Status: Under Review Version 1 posted Reviewers agreed at journal 19 May, 2026 Reviewers agreed at journal 13 May, 2026 Reviewers invited by journal 06 May, 2026 Editor assigned by journal 04 May, 2026 Editor invited by journal 09 Apr, 2026 Submission checks completed at journal 09 Apr, 2026 First submitted to journal 09 Apr, 2026 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-9253066","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":639958401,"identity":"11421cdb-4e42-4ed4-b6e4-7b8e50ebd7cb","order_by":0,"name":"Herbert Kiwalya","email":"","orcid":"","institution":"Busitema University","correspondingAuthor":false,"prefix":"","firstName":"Herbert","middleName":"","lastName":"Kiwalya","suffix":""},{"id":639958404,"identity":"6c295d07-5056-4469-a1e9-245156509e09","order_by":1,"name":"Chris Anold Balwanaki","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Chris","middleName":"Anold","lastName":"Balwanaki","suffix":""},{"id":639958405,"identity":"87296cc8-2fbd-4e1a-b263-02c3d7b35edb","order_by":2,"name":"Irene Wanyana","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Irene","middleName":"","lastName":"Wanyana","suffix":""},{"id":639958407,"identity":"473ae5d3-f347-4b63-b04e-3199bb13ba55","order_by":3,"name":"Elvis Amunyo","email":"","orcid":"","institution":"Elgon Centre for Health Research \u0026 Innovation","correspondingAuthor":false,"prefix":"","firstName":"Elvis","middleName":"","lastName":"Amunyo","suffix":""},{"id":639958409,"identity":"104a325b-cbbe-49e9-a68f-6d2b6452fb57","order_by":4,"name":"Hasifah Namutebi","email":"","orcid":"","institution":"Elgon Centre for Health Research \u0026 Innovation","correspondingAuthor":false,"prefix":"","firstName":"Hasifah","middleName":"","lastName":"Namutebi","suffix":""},{"id":639958411,"identity":"d2a35618-9cce-49b8-ab25-b543d52bc5b7","order_by":5,"name":"Fred Maiso","email":"","orcid":"","institution":"Elgon Centre for Health Research \u0026 Innovation","correspondingAuthor":false,"prefix":"","firstName":"Fred","middleName":"","lastName":"Maiso","suffix":""},{"id":639958413,"identity":"7e6e1eb3-22d5-4224-8124-e4b3015cf1e1","order_by":6,"name":"Muzamiru Kawiso","email":"","orcid":"","institution":"Elgon Centre for Health Research \u0026 Innovation","correspondingAuthor":false,"prefix":"","firstName":"Muzamiru","middleName":"","lastName":"Kawiso","suffix":""},{"id":639958415,"identity":"679be72d-04dd-49b6-b2b1-5fc7c9cb114b","order_by":7,"name":"Richard Gamubaka","email":"","orcid":"","institution":"Elgon Centre for Health Research \u0026 Innovation","correspondingAuthor":false,"prefix":"","firstName":"Richard","middleName":"","lastName":"Gamubaka","suffix":""},{"id":639958416,"identity":"5a058a6d-2936-4932-b97a-13a708c94296","order_by":8,"name":"Fredrick Makumbi","email":"","orcid":"","institution":"Makerere University","correspondingAuthor":false,"prefix":"","firstName":"Fredrick","middleName":"","lastName":"Makumbi","suffix":""},{"id":639958419,"identity":"01ffcee8-5520-4219-af6a-fd7329299308","order_by":9,"name":"Adam Hewitt-Smith","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAABCElEQVRIiWNgGAWjYFCCBAZmIMkDZR+QA9EHHhCjhYcNxE44YAzWkkCEFgawFoaEA4kNEEHcgL89+enmgorDMvby7U83PPxxJ31+2OGHQFvs5HQbsGuROPPM7PaMM4eBDuMxu5GQ8Cx34+00A6CWZGOzAzisuZFgdpu37TZICxtQy+HcjbMTQFoOJG7DoUX+Rvq327z/QFrYn4G0pBvOTv+AV4vBjRygLQ0gLQwghx1OkJfOwW+L4Zk3Zbd5jv3n4TmWA9SSdthwg3ROwYEEA9x+kTuevu02T02aPXvz8Wc3f9gclpefnb75w4cKOzmc3sd0KlilAbHKQUC+gRTVo2AUjIJRMBIAAAdKadcfN1rnAAAAAElFTkSuQmCC","orcid":"","institution":"Busitema University","correspondingAuthor":true,"prefix":"","firstName":"Adam","middleName":"","lastName":"Hewitt-Smith","suffix":""}],"badges":[],"createdAt":"2026-03-28 13:24:14","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-9253066/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-9253066/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":109296447,"identity":"6d56572f-21ec-46c9-9738-e9ec647f722d","added_by":"auto","created_at":"2026-05-15 08:47:03","extension":"jpeg","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":572184,"visible":true,"origin":"","legend":"\u003cp\u003eA map showing the districts served by the hospital\u003c/p\u003e","description":"","filename":"floatimage1.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9253066/v1/13ae0114f087e0908178d455.jpeg"},{"id":109279036,"identity":"25058715-4582-40cd-92bf-19698f463d22","added_by":"auto","created_at":"2026-05-14 16:16:45","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":151680,"visible":true,"origin":"","legend":"\u003cp\u003eWorkflow diagram of the perioperative registry implementation\u003c/p\u003e","description":"","filename":"floatimage2.png","url":"https://assets-eu.researchsquare.com/files/rs-9253066/v1/a2807a37225321a238855575.png"},{"id":109279038,"identity":"503f3b84-ac94-4d14-9490-9530819f00ef","added_by":"auto","created_at":"2026-05-14 16:16:45","extension":"jpeg","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":390926,"visible":true,"origin":"","legend":"\u003cp\u003eTechnical architecture of the perioperative registry\u003c/p\u003e","description":"","filename":"floatimage4.jpeg","url":"https://assets-eu.researchsquare.com/files/rs-9253066/v1/066b950b6d11dcd63e3e11de.jpeg"},{"id":109296352,"identity":"5fe08975-c5b3-4d95-96a1-dec15dbc40f1","added_by":"auto","created_at":"2026-05-15 08:46:36","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":1249541,"visible":true,"origin":"","legend":"\u003cp\u003e\u003cem\u003eScreenshot of DHIS2 showing the dashboard.\u003c/em\u003e\u003c/p\u003e","description":"","filename":"floatimage5.png","url":"https://assets-eu.researchsquare.com/files/rs-9253066/v1/a4c176e3fce93c1e4ef760ee.png"},{"id":109296241,"identity":"10f7260c-ee5a-456f-a0ea-fe9025361a51","added_by":"auto","created_at":"2026-05-15 08:46:20","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":984828,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-9253066/v1/1d1c3540-ff30-475f-8ca0-fa85432a6454.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Implementing a Perioperative Registry at Mbale Regional Referral Hospital in Eastern Uganda: Insights and future possibilities","fulltext":[{"header":"Background","content":"\u003cp\u003eSurgery is a fundamental component of Universal Health Coverage \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e1\u003c/span\u003e\u003c/sup\u003e, with approximately 30% of the global burden of disease requiring surgical care \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e2\u003c/span\u003e\u003c/sup\u003e. Despite 90% of the world’s population living in the poorest countries, only 6% of global surgical procedures are conducted here \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e3\u003c/span\u003e\u003c/sup\u003e. Efforts to address this unmet need include improving access to surgery \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e4\u003c/span\u003e\u003c/sup\u003e, expanding the surgical and anaesthesia workforce \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e5\u003c/span\u003e\u003c/sup\u003e, and greater advocacy at local and continental levels \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e6\u003c/span\u003e\u003c/sup\u003e. There is however, a risk that focusing on improvements to surgical access, will lead to an increase in the number of post-surgical deaths. Currently, an estimated 4.2\u0026nbsp;million deaths occur within 30 days of surgery each year, half of which occur in In low- and middle-income countries (LMICs), where mortality rates after surgery are twice as high as the global average \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e7\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eMany countries in Africa have developed national surgical, obstetric and anaesthesia plans to support improvements in surgical care pathways, including Ethiopia \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e8\u003c/span\u003e\u003c/sup\u003e, Tanzania\u003csup\u003e\u003cspan class=\"CitationRef\"\u003e9\u003c/span\u003e\u003c/sup\u003e and Zambia \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e10\u003c/span\u003e\u003c/sup\u003e, focusing on improving both access and quality of care. A core theme across all national plans is the need for improvement strategies to be informed by accurate, timely data. Global collaborative efforts to reach consensus on the most effective ways to expand surgical care pathways, have led to recommendations to use data to inform future priorities, for monitoring and evaluation and to showcase advances in care \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e11\u003c/span\u003e\u003c/sup\u003e. There are multiple examples reinforcing this need for accessible and comprehensive patient-level data in modern healthcare. It supports quality improvement initiatives at facility level and enables decision making with valuable insights into patient outcomes and treatment procedures \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e12\u003c/span\u003e\u003c/sup\u003e. By facilitating analysis of trends, patient data also plays a key role in pointing out areas for improving clinical practices and optimising resource distribution \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e13\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn 2019, Uganda, like many other LMICs, relied heavily on paper-based records for managing healthcare data \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e14\u003c/span\u003e\u003c/sup\u003e. Paper-based records are inherently limited in their accessibility and capacity to provide real-time information, particularly in critical healthcare settings such as surgical care pathways \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e15\u003c/span\u003e\u003c/sup\u003e. The need to transition to electronic healthcare data systems to improve data management and accessibility was a priority for the country and Ministry of Health \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e16\u003c/span\u003e\u003c/sup\u003e. In Mbale Regional Referral Hospital (RRH) in eastern Uganda, the need for improvements in surgical care had been previously identified \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e17\u003c/span\u003e\u003c/sup\u003e. We describe the iterative development and implementation of an electronic perioperative registry, including its use to support efforts to improve perioperative data management in similar settings.\u003c/p\u003e\n\u003ch3\u003eDevelopment and implementation of the perioperative registry\u003c/h3\u003e\n\u003cp\u003eOur goal was to improve access to perioperative data for the surgical care teams working on the frontline. Improved access would enable them to understand and improve the quality of surgical care within the hospital. By consolidating and digitising perioperative information through an electronic registry, the hospital aimed to streamline data flow and access, enabling near real-time analysis and response to emerging trends or issues. This approach would enable the team to refine surgical practices and foster a more accountable and evidence-based perioperative environment, where process decisions and improvements are directly driven by reliable, comprehensive data.