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Evaluating the collection, comparability and findings of six global surgery indicators

. 2019 Jan;106(2):e138-e150. doi: 10.1002/bjs.11061. Epub 2018 Dec 20. Evaluating the collection, comparability and findings of six global surgery indicators A Bekele^{3 4}, L Hagander^{1 5}, E M Harrison⁶, P Kamali^{7 8}, J S Ng-Kamstra⁹, M A Khan^{8 10}, L Knowlton¹¹, A J M Leather¹², I H Marks^{13 8}, J G Meara^{14 15}, M G Shrime^{14 16}, M Smith^{17 18}, K Søreide^{6 19 20}, T G Weiser^{6 11}, J Davies^{12 21 22}

Affiliations

¹ WHO Collaborating Centre for Surgery and Public Health, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.
² Karolinska University Hospital, Solna, Stockholm, Sweden.
³ Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
⁴ University of Global Health Equity, Kigali, Rwanda.
⁵ Department of Paediatric Surgery, Skåne University Hospital Children's Hospital, Lund, Sweden.
⁶ Department of Clinical Surgery, Royal Infirmary of Edinburgh and Surgical Informatics, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
⁷ Division of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.
⁸ InciSioN, International Student Surgical Network, Leuven, Belgium.
⁹ Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
¹⁰ CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan.
¹¹ Department of Surgery, Stanford University, Stanford, California, USA.
¹² King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
¹³ Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
¹⁴ Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
¹⁵ Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, USA.
¹⁶ Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, USA.
¹⁷ Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁸ Department of General Surgery, Chris Hani Baragwaneth Academic Hospital, Johannesburg, South Africa.
¹⁹ Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
²⁰ Department of Clinical Medicine, University of Bergen, Bergen, Norway.
²¹ Institute for Applied Health Research, University of Birmingham, Birmingham, UK.
²² MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Parktown, South Africa.

PMID: 30570764
PMCID: PMC6790969
DOI: 10.1002/bjs.11061

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Evaluating the collection, comparability and findings of six global surgery indicators

H Holmer et al. Br J Surg. 2019 Jan.

. 2019 Jan;106(2):e138-e150. doi: 10.1002/bjs.11061. Epub 2018 Dec 20. Authors H Holmer^{1 2}, A Bekele^{3 4}, L Hagander^{1 5}, E M Harrison⁶, P Kamali^{7 8}, J S Ng-Kamstra⁹, M A Khan^{8 10}, L Knowlton¹¹, A J M Leather¹², I H Marks^{13 8}, J G Meara^{14 15}, M G Shrime^{14 16}, M Smith^{17 18}, K Søreide^{6 19 20}, T G Weiser^{6 11}, J Davies^{12 21 22} Affiliations

¹ WHO Collaborating Centre for Surgery and Public Health, Department of Clinical Sciences Lund, Faculty of Medicine, Lund University, Lund, Sweden.
² Karolinska University Hospital, Solna, Stockholm, Sweden.
³ Department of Surgery, School of Medicine, Addis Ababa University, Addis Ababa, Ethiopia.
⁴ University of Global Health Equity, Kigali, Rwanda.
⁵ Department of Paediatric Surgery, Skåne University Hospital Children's Hospital, Lund, Sweden.
⁶ Department of Clinical Surgery, Royal Infirmary of Edinburgh and Surgical Informatics, Centre for Medical Informatics, Usher Institute, University of Edinburgh, Edinburgh, UK.
⁷ Division of Plastic and Reconstructive Surgery, Medisch Spectrum Twente, Enschede, the Netherlands.
⁸ InciSioN, International Student Surgical Network, Leuven, Belgium.
⁹ Department of Critical Care Medicine, University of Calgary, Calgary, Alberta, Canada.
¹⁰ CMH Lahore Medical College and Institute of Dentistry, Lahore, Pakistan.
¹¹ Department of Surgery, Stanford University, Stanford, California, USA.
¹² King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London, London, UK.
¹³ Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK.
¹⁴ Department of Global Health and Social Medicine, Harvard Medical School, Boston, USA.
¹⁵ Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, USA.
¹⁶ Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary, Boston, USA.
¹⁷ Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
¹⁸ Department of General Surgery, Chris Hani Baragwaneth Academic Hospital, Johannesburg, South Africa.
¹⁹ Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
²⁰ Department of Clinical Medicine, University of Bergen, Bergen, Norway.
²¹ Institute for Applied Health Research, University of Birmingham, Birmingham, UK.
²² MRC/Wits Rural Public Health and Health Transitions Research Unit, School of Public Health, University of Witwatersrand, Parktown, South Africa.

PMID: 30570764
PMCID: PMC6790969
DOI: 10.1002/bjs.11061

Item in Clipboard

Abstract

Background: In 2015, six indicators were proposed to evaluate global progress towards access to safe, affordable and timely surgical and anaesthesia care. Although some have been adopted as core global health indicators, none has been evaluated systematically. The aims of this study were to assess the availability, comparability and utility of the indicators, and to present available data and updated estimates.

Methods: Nationally representative data were compiled for all World Health Organization (WHO) member states from 2010 to 2016 through contacts with official bodies and review of the published and grey literature, and available databases. Availability, comparability and utility were assessed for each indicator: access to timely essential surgery, specialist surgical workforce density, surgical volume, perioperative mortality, and protection against impoverishing and catastrophic expenditure. Where feasible, imputation models were developed to generate global estimates.

Results: Of all WHO member states, 19 had data on the proportion of the population within 2h of a surgical facility, 154 had data on workforce density, 72 reported number of procedures, and nine had perioperative mortality data, but none could report data on catastrophic or impoverishing expenditure. Comparability and utility were variable, and largely dependent on different definitions used. There were sufficient data to estimate that worldwide, in 2015, there were 2 038 947 (i.q.r. 1 884 916-2 281 776) surgeons, obstetricians and anaesthetists, and 266·1 (95 per cent c.i. 220·1 to 344·4) million operations performed.

Conclusion: Surgical and anaesthesia indicators are increasingly being adopted by the global health community, but data availability remains low. Comparability and utility for all indicators require further resolution.

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Figures
Figure 1

Proportion of population within 2h…

Figure 1

Proportion of population within 2h of a facility able to provide laparotomy, caesarean…

Figure 1

Proportion of population within 2h of a facility able to provide laparotomy, caesarean section and open fracture repair

Figure 2

Specialist surgeons, obstetricians and anaesthetists…

Figure 2

Specialist surgeons, obstetricians and anaesthetists per 100 000 people. a WHO member states…

Figure 2

Specialist surgeons, obstetricians and anaesthetists per 100 000 people. a WHO member states with complete data on specialist surgeons, obstetricians and anaesthetists, 2010–2016, and b estimated number of specialist surgeons, obstetricians and anaesthetists per 100 000 people in WHO member states in 2015. n.a, Countries or territories that are not WHO members and therefore excluded from the data

Figure 3

Annual number of surgical operations…

Figure 3

Annual number of surgical operations per 100 000 population. a WHO member states…

Figure 3

Annual number of surgical operations per 100 000 population. a WHO member states with available data on annual number of surgical operations, 2010–2016, and b estimated number of surgical operations per 100 000 population in WHO member states in 2015. n.a, Countries or territories that are not WHO members and therefore excluded from the data