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World Journal of Surgery

, Volume 36, Issue 2, pp 232–239 | Cite as

Development of a Surgical Capacity Index: Opportunities for Assessment and Improvement

  • Steve KwonEmail author
  • T. Peter Kingham
  • Thaim B. Kamara
  • Lawrence Sherman
  • Eileen Natuzzi
  • Charles Mock
  • Adam Kushner
Article

Abstract

Background

Significant gaps exist in the provision of surgical care in low- and middle-income countries (LMICs). The purpose of this study was to develop a metric to monitor surgical capacity in LMICs.

Methods

The World Health Organization developed a survey called the Tool for Situational Analysis to Assess Emergency and Essential Surgical Care. Using this tool, we developed a surgical capacity scoring index and assessed its usefulness with data from Sierra Leone, Liberia, and the Solomon Islands.

Results

There were data from 10 hospitals in Sierra Leone, 16 hospitals in Liberia, and 9 hospitals in the Solomon Islands. The levels of surgical capacity were created using our scoring index based on a possible 100 points: level 1 for hospitals with <50 points, level 2 with 50–70 points, level 3 with 70–80 points, and level 4 with >80 points. In Sierra Leone, 44% of the hospitals had a surgical capacity rating of level 1, 50% level 2, and 10% level 3. In Liberia, 37.5% of the hospitals had a surgical capacity rating of level 1, 56.3% level 2, and only one hospital level 3. For Sierra Leone and Liberia, two factors—infrastructure and personnel—had the greatest deficits. In the Solomon Islands, 44.4% of the hospitals had their surgical capacity rated at level 1, 22.2% at level 2, 11.1% at level 3, and 22.2% at level 4.

Conclusions

Pending pilot testing for reliability and validity, it appears that a systematic hospital surgical capacity index can identify areas for improvement and provide an objective measure for monitoring changes over time.

Keywords

Surgical Care Solomon Island Surgical Capacity Effective Coverage Procedural Volume 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Notes

Conflict of interest

There is no financial or personal conflict of interest by any of the authors.