\u003c/p\u003e "},{"header":"Methods","content":"\u003ch2\u003eSetting\u003c/h2\u003e\u003cp\u003eMbale RRH is a 470-bed referral and teaching hospital in eastern Uganda, serving over 4.6\u0026nbsp;million people across 17 districts as shown in Fig.\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e. In 2019 the hospital was the only government hospital in the region providing specialist surgical care in obstetrics, orthopaedics and general surgery. Anaesthesia was provided mainly by non-physician anaesthesia providers with one volunteer anaesthesiologist and intermittent support from one anaesthesiologist employed by the Faculty of Health Sciences of Busitema University. Postoperative care was provided on the wards where nurse to patient ratios reached as high as 1:40 \u003csup\u003e18\u003c/sup\u003e. Patient medical records were paper based. For the collation and submission of monthly reports into the National Health Management Information System (HMIS) and mandated by the Ministry of Health (MoH), the hospital relied on fragmented paper logbooks to document surgical information. Data was entered in separate logbooks at multiple points, including initial admissions in the casualty ward, surgical procedure details in the operating theatre and ward admission and outcome data in the postoperative wards. This fragmentation hindered the ability to compile a comprehensive view of a patient's perioperative journey, coordinate care across all stages and track outcomes effectively. The manual tallying of data from these paper logbooks by non-clinical medical records personnel, for entry into the HMIS further compounded inefficiencies, leading to delays, inaccuracies and limited use of surgical data for informing process and improvement at the facility level.\u003c/p\u003e\u003ch3\u003ePlanning and design\u003c/h3\u003e\u003cp\u003eThe first phase of the implementation process involved planning and design. Through a series of collaborative meetings with the surgical, anaesthesia, nursing and medical records teams we generated user requirements and were able to identify challenges with the existing paper-based system that would strengthen the use case for an electronic system. Two examples of frustrations identified included the accurate reporting of facility surgical procedure rates because non-clinical medical records staff had difficulty reading and interpreting the handwriting in the operating theatre logbook and complaints from the surgeons about the time required to manually collate monthly and annual reports of their surgical activity required for their annual appraisals. To avoid double data entry into both paper logbooks and the electronic registry, we ensured that all MoH mandated data points from the paper logbooks were incorporated and that this data would be accessible when teams from the MoH visited the facility and required data. Examples of these MoH HMIS forms included the operating theatre register HMIS SUR 003 and the inpatient monthly report HMIS form 108 \u003csup\u003e19\u003c/sup\u003e. During this stage, all existing data collection procedures were examined to help ensure a smooth transition to the electronic registry.\u003c/p\u003e\u003ch3\u003eTechnology and infrastructure\u003c/h3\u003e\u003cp\u003eFor the technology backbone of the perioperative registry, we utilised District Health Information Software 2 (DHIS2), a widely adopted open-source health management data platform \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e20\u003c/span\u003e\u003c/sup\u003e. The DHIS2 Tracker programme was employed to capture and manage detailed, patient-level data throughout the perioperative process, allowing for individual patient tracking from admissions to hospital discharge. At the time, this was the first use case of the DHIS2 tracker programme for this purpose that we were aware of. The registry was structured to mirror the organisational logic and reporting hierarchy of Uganda’s HMIS ensuring alignment with the Ministry of Health. DHIS2 Tracker was selected in preference to aggregate data modules because it supports longitudinal patient-level records and enables linkage of multiple events across the perioperative pathway. The system was deployed using a PostgreSQL backend database consistent with DHIS2 architecture \u003csup\u003e\u003cspan class=\"CitationRef\"\u003e21\u003c/span\u003e\u003c/sup\u003e. Figure\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e shows the technical architecture of the perioperative registry with role-based user access through web and android interfaces connected securely to a cloud server via SSL encryption. Our first instance of the registry was implemented on a standalone computer in the main operating theatre, which was secured with a lock and had daily backups on a hard drive to ensure data security. This pilot phase enabled us to test the feasibility of transitioning from a paper to an electronic logbook within the context of Mbale RRH. This standalone instance only captured intraoperative data. Visual dashboards using DHIS2 visualisation tools were integrated to automatically display routine monthly reports and generate near real time data analysis to identify trends in caseload distribution of procedures across different surgical specialties. Figure\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e4\u003c/span\u003e shows a sample dashboard designed in the perioperative registry providing near real-time visual summaries to support routine monitoring and reporting.\u003c/p\u003e\u003cp\u003eFollowing a successful pilot, in which the operating theatre teams embraced electronic logging of cases, we transitioned to a scalable and more secure cloud-based setup. The perioperative registry's database was then hosted on a cloud server physically located within Uganda managed by the Research and Education Network Uganda (RENU). Automated analytics routines were scheduled to run nightly at 02:00 hours enabling near real-time generation of dashboards and routine reports. With this transition, our DHIS2 Tracker programme was expanded to capture data from the entire perioperative pathway, including basic admission data before surgery and ward admission data after surgery including surgical complications and hospital outcomes. Figure\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e illustrates the workflow within our tracker programme. The hosting arrangement complied with the Data Protection and Privacy Act of 2019 ensuring that all patient information is handled in accordance with national data protection requirements. System access was restricted through role-based user permissions with password-protected accounts assigned to authorised users only. Data was stored on secure servers with controlled access via secure shell (SSH) and all user activity was logged to support audit. In addition, data transmission and storage were protected through encryption-at-rest \u0026amp; transit mechanisms implemented at the server level with restricted administrative access and routine backups performed to safeguard against data loss and ensure system integrity. With future scalability to other facilities and clinical areas in mind, we named our programme Mbale Digital Analytics System (MDAS).\u003c/p\u003e\u003ch3\u003eData quality and standards in MDAS\u003c/h3\u003e\u003cp\u003eThe success of MDAS relied heavily on the accuracy, consistency and timeliness of data entry. To standardise data collection, MDAS utilised a set of predefined variables that include patient demographics, detailed surgical procedure information, outcomes and complications. These variables were carefully chosen to ensure they captured all the relevant details of perioperative care needed for the generation of key surgical indicators requested by the local teams and that align with Uganda’s national health reporting standards and international best practices. (Table\u0026nbsp;\u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e)\u003c/p\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab1\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKey HMIS surgical procedures monitored by the perioperative registry\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eHMIS Code\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eIndicator\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"5\"\u003e \u003cp\u003eObstetrics/Gynaecology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSP01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCaesarean sections\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSP02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eObstetric fistula repair (RVF, VVF, RVVF)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSP03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eEvacuations (incomplete abortion)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSP04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLaparotomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSP05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHysterectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCardiothoracic Surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCS01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThoracotomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePlastic/ reconstructive surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePR01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSkin grafting\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"11\"\u003e \u003cp\u003ePaediatric Surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePS01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eRamsteidts Procedure\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePS02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eExcision of Sacro-coccygeal teratome\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePS03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePSARP (Posterior Saggital Anorectoplasty)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePS04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePull through\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePS05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eKasai Procedure\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePS06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGastroschisis repair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePS07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDiaphragmatic hernia repair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePS08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTracheal-eosophageal fistula repair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePS09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCongenital cyst excision\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePS10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCongenital hernia repair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePS11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCut