Novel community-based approach for enhanced postoperative follow-up in rural Sierra Leone: Is it sustainable?

INTRODUCTION: Barriers to patient follow-up after short-term surgical trips (STSTs) are multifactorial. Follow-up is essential for identifying and managing complications. Compliance greater than 90% was achieved in a previously implemented community-based follow-up protocol. We hypothesized decreased follow-up rates after a two-year hiatus from the COVID-19 pandemic. METHODS: Retrospective review of STSTs from 2017 to 2019 (pre-pandemic) vs 2022-2024 (post-pandemic) at Kabala Government Hospital, Sierra Leone. Consistent follow-up protocol was used across trips, emphasizing patient education and community recruitment. Patient and operative details were compared. RESULTS: 381 patients included across six STSTs. Post-pandemic patients were older. Similar surgeries were performed (hernia repairs and hydrocelectomies). Post-pandemic STSTs demonstrated at least 90% follow-up rates, similar to pre-pandemic without difference in complication rates. This result was also consistent when variables were controlled for in a multivariable regression analysis CONCLUSIONS: High postoperative follow-up rates in rural Sierra Leone were sustained despite hiatus due to the COVID-19 pandemic. Incorporating local communities can achieve consistently high follow-up rates and accountability at low cost. Others may consider adapting this multifaceted protocol to improve sustainable follow-up rates.