Impact of Surgeon cadre, theatre location, and presence of intern healthcare professionals on decision-to-delivery interval in women undergoing emergency caesarean section in Northern Uganda: a historical cohort study

Background: Emergency caesarean sections (CS) are critical to avert adverse maternal and neonatal outcomes. The Decision-to-Delivery Interval (DDI), the interval between making the decision and achieving delivery of a newborn in an emergency CS, impacts maternal and neonatal outcomes. Although the World Health Organisation recommends achieving a DDI of <30 minutes, this is often difficult in resource-constrained areas. This study assessed the influence of the surgeon’s cadre, operating theatre location, and presence of intern healthcare professionals on DDI and whether these relationships differed by CS indication. Methods: We conducted a historical cohort study at St. Mary’s Hospital Lacor, a tertiary hospital in Northern Uganda, involving women who underwent emergency CS (6 September 2022 to 1 June 2024). Logistic regression was used to examine the association between prolonged DDI (≥60 minutes) and surgeon cadre, operating theatre location, and intern presence, adjusting for confounders. We also assessed effect modification by CS indication. Results: Of the 760 participants enrolled (median DDI was 51 minutes (IQR: 36-67)), 36.0% had prolonged DDI. Emergency CS performed by junior doctors had twice the odds of prolonged DDI compared to senior doctors (adjusted OR: 2.07; 95% CI: 1.38-3.10). Theatre location and presence of interns showed no association with prolonged DDI (OR: 0.89; 95% CI: 0.61-1.28) and (OR: 0.71; 95% CI: 0.51-1.02), respectively. There was no statistically significant evidence that these associations differed by the CS indication. Conclusions: Emergency CS performed by junior doctors is associated with increased odds of prolonged DDI compared to those performed by senior doctors, emphasising the need to strengthen training, supervision, and mentorship for inexperienced surgeons. While theatre location and intern presence were not significantly associated with DDI, further research across diverse settings is warranted.