down\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"9\"\u003e \u003cp\u003eOcular surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOC01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCataract Surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOC02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGlaucoma Surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOC03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOrbital Surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOC04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOculoplasty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOC05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eEye lid Operation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOC06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOpthalmic laser Interventions\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOC07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eStrabismus Surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOC08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTrachoma surgery for TT\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOC09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOther Extra Ocular Surgeries\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"12\"\u003e \u003cp\u003eOrthopaedics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOR01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSequestrectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOR02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSpine surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOR03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eArthroplasty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOR04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eArthrotomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOR05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLimb disarticulation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOR06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eBone reconstruction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOR07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAmputation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOR08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCorrective osteotomies\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOR09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eArthrodesis\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOR10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eArthroscopy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOR11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eInternal fixation\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOR12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSoft tissue releases\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"9\"\u003e \u003cp\u003eNeurosurgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNS01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCraniotomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNS02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eBurr Hole\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNS03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCranioplasty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNS04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMicrodiscectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNS05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eETV/CPC (Endoscopic 3rd Ventriculostomy/choroid plexus cauterization)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNS06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSpina-bifida surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNS07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eEVD (External Ventricular Drainage)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNS08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eElevation of depressed skull fracture\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNS09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eVP shunts\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"7\"\u003e \u003cp\u003eENT Surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTS01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTracheostomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTS02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAdenotonsillectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTS03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNasal surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTS04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLaryngological surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTS05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOtological surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTS06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eENT endoscopic surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTS07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOther ENT surgeries\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"3\"\u003e \u003cp\u003eEndocrine Surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eES01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThyroidectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eES02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMastectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eES03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAdrenalectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"18\"\u003e \u003cp\u003eUrology\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOpen Prostatectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eRadical prostatectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eEndo-urology\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eRenal surgery (Nephrectomy etc.)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUrinary stone Surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePyeloplasty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUreteric surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eRadical cystectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTesticular Surgery (Orchidopexy, orchidectomy ,BSO )\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUrine diversion (SPC, Nephrostomy)\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUrethroplasty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePenectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR13\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGenitoplasty\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR14\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eVaricocelectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR15\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHypospadias repair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR16\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eEpispadias repair\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR17\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eBladder exstrophy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUR18\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eKidney transplant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"12\"\u003e \u003cp\u003eGastro-intestinal tract\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGI01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCholecystectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGI02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGastric Surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eG103\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePancreatic Surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eG104\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSplenic Surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGI05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLiver Surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGI06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLiver transplant\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGI07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eColectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGI08\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLaparoscopic Surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGI09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eEndoscopic Surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGI10\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eColostomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGI11\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHerniorrhaphy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGI12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAppendicectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"7\"\u003e \u003cp\u003eOral surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOS01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHemi-Mandibulectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOS02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTotal Mandibulectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOS03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSegmental Resection of Mandible\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOS04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSalivary gland Surgery\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOS05\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNeck dissection\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOS06\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePartial-glossectomy\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOS07\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eExcision biopsy of tumour\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"4\"\u003e \u003cp\u003eOther Un classified Surgical Procedures\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOT01\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDebridement\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOT02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIncision and drainage of abscesses\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOT03\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSafe Male Circumcision\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOT04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOthers\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\u003cdiv class=\"gridtable\"\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003cdiv align=\"left\" class=\"colspec\"\u003e\u003c/div\u003e\u003ctable id=\"Tab2\" border=\"1\"\u003e \u003ccaption\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eKey variables captured by the perioperative registry\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003c/colgroup\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\"\u003e \u003cp\u003eSection\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eVariable name\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eDescription\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eMetadata type\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\"\u003e \u003cp\u003eDatatype\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"30\"\u003e \u003cp\u003ePROFILE\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eEnrolment organizational unit\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHealth facility where data entry is taking place\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eenrolment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003en/a\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eEnrolment date\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDate of registration\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eenrolment\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePatient System ID*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eID number automatically assigned by the system when registering a new patient. Comprises facility code, year, week number and a unique 5-digit number\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIPD No.