Developing a Validated Nigerian Oral and Maxillofacial Surgical Complexity Scoring System for Resource Allocation in Public Tertiary Hospitals

The equitable allocation of limited surgical resources in Nigerian public tertiary hospitals requires objective, validated tools to quantify the complexity of oral and maxillofacial surgical cases and predict resource requirements. Existing international surgical complexity scoring systems were not designed for the Nigerian healthcare environment and fail to account for local disease burden patterns, comorbidity profiles, and institutional capacity constraints. This study develops and validates the Nigerian Oral and Maxillofacial Surgical Complexity Score (NOMSCS), a novel context-specific scoring instrument. Using a sequential mixed-methods design, the tool development phase involved structured expert elicitation from 40 consultant oral and maxillofacial surgeons from all six geopolitical zones through modified Delphi rounds, identifying and weighting the most clinically relevant complexity determinants. The validation phase prospectively applied NOMSCS to 300 consecutive surgical cases at five teaching hospitals, testing for correlation with actual theatre time, resource utilization, length of hospital stay, complication rate, and clinician-assigned complexity rating. Psychometric analysis confirmed high internal consistency (Cronbach's alpha = 0.87) and strong criterion validity against resource utilization measures. The NOMSCS demonstrated superior predictive performance for theatre time and blood product use compared to two international comparator tools. The study contributes an original, evidence-based measurement instrument to Nigerian oral surgical governance and recommends its adoption by the National Postgraduate Medical College of Nigeria for training and resource planning purposes. Keywords: surgical complexity scoring, resource allocation, oral surgery, Nigeria, validation.