Athni, Tejas S.

AbstractObjectiveThis study aims to document and analyze the challenges and outcomes of performing complex airway surgery in a low‐resource, post‐war setting in Mekelle, Ethiopia.MethodsThis prospective case series examines clinical data from five patients who underwent airway reconstruction surgeries and one patient who underwent total laryngectomy at Ayder Comprehensive Specialized Hospital in Mekelle. Data included patient demographics, airway stenosis etiology and severity, operative details, postoperative outcomes, complications, and hospital length of stay. Ethical approval was obtained from institutional review boards at Mayo Clinic and Mekelle University.ResultsThe study included six patients aged 9–62 years, with surgeries comprising three cricotracheal resections, two tracheal resections, and one laryngectomy. Three reconstructions were for war‐related injuries. Challenges included power outages during surgeries, limitations in medical supplies and equipment, and inadequate perioperative care. Despite these, three patients requiring tracheostomies were successfully decannulated within a year. However, complications such as restenosis, infections, and the need for reintubation were common.ConclusionAirway surgeries in a low‐resource, post‐war setting face significant hurdles, including perioperative care quality, resource limitations, and infrastructure issues. Successful outcomes require multidisciplinary training tailored to local contexts, investments in hospital infrastructure and reliable electricity, and proper perioperative nutrition. This study highlights the need for comprehensive interventions to improve surgical care in such settings.Level of evidence: IV.

Abstract Background: The three delays model, identifies three key stages to delays in care that can contribute to adverse outcomes: decision-making to seek care, accessing healthcare facilities, and receiving appropriate medical care. However, the application of this model in otolaryngology-head and neck surgery (OHNS) and in a human conflict environment has not been examined. This study aims to explore the impact of each delay type within the OHNS population in post-war Mekelle, Ethiopia. By investigating these delays, the study seeks to uncover strategies for reducing delays and improving outcomes in the management of OHNS pathology for this and similar environments. Methods: This study was conducted during a 3-week short term OHNS surgical trip in Mekele, Ethiopia, following a 2 year war. A total of 105 patients attending the OHNS clinic were identified and given verbal interviews and semi-structured questionnaires. The three delays model was applied to analyze the data collected, focusing on the following aspects: 1) decision to seek care, 2) reaching care, and 3) receiving care. Results: A total of 105 patients were included in the analysis, with 100% (105/105) experiencing type 1 delays (decision to seek care), 75% experiencing type 2 delays (75/105) and an additional 77% (77/105) facing type 3 delays (receiving appropriate care after reaching health care facility). More than half of the patients encountered delays in all three types. Various factors contributed to type 3 delays, including multiple delays at the time of admission, drug shortages, non-availability of skilled staff, and incompetence. Cost of transportation emerged as the primary factor contributing to type 2 delays. Conclusion: The findings provide valuable insights into the specific delays experienced by patients seeking OHNS services in a post-war setting and inform potential strategies for improving healthcare delivery in similar contexts.