*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUnique serial number given to the client during their inpatient admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNIN\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNational Identification Number\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSurname*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSurname of the client\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGiven Name*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGiven name of the client\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDate of Birth/Age*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eClient's date of birth or age in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003enumber\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAge (years)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAutomatically calculated client's age in years\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003enumber\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSex*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGender of the client\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eClient Category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eClient citizenship status\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDistrict*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eClient's district address\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSub-county\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eClient's sub-county address\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eParish\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eClient's parish address\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eVillage\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eClient's village address\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReferral in? *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIf the patient was referred in select yes. This will result in the options below.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReferred from\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIf the patient was referred in. Choose the appropriate source of referral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReferring health facility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe name of the health facility the client was referred from\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReason for referral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReason client was referred\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReason for referral (Other)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eFree text box to collect 'other' reasons for referral\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReferred by\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eName of person referring\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eClient Phone number\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eClient's phone number\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ephone number\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTobacco use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIndicates whether the patient currently uses tobacco products\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAlcohol use\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIndicates whether the patient currently consumes alcohol\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTobacco exposure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIndicates whether the patient is regularly exposed to tobacco smoke\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNext of kin surname\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNext of kin's surname\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNext of kin given name\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNext of kin's given name\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNext of kin relationship\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNext of kin's relationship with the patient\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNext of kin phone number 1\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNext of kin's phone number\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ephone number\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNext of kin phone number 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNext of kin's other phone number\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eattribute\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ephone number\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"12\"\u003e \u003cp\u003ePRE-OPERATIVE INFORMATION\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReport date\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAutomatically generated by system when stage created\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ereport date\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDate of hospital admission*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDate of hospital admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTime of hospital admission*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTime of hospital admission\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etime\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCo-morbid disease*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIndicates whether the patient has any co-morbid conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCo-morbid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eList of co-morbid conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNYHA Classification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNew York Heart Association Classification - this is a severity of illness score for heart failure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOther co-morbid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAny additional co-morbid diseases not listed in the primary co-morbid disease field\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCo-morbid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eList of co-morbid conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOther co-morbid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAny additional co-morbid diseases not listed in the co-morbid disease field\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCo-morbid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eList of co-morbid conditions\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOther co-morbid disease\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAny additional co-morbid diseases not listed in the co-morbid disease field\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHaemoglobin (g/dl)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eConcentration of haemoglobin in the blood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003enumber\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"48\"\u003e \u003cp\u003eINTRA-OPERATIVE INFORMATION\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReport date\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAutomatically generated by system when stage created\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReport date\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDate of surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe date on which the surgery was performed\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eASA physical status classification\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eA classification score that assesses the fitness of patients before surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eASOS Risk score\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eA score assessing the risk associated with surgery based on preoperative health\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003enumber\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSurgical specialty\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAllows selection of specialties with additional data elements e.g. obstetrics\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTime patient on theatre table\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etime\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAnaesthesia start time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etime\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTime of skin incision*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe time when the surgical incision was made in 24-hour format\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etime\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSurgery end time\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etime\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTime patient off theatre table\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etime\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eRe-operation for surgical complication*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIndicates whether the patient underwent re-operation due to complications from the initial surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOperation diagnosis*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe medical diagnosis necessitating the surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIndication for surgery*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe primary medical reason for the surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUrgency of surgery*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDescribes the urgency of the surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOperation technique − 1*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe primary surgical technique used during the procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOther procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDetails any additional procedures performed during the surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOperation technique − 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSecondary surgical technique used, if applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOther procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDetails any additional procedures performed during the surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSurgical procedure category*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eCategorization of the surgical procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSeverity of surgery*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe overall severity of the surgical procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDid the patient receive blood products? *\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIndicates whether the patient received a blood transfusion during surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDid the patient receive whole blood?