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Evaluation of Surgical Care in El Salvador Using the WHO Surgical Vital Statistics

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Abstract

Objective

Vital statistics to assess surgical care worldwide have been published by the World Health Organization. These data have not been reported for any Latin American country. We sought to measure these metrics as a starting point for understanding how to improve the safety of surgery in El Salvador.

Methods

We designed an institutional survey that was sent to 21 hospitals and used national administrative data sources to estimate the number of surgeons, anesthesia professionals, operating rooms, and annual surgical volume for El Salvador. We reviewed surgical and death logs for 12 Ministry of Health hospitals to calculate day-of-surgery and postoperative in-hospital mortality ratios for a 6-month period (October 2009–March 2010).

Findings

We estimate there to be 1,222 surgeons [95 % confidence interval (CI) 1,137–1,307], 539 anesthesia providers, 168 operating rooms (95 % CI 136–199), and 172,972 operations (95 % CI 171,961–173,983) annually in El Salvador. There were on average 1,197 annual cases per operating room and 436 annual cases per surgeon in the 21 hospitals we studied. The day-of-surgery mortality ratio was 0.42 % (95 % CI 0.35–0.5), whereas the postoperative in-hospital mortality ratio was 1.58 % (95 % CI 1.44–1.72). The postoperative in-hospital mortality ratio was higher for hospitals with a greater number of hospital beds (p = 0.01) and operating rooms (p = 0.02).

Conclusions

Despite the challenges that El Salvador faces to provide surgical care, national collection of surgical vital statistics is feasible. Collection of additional process and outcome measures may be insightful for improving the surgical safety in El Salvador and elsewhere.

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Acknowledgments

This project was funded with a Traveling Fellowship Grant from the Scholars in Medicine Office at Harvard Medical School. The authors thank Dr. Sandra Leal, the President of the Salvadoran Anesthesiology Association, for providing data on the number of anesthesiologists in El Salvador.

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Authors and Affiliations

  1. Harvard Medical School, Boston, MA, USA

    George Molina

  2. Brigham and Women’s Hospital—General Surgery, Boston, MA, USA

    Luke M. Funk & Atul Gawande

  3. National Hospital, “Rosales”, San Salvador, El Salvador, CA

    Virginia Rodriguez

  4. Division of General Internal Medicine, Brigham and Women’s Hospital, Boston, MA, USA

    Stuart R. Lipsitz

Authors
  1. George Molina
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  2. Luke M. Funk
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  3. Virginia Rodriguez
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  4. Stuart R. Lipsitz
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  5. Atul Gawande
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Corresponding author

Correspondence to George Molina.

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Molina, G., Funk, L.M., Rodriguez, V. et al. Evaluation of Surgical Care in El Salvador Using the WHO Surgical Vital Statistics. World J Surg 37, 1227–1235 (2013). https://doi.org/10.1007/s00268-013-1990-0

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  • DOI: https://doi.org/10.1007/s00268-013-1990-0

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