Acceptability of ambulatory surgery provided in freestanding ambulatory surgical centers and its associated factors among surgical healthcare providers in Uganda.

backgroundThe global burden of surgical disease continues to increase. However, access remains limited by high costs and inadequate theater capacity, particularly in Africa, which accounts for only 6% of all global surgeries. Ambulatory surgery in freestanding ambulatory surgery centers is becoming increasingly prevalent in western countries because of its potential to reduce the cost of surgical care. However, its proliferation in low- and middle-income countries depends on its acceptance by surgical healthcare providers, not only by patients. This study assessed surgical healthcare providers' acceptance of ambulatory surgery at a freestanding ambulatory surgery center in Uganda.

methodAn analytical cross-sectional study was conducted among surgical healthcare providers in the central and eastern regions of Uganda. Hospitals and health centers were sampled randomly and individual surgical care providers were consecutively sampled to participate in structured interviews. These interviews were designed to capture a multidimensional dataset, including (1) sociodemographic profiles (e.g., age, gender, and level of education); (2) intrapersonal factors (e.g., individual attitudes, self-efficacy, and clinical knowledge); (3) interinstitutional dynamics (e.g., referral networks and professional collaboration); and (4) provider-specific characteristics (e.g., years of surgical experience and specific clinical roles). Descriptive analysis was performed to summarize the data, followed by multivariate analysis using a log-binomial model with an alpha level of 5%.

resultsOf 516 respondents, 400 provided valid data (77.5% completion rate). The majority were male (55.2%), aged 30-39 years (40.8%), and had postgraduate qualifications (54.3%). Half of the participants were surgeons from various sub-specialties. The overall acceptability of ambulatory surgery was low (13%). The primary concerns among non-users include safety, care gaps, limited procedural scope, and poor postoperative outcomes. Lower acceptability was significantly associated with being a graduate (aPR = 0.527), having 5-10 years of experience (aPR = 0.393), having a higher risk of adverse events (aPR = 0.222), and believing that few colleagues would adopt the practice (aPR = 0.537). Conversely, perceived ambulatory surgery as cost-effective was associated with a higher acceptability (aPR = 2.305).

conclusionAcceptability of a freestanding ASC model is low among surgical care providers in Uganda, which may hinder its expansion of this care model. Improving acceptance will likely require targeted mindset-change interventions that address negative perceptions of ambulatory surgery and the intrapersonal factors identified in this study.