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNumber of units of whole blood\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe number of units of whole blood transfused\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDid the patient receive packed red cells?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNumber of units of packed red cells\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe number of units of packed red cells transfused\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDid the patient receive platelets?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNumber of units of platelets\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe number of units of platelets transfused\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDid the patient receive FFP?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNumber of units of FFP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe number of units of FFP transfused\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDid the patient receive other blood products?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e\u0026nbsp;\u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOther blood products received\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003efree text box\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLead surgeon category*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe professional category of the lead surgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLead surgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eName of the lead surgeon in charge of the procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSecond surgeon category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe professional category of the second surgeon, if any\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSecond surgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eName of the second surgeon, if any\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThird surgeon category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe professional category of the third surgeon, if any\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThird surgeon\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eName of the third surgeon, if any\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eInstrument Nurse\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe nurse responsible for managing surgical instruments\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAnaesthesia technique*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe primary technique of anaesthesia used during surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLead anaesthesia provider category*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe professional category of the lead anaesthesia provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLead anaesthesia provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eName of the primary provider of anaesthesia, other professional category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSecond anaesthesia provider category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe professional category of the second anaesthesia provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSecond anaesthesia provider\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eName of the second anaesthesia provider, other professional category\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTheatre outcome*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOutcome of the surgical procedure\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDestination after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe location to which the patient was moved post-surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eWas the level of care where the patient was admitted postoperatively sufficient for their needs?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eEvaluates if the postoperative care level was adequate\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReason for gap in higher level care\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDiscrepancies in the expected versus received level of care post-surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTime of death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eThe time of the patient's death, if applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etime\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" rowspan=\"19\"\u003e \u003cp\u003ePOST-OPERATIVE INFORMATION\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReport date\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eAutomatically generated by system\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eReport date\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eUnplanned critical care admission*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDid the patient have an unplanned critical care admission?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePostoperative complications*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDid the patient have any postoperative complications?\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eyes/no\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMorbidity type\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSpecifies the type of morbidity experienced by the patient, if any\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eInfectious complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSpecifies the site of postoperative infection\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGastrointestinal complication\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSpecifies the type of gastrointestinal issue post-surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eComplication severity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eClassification of surgical complications by severity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMorbidity type − 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSpecifies the second type of morbidity experienced by the patient, if applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eInfectious complication − 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIdentifies a second site of postoperative infection, if another occurs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGastrointestinal complication − 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNotes a second type of gastrointestinal issue that occurred post-surgery, if applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eComplication severity − 2\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eClassification of surgical complications by severity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eMorbidity type − 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eSpecifies the third type of morbidity experienced by the patient, if applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eInfectious complication − 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eIdentifies a third site of postoperative infection, if another occurs\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eGastrointestinal complication − 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNotes a third type of gastrointestinal issue that occurred post-surgery, if applicable\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eComplication severity − 3\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eClassification of surgical complications by severity\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDate of hospital outcome*\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eDate on which the hospital outcome was determined post-op\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edate\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eHospital outcome\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eOverall outcome of the hospital stay post-surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eTime of death\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003ePatient time of death in the hospital in 24-hour format\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eLength of stay after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003eNumber of days in hospital after the date of surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003edata element\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\"\u003e \u003cp\u003etext\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/table\u003e\u003c/div\u003e\u003cp\u003eImplementation of novel data collection tools, whilst recognised to be necessary often require additional human resource for data entry. At Mbale RRH, with central recruitment through the Ministry of Public Service and a limited resource envelope for wages, the employment of additional data entry or medical records staff was not a priority. Paper based records had been completed by existing clinical staff (usually medical interns and students) and it was expected that the transition to an electronic system to replace the paper logbooks would enable this to continue. Staff were trained and given login details to enable access to the system. Despite system design features to improve data quality (for example input validation, drop down menus and normal ranges) data quality remained poor due to inconsistencies and missed entries. To address this, a project funded data validation role was introduced. Data validation was conducted weekly to capture missed entries (these were identified through cross referencing with theatre lists and the nurses report books) and ensure accuracy, thereby improving the overall reliability of the registry. Using the existing workforce for data entry served multiple purposes: it integrated the registry into the hospital’s clinical workflow, ensuring that there was a sustainable team responsible for data entry. It also promoted a culture of responsibility among the future healthcare workforce by integrating data collection standards into the training of intern doctors and students.