Disparities in Surgical Outcomes Between Public and Private Hospitals in Nigeria: A Nationwide Comparative Study

Significant disparities in surgical quality between public and private hospitals in Nigeria are widely perceived but have never been rigorously quantified using nationally representative comparative data. This dissertation conducts the first nationwide comparative analysis of surgical outcomes between public and private hospitals in Nigeria, using a structured registry approach across all six geopolitical zones. A prospective surgical outcomes registry was established at 36 hospitals (18 public, 18 private) over a 24-month period from 2021 to 2023. Standardized data on elective and emergency surgical procedures were collected, with primary outcomes including 30-day mortality, SSI rates, unplanned reoperation rates, and hospital stay duration. Propensity score matching was applied to control for patient-level confounding. Private hospitals demonstrated significantly lower 30-day mortality (3.1% versus 7.4%), SSI rates (6.2% versus 14.8%), and shorter hospital stays across matched elective surgical cases. Emergency surgical outcomes were comparable between sectors, reflecting acute resource constraints in both settings. Equipment availability, staffing ratios, and drug supply consistency were the strongest mediating factors of outcome disparities. The study provides a rigorous empirical basis for surgical quality improvement investment in the public sector and recommends a national surgical outcome benchmarking program, universal health coverage expansion, and public hospital facility investment as priority policy interventions. Keywords: surgical outcomes, public versus private, health disparities, Nigeria, benchmarking