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Disability Weights for Pediatric Surgical Procedures: A Systematic Review and Analysis

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Abstract

Background

Metrics to measure the burden of surgical conditions, such as disability weights (DWs), are poorly defined, particularly for pediatric conditions. To summarize the literature on DWs of children’s surgical conditions, we performed a systematic review of disability weights of pediatric surgical conditions in low- and middle-income countries (LMICs).

Method

For this systematic review, we searched MEDLINE for pediatric surgery cost-effectiveness studies in LMICs, published between January 1, 1996, and April 1, 2017. We also included DWs found in the Global Burden of Disease studies, bibliographies of studies identified in PubMed, or through expert opinion of authors (ES and HR).

Results

Out of 1427 publications, 199 were selected for full-text analysis, and 30 met all eligibility criteria. We identified 194 discrete DWs published for 66 different pediatric surgical conditions. The DWs were primarily derived from the Global Burden of Disease studies (72%). Of the 194 conditions with reported DWs, only 12 reflected pre-surgical severity, and 12 included postsurgical severity. The methodological quality of included studies and DWs for specific conditions varied greatly.

Interpretation

It is essential to accurately measure the burden, cost-effectiveness, and impact of pediatric surgical disease in order to make informed policy decisions. Our results indicate that the existing DWs are inadequate to accurately quantify the burden of pediatric surgical conditions. A wider set of DWs for pediatric surgical conditions needs to be developed, taking into account factors specific to the range and severity of surgical conditions.

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Acknowledgements

We want to thank the Global Initiative for Children’s Surgery (GICS) for its support of this work. GICS (www.globalchildrenssurgery.org) is a network of children’s surgical and anesthesia providers from low-, middle-, and high-income countries collaborating for the purpose of improving the quality of surgical care for children globally.

Funding

Duke Global Health Institute.

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Authors and Affiliations

  1. Robbins College of Health and Human Services, Baylor University, Waco, TX, USA

    Emily R. Smith

  2. Duke Global Health Institute, Duke University, 310 Trent Drive, Durham, NC, 27710, USA

    Emily R. Smith, Tessa Concepcion, Anthony T. Saxton & Henry E. Rice

  3. Duke University School of Medicine, Durham, NC, USA

    Stephanie Lim

  4. Duke University, Durham, NC, USA

    Sam Sadler

  5. Division of Pediatric General and Thoracic Surgery, The Montreal Children’s Hospital, McGill University Health Centre, Montreal, QC, Canada

    Dan Poenaru

  6. Department of Surgery, Duke University Medical Center, Durham, NC, USA

    Anthony T. Saxton & Henry E. Rice

  7. Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, USA

    Mark Shrime

  8. Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, USA

    Mark Shrime

  9. Division of Paediatric Surgery, Department of Surgery, National Hospital, Abuja, Nigeria

    Emmanuel Ameh

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  1. Emily R. Smith
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on behalf of the Global Initiative for Children’s Surgery

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Correspondence to Emily R. Smith.

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Conflict of interest

MGS receives support from the GE Foundation Safe Surgery 2020 project and from the Damon Runyon Cancer Research Foundation. No specific funding was obtained for this paper.

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Smith, E.R., Concepcion, T., Lim, S. et al. Disability Weights for Pediatric Surgical Procedures: A Systematic Review and Analysis. World J Surg 42, 3021–3034 (2018). https://doi.org/10.1007/s00268-018-4537-6

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