\u003c/p\u003e"},{"header":"Results","content":"\u003cdiv id=\"Sec9\" class=\"Section2\"\u003e \u003ch2\u003eValue and immediate impact of MDAS\u003c/h2\u003e \u003cp\u003eDuring the pilot phase of MDAS, between May 2019 and November 2020 implemented on a standalone laptop in the main operating theatres, a total of 2,751 procedures were logged. Over the following four-year period 11,541 procedures were logged in the cloud-based MDAS. This included all elective and emergency general surgery, orthopaedic, gynaecological and ear nose and throat procedures in the hospital. Obstetric procedures were conducted in a separate operating theatre and not included in MDAS during this period. Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e shows immediate benefits observed during this period included improved data security (previous paper logbooks were kept out and could be accessed by anyone entering theatres) and longevity (paper logbooks would frequently break before they were full of pages easily becoming detached and going missing). Nursing staff no longer needed to compile weekly and monthly reports by hand and could access their own bespoke automated dashboard including flexibility to change date ranges to fit their needs.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eSummary of immediate benefits observed following the implementation of the perioperative registry at Mbale Regional Referral Hospital\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"3\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eCategory\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePrevious situation\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eImproved outcome with registry\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eData security\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaper logbooks were openly accessible in theatres and could be viewed by anyone\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDigital registry system restricted access to authorized users, improving confidentiality and data protection\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eRecord durability\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003ePaper logbooks were prone to wear and tear; pages often got lost or detached.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDigital records ensured long-term preservation of data with secure backup and no risk of physical damage.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eReporting burden\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNurses manually compiled weekly and monthly reports from paper logbooks.\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eAutomated dashboards replaced manual summaries, saving time and reducing errors.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eData accessibility\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003eLimited visibility and inflexible reporting formats\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003eCustom dashboards allow nursing staff to view data in real-time and filter by date range as needed.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eAlthough MDAS used a custom surgical procedure list to match commonly used procedure names familiar to the surgical teams, these were mapped to the MoH HMIS tool procedures to enable automated monthly reporting accessible to the medical records team immediately at the end of the month and without the previous requirement to enter the clean clinical area of theatres. This improved data accuracy and reduced incidence of late reporting. Additional immediate benefits included the ability for individual surgeons to request individualised procedure lists and statistics to support them in assessment of medical interns and for use during their own annual appraisals. MDAS also enabled data-driven quality improvement efforts. With real-time access to perioperative data, the surgical team was able to identify trends and pinpoint areas that needed improvement. MDAS acted as a trigger for quality improvement. In one such example, ward staff reported seemingly higher mortality rates in patients especially young children undergoing emergency laparotomies. Data from the registry was used to accurately describe outcomes and coincided with an opportunity to establish a high dependency unit and a dedicated nursing team to care for these high-risk patients.\u003c/p\u003e \u003c/div\u003e\n\u003ch3\u003eLessons learnt\u003c/h3\u003e\n\u003cp\u003eA significant challenge encountered during the implementation of MDAS was unstable internet connectivity. This issue disrupted online real-time data capture on several occasions. As a mitigation strategy, we utilised the DHIS2 mobile application designed to allow offline data entry. This feature allowed medical staff to continue entering data into the system without an internet connection. The data was then synchronised with the DHIS2 server automatically once internet connectivity was restored, ensuring no data loss and maintaining the integrity of the registry\u0026rsquo;s information. While the DHIS2 mobile application allowed the team to continue data entry offline during periods of unstable internet connectivity, there was a trade-off in its use. The team found the mobile app harder to use compared to the web-based system. After a period, when the hospital internet connectivity stabilised, the app was no longer used.\u003c/p\u003e \u003cp\u003eMbale RRH is a training hospital for intern doctors, medical and nursing students. This high rate of staff turnover especially medical interns led to inconsistencies in data entry. To address this, we endeavoured to have regular training sessions for new and existing staff to ensure everyone was well-versed in the registry operations. Our dedicated data validator also held this training role. When the junior team members were well trained, there was a noticeable reduction in the data validation tasks required to maintaining the accuracy and reliability of the registry data.\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eMbale Digital Analytics System was a perioperative registry platform co-designed using an iterative approach in eastern Uganda using open source DHIS2 software. It was successfully implemented in a regional referral hospital with immediate benefits that included improved data workflows, automated reporting with outputs mapped to mandatory MoH reporting tools and more accessible data for frontline surgical teams to use for individual performance appraisals and for data driven quality improvement efforts.\u003c/p\u003e \u003cdiv id=\"Sec12\" class=\"Section2\"\u003e \u003ch2\u003eSupport for research and policy making\u003c/h2\u003e \u003cp\u003eThe data collected through the perioperative registry serves as a valuable resource for clinical research helping to generate new insights into surgical care in low-resource settings \u003csup\u003e\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e\u003c/sup\u003e. Additionally, this data can inform healthcare policy decisions, advocating for resource allocation and systemic changes that improve surgical care quality and accessibility \u003csup\u003e\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e\u003c/sup\u003e. By embedding variables within the routinely collected data in the perioperative registry, researchers can seamlessly integrate their research without the need for separate data collection systems or reliance on paper records. Also, the availability of pre-existing data in the registry eliminates the initial burden of data gathering for research, speeding up study processes. This capability not only improves the efficiency of research initiatives but also encourages a culture of evidence-based practice and continuous learning among all healthcare providers. Additionally, the registry's comprehensive dataset provides a fertile ground for medical students to engage in research projects, promoting a deeper understanding of surgical care dynamics and outcomes analysis.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec13\" class=\"Section2\"\u003e \u003ch2\u003eBenchmarking and performance evaluation\u003c/h2\u003e \u003cp\u003eThe perioperative registry provides a platform for benchmarking against national and international standards \u003csup\u003e\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e\u003c/sup\u003e, allowing Mbale Regional Referral Hospital to evaluate its performance in various surgical domains. By comparing our data with that of similar institutions both locally and globally, Mbale Regional Referral Hospital can adopt innovative surgical techniques and care protocols that have proven successful elsewhere. This capability improves the hospital's responsiveness to emerging trends and challenges in surgical care. In addition, benchmarking through clinical registries has been shown to drive continuous quality improvement by identifying performance gaps and guiding targeted interventions to improve surgical outcomes\u003csup\u003e\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec14\" class=\"Section2\"\u003e \u003ch2\u003eEnhanced patient care and safety\u003c/h2\u003e \u003cp\u003eThe registry enables detailed tracking and analysis of perioperative processes, from pre-operative assessments through post-operative recovery thus can be used to measure and report additional quality metrics \u003csup\u003e\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e\u003c/sup\u003e. By capturing patient-level clinical data, the registry supports continuous monitoring of surgical outcomes. Routine collection and analysis of perioperative indicators has been recommended as a key strategy for strengthening surgical safety and quality of care in health systems globally\u003csup\u003e\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u003c/sup\u003e.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec15\" class=\"Section2\"\u003e \u003ch2\u003eStrengths and limitations\u003c/h2\u003e \u003cp\u003eA key strength of this work is the pragmatic, clinician-led approach used to design and implement the registry within a public hospital setting. The system was developed iteratively with direct input from end users ensuring alignment with existing clinical workflows and minimising disruption to routine care. The use of open-source DHIS2 software enhanced sustainability and facilitated alignment with national digital health strategies. Embedding the registry within routine practice rather than as a parallel research tool strengthened ownership among clinical staff and increased the likelihood of long-term adoption. In addition, the integration of automated dashboards and reporting tools reduced the burden of manual data aggregation and improved access to timely information.\u003c/p\u003e \u003cp\u003eHowever, several limitations should be acknowledged. Data completeness and accuracy were initially affected by staff turnover and competing clinical priorities. Although the introduction of a dedicated data validation role improved data quality, this represents an additional resource requirement that may not be readily available in all settings. Finally, while the registry captures detailed perioperative data, outcome follow-up beyond hospital discharge was not done, restricting longer-term outcome assessment.