References

  1. 1.
    Bickler SW, Spiegel DA (2008) Global surgery: defining a research agenda. Lancet 372:90–92PubMedCrossRefGoogle Scholar
  2. 2.
    Debas H, Gosselin R, McCord C et al (2006) Disease Control Priorities in Developing Countries, 2nd edn. Oxford University Press, New York, pp 1245–1259Google Scholar
  3. 3.
    Gosselin RA, Thind A, Bellardinelli A (2006) Cost/DALY averted in a small hospital in Sierra Leone: what is the relative contribution of different services? World J Surg 30:505–511PubMedCrossRefGoogle Scholar
  4. 4.
    McCord C, Chowdhury Q (2003) A cost effective small hospital in Bangladesh: what it can mean for emergency obstetric care. Int J Gynaecol Obstet 81:83–92PubMedCrossRefGoogle Scholar
  5. 5.
    Ozgediz D, Jamison D, Cherian M et al (2008) The burden of surgical conditions and access to surgical care in low- and middle-income countries. Bull World Health Organ 86:646–647PubMedCrossRefGoogle Scholar
  6. 6.
    Weiser TG, Makary MA, Haynes AB et al (2009) Standardised metrics for global surgical surveillance. Lancet 374:1113–1117PubMedCrossRefGoogle Scholar
  7. 7.
    Spiegel DA, Gosselin RA (2007) Surgical services in low-income and middle-income countries. Lancet 370:1013–1015PubMedCrossRefGoogle Scholar
  8. 8.
    Weiser TG, Regenbogen SE, Thompson KD et al (2008) An estimation of the global volume of surgery: a modelling strategy based on available data. Lancet 372:139–144PubMedCrossRefGoogle Scholar
  9. 9.
    Kable AK, Gibberd RW, Spigelman AD (2002) Adverse events in surgical patients in Australia. Int J Qual Health Care 14:269–276PubMedCrossRefGoogle Scholar
  10. 10.
    Gawande AA, Thomas EJ, Zinner MJ et al (1999) The incidence and nature of surgical adverse events in Colorado and Utah in 1992. Surgery 126:66–75PubMedCrossRefGoogle Scholar
  11. 11.
    Ozgediz D, Hsia R, Weiser T et al (2009) Population health metrics for surgery: effective coverage of surgical services in low-income and middle-income countries. World J Surg 33:1–5PubMedCrossRefGoogle Scholar
  12. 12.
    Bickler SW, Spiegel D (2010) Improving surgical care in low- and middle-income countries: a pivotal role for the World Health Organization. World J Surg 34:386–390PubMedCrossRefGoogle Scholar
  13. 13.
    Haynes AB, Weiser TG, Berry WR et al (2010) A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 360:491–499CrossRefGoogle Scholar
  14. 14.
    Kingham TP, Kamara TB, Cherian MN et al (2009) Quantifying surgical capacity in Sierra Leone: a guide for improving surgical care. Arch Surg 144:122–127 discussion 128PubMedCrossRefGoogle Scholar
  15. 15.
    Natuzzi ES, Kushner A, Jagilly R et al (2011) Surgical care in the Solomon Islands: a road map for universal surgical care delivery. World J Surg 35:1183–1193PubMedCrossRefGoogle Scholar
  16. 16.
    Taira BR, Cherian MN, Yakandawala H et al (2010) Survey of emergency and surgical capacity in the conflict-affected regions of Sri Lanka. World J Surg 34:428–432PubMedCrossRefGoogle Scholar
  17. 17.
    Choo S, Perry H, Hesse AA, et al. (2010) Assessment of capacity for surgery, obstetrics and anaesthesia in 17 Ghanaian hospitals using a WHO assessment tool. Trop Med Int Health July. [Epub ahead of print]Google Scholar
  18. 18.
    Contini S, Taqdeer A, Cherian M et al (2010) Emergency and essential surgical services in Afghanistan: still a missing challenge. World J Surg 34:473–479PubMedCrossRefGoogle Scholar
  19. 19.
    Sherman L, Clement PT, Cherian MN et al (2011) Implementing Liberia’s poverty reduction strategy: an assessment of emergency and essential surgical care. Arch Surg 146:35–39PubMedCrossRefGoogle Scholar
  20. 20.
    Spiegel DA, Choo S, Cherian M et al (2011) Quantifying surgical and anesthetic availability at primary health facilities in Mongolia. World J Surg 5:272–279CrossRefGoogle Scholar
  21. 21.
    Kushner AL, Cherian MN, Noel L et al (2010) Addressing the Millennium Development Goals from a surgical perspective: essential surgery and anesthesia in 8 low- and middle-income countries. Arch Surg 145:154–159PubMedCrossRefGoogle Scholar
  22. 22.
    Galukande M, von Schreeb J, Wladis A et al (2010) Essential surgery at the district hospital: a retrospective descriptive analysis in three African countries. PLoS Med 7:e1000243PubMedCrossRefGoogle Scholar
  23. 23.
    Kruk ME, Wladis A, Mbembati N et al (2010) Human resource and funding constraints for essential surgery in district hospitals in Africa: a retrospective cross-sectional survey. PLoS Med 7:e1000242PubMedCrossRefGoogle Scholar
  24. 24.
    Demetriades D, Martin M, Salim A et al (2005) The effect of trauma center designation and trauma volume on outcome in specific severe injuries. Ann Surg 242:512–517 discussion 517–519PubMedGoogle Scholar
  25. 25.
    Cudnik MT, Newgard CD, Sayre MR et al (2009) Level I versus Level II trauma centers: an outcomes-based assessment. J Trauma 66:1321–1326PubMedCrossRefGoogle Scholar
  26. 26.
    Lozano R, Soliz P, Gakidou E et al (2006) Benchmarking of performance of Mexican states with effective coverage. Lancet 368:1729–1741PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2011

Authors and Affiliations

  • Steve Kwon
    • 1
    Email author
  • T. Peter Kingham
    • 2
    • 3
  • Thaim B. Kamara
    • 4
  • Lawrence Sherman
    • 5
  • Eileen Natuzzi
    • 7
  • Charles Mock
    • 1
  • Adam Kushner
    • 3
    • 6
  1. 1.Department of SurgeryUniversity of WashingtonSeattleUSA
  2. 2.Department of SurgeryMemorial Sloan-Kettering Cancer CenterNew YorkUSA
  3. 3.Surgeons OverSeas (SOS)New YorkUSA
  4. 4.Department of SurgeryConnaught HospitalFreetownSierra Leone
  5. 5.Department of SurgeryFirestone HospitalMonroviaLiberia
  6. 6.Department of SurgeryColumbia UniversityNew YorkUSA
  7. 7.Department of SurgeryScripps Memorial HospitalEncinitasUSA

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