Rech, D., Bertrand, J.T., Thomas, N., et al. PLOS ONE (May 2014), 9(4): e84271, doi: 10.1371/journal.pone.0084271.
This analysis examined the association among elements of surgical efficiency in voluntary medical male circumcision (VMMC), the quality of surgical technique, and the time required to conduct VMMC procedures. The primary provider's time with the client (PPTC) and total elapsed operating time (TEOT) were the efficiency outcomes of interest. The analysis drew on cross-sectional data from the Systematic Monitoring of the VMMC Scale-up study in Kenya, South Africa, Tanzania and Zimbabwe in 2011 and 2012. Trained clinicians observed VMMC surgery to assess technique and timed nine specific steps in the procedure. Having a secondary provider perform suturing and electrocautery reduced PPTC. Task-sharing for suturing and/or electrocautery were also significantly related to TEOT in two of the four countries. The overall quality of the surgical technique was not significantly related to either variable, except in South Africa in 2012, where higher surgical quality was associated with lower TEOT. These data confirmed that task-sharing of suturing and use of electrocautery for VMMC increased efficiency and decreased TEOT. Lower elapsed time and provider time with patients did not lead to lower quality of surgical care.