\u003c/p\u003e \u003c/div\u003e"},{"header":"Conclusion","content":"\u003cdiv id=\"Sec17\" class=\"Section2\"\u003e \u003ch2\u003eFuture perspectives\u003c/h2\u003e \u003cp\u003eThe immediate priority is to achieve seamless interoperability between the perioperative registry and the Ministry of Health\u0026rsquo;s new electronic medical records system known as eAFYA \u003csup\u003e\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u003c/sup\u003e. This integration aims to allow data entry primarily through eAFYA, while enabling frontline healthcare workers to engage with that data through the perioperative registry to drive quality improvement initiatives. Future efforts will focus on refining this interoperability within the Ministry of Health\u0026rsquo;s Data Warehouse infrastructure. Additionally, plans are underway to extend the registry\u0026rsquo;s coverage to other clinical specialties within Mbale Regional Referral Hospital building on successes already seen in the neonatal intensive care unit and eventually scale the registry to other hospitals across the region and nationally. To ensure sustainability, the roles of medical records personnel and data collectors need to be formalised within facility staffing structures. A long-term funding model will combine government support, grants and international partnerships to support ongoing operations, infrastructure development and staff training. This positions the registry as a national model for surgical care improvement.\u003c/p\u003e \u003c/div\u003e"},{"header":"Abbreviations","content":"\u003cdiv class=\"DefinitionList\"\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eDHIS2\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eDistrict Health Information Software, version 2\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eHMIS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eHealth Management Information System\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eLMIC\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eLow-and Middle-Income Country\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMDAS\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMbale Digital Analytics System\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eMOH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eMinistry of Health\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eRENU\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eResearch and Education Network Uganda\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eRRH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eRegional Referral Hospital\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003cdiv class=\"DefinitionListEntry\"\u003e \u003cdiv class=\"Term\"\u003e\u003cb\u003eSSH\u003c/b\u003e\u003c/div\u003e \u003cdiv class=\"Description\"\u003e \u003cp\u003eSecure Socket Shell\u003c/p\u003e \u003c/div\u003e \u003c/div\u003e \u003c/div\u003e"},{"header":"Declarations","content":"\u003ch2\u003eConsent for publication\u003c/h2\u003e\n\u003cp\u003eNot applicable\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eEthics approval and consent to participate\u003c/h2\u003e\n\u003cp\u003eThis implementation was conducted in accordance with the declaration of Helsinki. Ethics approval for the registry was obtained from the Busitema University Faculty of Health Sciences Research and Ethics Committee, Busitema University Faculty of Health Sciences, Uganda (Approval No. BUFHS-2024-162) and approved by the Uganda National Council of Science and Technology (UNCST) (Ref No. HS4359ES).. As MDAS was implemented as a service improvement initiative replacing paper-based medical records with an electronic system and forming part of routine hospital health records, individual informed consent to participate was not required.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAvailability of data and materials\u003c/h2\u003e\n\u003cp\u003eThe datasets generated and/or analysed during the implementation are available from the corresponding author on reasonable request and following review and approval by the research and ethics committee in Uganda.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eCompeting interests\u003c/h2\u003e\n\u003cp\u003eNone declared\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eFunding\u003c/h2\u003e\n\u003cp\u003eThe following organisations have provided financial support to enable the development and implementation of the perioperative registry. University of California San Francisco, Partnerships Overseas Networking Trust, and Busitema University. We are grateful for their support. \u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAuthors\u0026apos; contributions\u003c/h2\u003e\n\u003cp\u003eHK and AHS conceptualised the project and system design. HK led system development, implementation, data curation, and manuscript drafting. CAB and FM contributed to methodology and data analysis oversight. AHS, IW, EA, HN, MK, and RG supported implementation, validation and clinical data interpretation. FM provided statistical guidance. AHS supervised the project and critically revised the manuscript. All authors reviewed and approved the final manuscript.\u0026nbsp;\u003c/p\u003e\n\u003ch2\u003eAcknowledgements\u003c/h2\u003e\n\u003cp\u003eOur gratitude to all those who contributed to the successful implementation and ongoing operation of the perioperative registry at Mbale Regional Referral Hospital. Special thanks go to the dedicated hospital staff, including surgeons, nurses, anaesthesia providers, and medical interns, whose daily efforts and commitment have been key in the registry\u0026apos;s development and integration into the hospital\u0026rsquo;s workflow. Our appreciation also extends to the IT and administrative teams for their role in managing the technical aspects of the registry, ensuring data integrity, and addressing the challenges of system integration and user training.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003ePrice R, Makasa E, Hollands M, World Health Assembly Resolution WHA68.15. Strengthening Emergency and Essential Surgical Care and Anesthesia as a Component of Universal Health Coverage\u0026mdash;Addressing the Public Health Gaps Arising from Lack of Safe, Affordable and Accessible Surgical and Anesthetic Services. World J Surg. 2015;39(9):2115\u0026ndash;25. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00268-015-3153-y\u003c/span\u003e\u003cspan address=\"10.1007/s00268-015-3153-y\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eShrime MG, Bickler SW, Alkire BC, Mock C. Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health. 2015;3(Suppl 2):S8\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S2214-109X(14)70384-5\u003c/span\u003e\u003cspan address=\"10.1016/S2214-109X(14)70384-5\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMeara JG, Leather AJM, Hagander L, et al. Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet. 2015;386(9993):569\u0026ndash;624. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(15)60160-X\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(15)60160-X\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWong EG, Deckelbaum DL, Razek T. Global access to surgical care: moving forward. Lancet Glob Health. 2015;3(6):e298\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S2214-109X(15)00004-2\u003c/span\u003e\u003cspan address=\"10.1016/S2214-109X(15)00004-2\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHolmer H, Lantz A, Kunjumen T, et al. Global distribution of surgeons, anaesthesiologists, and obstetricians. Lancet Glob Health. 2015;3(Suppl 2):S9\u0026ndash;11. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S2214-109X(14)70349-3\u003c/span\u003e\u003cspan address=\"10.1016/S2214-109X(14)70349-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlayande B, Seyi-Olajide J, Fenta B, et al. The Pan-African Surgical Healthcare Forum: An African qualitative consensus propagating continental national surgical healthcare policies and plans. PLOS Glob Public Health. 2024;4. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1371/journal.pgph.0003635\u003c/span\u003e\u003cspan address=\"10.1371/journal.pgph.0003635\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBiccard BM, Madiba TE, Kluyts HL, et al. Perioperative patient outcomes in the African Surgical Outcomes Study: a 7-day prospective observational cohort study. Lancet Lond Engl. 2018;391(10130):1589\u0026ndash;98. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/S0140-6736(18)30001-1\u003c/span\u003e\u003cspan address=\"10.1016/S0140-6736(18)30001-1\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eOsebo C, Grushka J, Deckelbaum D, Razek T. Assessing Ethiopia\u0026rsquo;s surgical capacity in light of global surgery 2030 initiatives: Is there progress in the past decade? Surg Open Sci. 2024;19:70\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.sopen.2024.03.015\u003c/span\u003e\u003cspan address=\"10.1016/j.sopen.2024.03.015\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCitron I, Jumbam D, Dahm J, et al. Towards equitable surgical systems: development and outcomes of a national surgical, obstetric and anaesthesia plan in Tanzania. BMJ Glob Health. 2019;4(2):e001282. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1136/bmjgh-2018-001282\u003c/span\u003e\u003cspan address=\"10.1136/bmjgh-2018-001282\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003ePeters AW, Roa L, Rwamasirabo E, et al. National Surgical, Obstetric, and Anesthesia Plans Supporting the Vision of Universal Health Coverage. Glob Health Sci Pract. 2020;8(1):1\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.9745/GHSP-D-19-00314\u003c/span\u003e\u003cspan address=\"10.9745/GHSP-D-19-00314\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlbutt K, Sonderman K, Citron I, et al. Healthcare Leaders Develop Strategies for Expanding National Surgical, Obstetric, and Anaesthesia Plans in WHO AFRO and EMRO Regions. World J Surg. 2019;43(2):360\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1007/s00268-018-4819-z\u003c/span\u003e\u003cspan address=\"10.1007/s00268-018-4819-z\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBhati D, Deogade MS, Kanyal D. Improving Patient Outcomes Through Effective Hospital Administration: A Comprehensive Review. Cureus. 2023;15(10):e47731. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.7759/cureus.47731\u003c/span\u003e\u003cspan address=\"10.7759/cureus.47731\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eRaghupathi W, Raghupathi V. Big data analytics in healthcare: promise and potential. Health Inf Sci Syst. 2014;2:3. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1186/2047-2501-2-3\u003c/span\u003e\u003cspan address=\"10.1186/2047-2501-2-3\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSsebibubbu S, Ssekamwa F, Muhumuza N, Mulumba M. Reforming Uganda\u0026rsquo;s digital health data systems: A policy analysis for inclusive, equitable, and decolonised data governance. Digit Health. 2026;12:20552076251408532. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/20552076251408532\u003c/span\u003e\u003cspan address=\"10.1177/20552076251408532\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoike L, Canala L, Kozminski K, Wynd CA. Development of an outpatient perioperative care record. J Post Anesth Nurs. 1995;10(3):140\u0026ndash;50.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Health (Uganda). Uganda Health Information and Digital Health Strategic Plan 2020/21\u0026ndash;2024/25. Ministry of Health; 2020.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHewitt-Smith A, Bulamba F, Olupot C, et al. Surgical outcomes in eastern Uganda: a one-year cohort study. South Afr J Anaesth Analg. 2018;24(5):122\u0026ndash;7. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1080/22201181.2018.1517476\u003c/span\u003e\u003cspan address=\"10.1080/22201181.2018.1517476\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHewitt-Smith A, Bulamba F, Patel A, et al. Family supplemented patient monitoring after surgery (SMARTER): a pilot stepped-wedge cluster-randomised trial. Br J Anaesth. 2024;133(4):846\u0026ndash;52. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1016/j.bja.2024.06.027\u003c/span\u003e\u003cspan address=\"10.1016/j.bja.2024.06.027\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Health (Uganda). Health Management Information System (HMIS) Manual. Ministry of Health; 2010. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://www.gou.go.ug/sites/default/files/media-files/THE%20HEALTH%20MANAGEMENT%20INFORMATION%20SYSTEM_0.pdf\u003c/span\u003e\u003cspan address=\"https://www.gou.go.ug/sites/default/files/media-files/THE%20HEALTH%20MANAGEMENT%20INFORMATION%20SYSTEM_0.pdf\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDehnavieh R, Haghdoost A, Khosravi A, et al. The District Health Information System (DHIS2): A literature review and meta-synthesis of its strengths and operational challenges based on the experiences of 11 countries. Health Inf Manag J Health Inf Manag Assoc Aust. 2019;48(2):62\u0026ndash;75. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/1833358318777713\u003c/span\u003e\u003cspan address=\"10.1177/1833358318777713\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003e\u0026Oslash;verland L. September. DHIS 2 to support PostgreSQL only? dhis2 community. 2017. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://community.dhis2.org/t/dhis-2-to-support-postgresql-only/4576\u003c/span\u003e\u003cspan address=\"https://community.dhis2.org/t/dhis-2-to-support-postgresql-only/4576\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGazzetta JD, Mutambo PP, Mpabalwani MB, et al. The Implementation of a Perioperative Registry in a Resource-Limited Setting: A Feasibility, Fidelity, and Acceptance Study. Med Res Arch. 2025;13(6):6574. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.18103/mra.v13i6.6574\u003c/span\u003e\u003cspan address=\"10.18103/mra.v13i6.6574\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAddressing priorities for surgical research in Africa. : implementation of a multicentre cloud-based peri-operative registry in Ethiopia. Anaesthesia. 2021;76(7):933\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1111/anae.15394\u003c/span\u003e\u003cspan address=\"10.1111/anae.15394\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eReilly JR, Shulman MA, Gilbert AM, et al. Towards a national perioperative clinical quality registry: The diagnostic accuracy of administrative data in identifying major postoperative complications. Anaesth Intensive Care. 2020;48(3):203\u0026ndash;12. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1177/0310057X20905606\u003c/span\u003e\u003cspan address=\"10.1177/0310057X20905606\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBath MF, Kohler K, Hobbs L, et al. The Impact of Trauma System Implementation on Patient Quality of Life and Economic Burden: A Systematic Review Study Protocol. Int J Surg Protoc. 2023;27(1):84\u0026ndash;9. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.29337/ijsp.187\u003c/span\u003e\u003cspan address=\"10.29337/ijsp.187\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJaraczewski TJ, Abebe BM, Diehl T, et al. Implementation of a perioperative registry in Ethiopia to enhance surgical quality improvement. World J Surg. 2024;48(8):1829\u0026ndash;39. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003e10.1002/wjs.12240\u003c/span\u003e\u003cspan address=\"10.1002/wjs.12240\" targettype=\"DOI\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eWorld Health Organization. World Health Organization. Global Guidelines for Safe Surgery 2009: Safe Surgery Saves Lives. Geneva: WHO;. 2009. World Health Organization. Accessed March 15, 2026. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://iris.who.int/handle/10665/44185\u003c/span\u003e\u003cspan address=\"https://iris.who.int/handle/10665/44185\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMinistry of Health (Uganda). Electronic Medical Records Rollout Transforms Patient Care and Data Management. Community Health. \u003cspan class=\"ExternalRef\"\u003e\u003cspan class=\"RefSource\"\u003ehttps://health.go.ug/electronic-medical-records-rollout-transforms-patient-care-and-data-management/\u003c/span\u003e\u003cspan address=\"https://health.go.ug/electronic-medical-records-rollout-transforms-patient-care-and-data-management/\" targettype=\"URL\" class=\"RefTarget\"\u003e\u003c/span\u003e\u003c/span\u003e\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"perioperative registry, electronic data collection, quality improvement, health systems strengthening, implementation science, DHIS2 tracker","lastPublishedDoi":"10.21203/rs.3.rs-9253066/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-9253066/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eAccess to safe surgery is a core component of Universal Health Coverage yet many low- and middle-income countries lack reliable patient-level data to inform quality improvement. In Uganda, surgical data collection has historically relied on fragmented paper-based logbooks, limiting data accessibility and use for decision-making. We describe the iterative development, implementation and early impact of a novel electronic perioperative registry at Mbale Regional Referral Hospital in eastern Uganda.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eUsing a clinician-led, co-design approach, we developed a perioperative registry built on the open-source District Health Information Software 2 (DHIS2) Tracker platform. User requirements were defined through stakeholder engagement with surgical, anaesthesia, nursing and medical records teams. The system was aligned with national Health Management Information System (HMIS) reporting tools to avoid duplication of data entry. After an initial pilot on a standalone computer the registry was migrated to a secure in-country cloud server hosted by the Research and Education Network Uganda (RENU). The registry captured patient-level data across the perioperative pathway including admission details, intraoperative variables and postoperative outcomes as shown in Table\u0026nbsp;2. Data quality was supported through on the job training, validation rules and a dedicated weekly data validation process.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eBetween May 2019 and November 2020, 2,751 surgical procedures were recorded during the pilot phase. Over four years of cloud-based implementation, 11,541 procedures were logged across multiple specialties. Implementation resulted in improved data security, elimination of manual logbook aggregation, automated generation of Ministry of Health reports and near real-time dashboard access for clinical teams. The registry supported data-driven quality improvement initiatives including identification of high-risk emergency laparotomy outcomes and subsequent establishment of enhanced postoperative care pathways. Challenges included unstable internet connectivity and staff turnover mitigated through offline data entry tools and regular training.\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eImplementation of a DHIS2-based perioperative registry in a regional referral hospital in Uganda was feasible and associated with improvements in data availability, reporting efficiency and clinical engagement with quality metrics. Embedding the registry within routine workflows and aligning with national reporting requirements enhanced sustainability. This model demonstrates how open-source digital health platforms can strengthen surgical service delivery and health system performance in resource-constrained settings.\u003c/p\u003e","manuscriptTitle":"Implementing a Perioperative Registry at Mbale Regional Referral Hospital in Eastern Uganda: Insights and future possibilities","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2026-05-14 16:16:41","doi":"10.21203/rs.3.rs-9253066/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"reviewerAgreed","content":"125148318902914088832731345903718919930","date":"2026-05-19T15:31:12+00:00","index":"hide","fulltext":""},{"type":"reviewerAgreed","content":"108090021004123118306760784094641497685","date":"2026-05-13T22:35:13+00:00","index":"hide","fulltext":""},{"type":"reviewersInvited","content":"","date":"2026-05-06T06:22:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-04T09:51:14+00:00","index":"","fulltext":""},{"type":"editorInvited","content":"","date":"2026-04-09T08:48:33+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2026-04-09T08:11:27+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Health Services Research","date":"2026-04-09T07:36:33+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-health-services-research","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bhsr","sideBox":"Learn more about [BMC Health Services Research](http://bmchealthservres.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/BHSR/default.aspx","title":"BMC Health Services Research","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"efb1467c-af81-47c3-bbc3-23af552b5925","owner":[],"postedDate":"May 14th, 2026","published":true,"recentEditorialEvents":[{"type":"reviewerAgreed","content":"125148318902914088832731345903718919930","date":"2026-05-19T15:31:12+00:00","index":69,"fulltext":""},{"type":"reviewerAgreed","content":"108090021004123118306760784094641497685","date":"2026-05-13T22:35:13+00:00","index":65,"fulltext":""},{"type":"reviewersInvited","content":"29","date":"2026-05-06T06:22:09+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2026-05-04T09:51:14+00:00","index":"","fulltext":""}],"rejectedJournal":[],"revision":"","amendment":"","status":"under-review","subjectAreas":[],"tags":[],"updatedAt":"2026-05-14T16:16:41+00:00","versionOfRecord":[],"versionCreatedAt":"2026-05-14 16:16:41","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-9253066","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-9253066","identity":"rs-9253066","version":["v1"]},"buildId":"XKTyCvWXoU3ODBz1xrDgd","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}