Pediatric neurosurgical bellwether procedures for infrastructure capacity building in hospitals and healthcare systems worldwide
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Quantifying the global burden of pediatric neurosurgical disease—and current efforts addressing it—is challenging, particularly in the absence of uniform terminology. We sought to establish bellwether procedures for pediatric neurosurgery, in order to standardize terminology, establish priorities, and facilitate goal-oriented capacity building.
Members of international pediatric neurosurgical and pediatric surgical societies were surveyed via the Research Electronic Data Capture (REDCap) platform. Among 15 proposed neurosurgical procedures, respondents assigned numerical grades of surgical necessity and selected hospital-level designation within a three-tiered system. A procedure was considered a bellwether if (a) the majority of respondents deemed it necessary for either a primary- or secondary-level hospital and (b) the procedure was graded at or above the 90th percentile on a continuous scale of essentiality. Data were compiled and analyzed using Stata software.
Complete responses were obtained from 459 surgeons from 76 countries, the majority of whom practiced in a tertiary referral hospital (88%), with a primarily public patient population (64%). Six bellwether procedures were identified for pediatric neurosurgery: shunt for hydrocephalus, myelomeningocele closure, burr holes, trauma craniotomy, external ventricular drain (EVD) insertion, and cerebral abscess evacuation. Few differences in bellwether criteria designations were observed among respondents from different World Health Organization regions and World Bank income groups.
The six bellwether procedures identified can be used as markers of infrastructure capacity at various hospital levels, hence allowing targeted neurosurgical capacity-building in low-resource settings in order to avert disability and death from childhood neurosurgical disease.
KeywordsBellwether Global Essential surgery Pediatric neurosurgery Surgery Worldwide
American region—Latin America
American region—United States and Canada
Emergency and Essential Surgical Care
Eastern Mediterranean region
endoscopic third ventriculostomy
low- and middle-income countries
lower middle-income countries
magnetic resonance imaging
South-East Asian region
upper middle-income countries
World Health Organization
Western Pacific region
The authors would like to acknowledge Archit Potharazu for his graphical expertise and assistance with the pictorial display of data within this manuscript.
REDcap use and management is funded by Institute for Clinical and Translational Research grant support (UL1 TR000445 from NCATS/NIH).
Compliance with ethical standards
Conflicts of interest
- 1.Dewan MC, Rattani A, Fieggen G, Arraez MA, Servadei F, Boop FA, Johnson WD, Warf BC, Park KB (2018) Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. J Neurosurg. https://doi.org/10.3171/2017.11.JNS171500
- 2.Meara JG, Leather AJM, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Mérisier ED, el-Halabi S, Farmer PE, Gawande A, Gillies R, Greenberg SLM, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykar NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W (2015) Global Surgery 2030: evidence and solutions for achieving health, welfare, and economic development. Lancet 386:569–624. https://doi.org/10.1016/S0140-6736(15)60160-X CrossRefPubMedGoogle Scholar
- 6.O’Neill KM, Greenberg SLM, Cherian M, Gillies RD, Daniels KM, Roy N, Raykar NP, Riesel JN, Spiegel D, Watters DA, Gruen RL (2016) Bellwether procedures for monitoring and planning essential surgical care in low- and middle-income countries: caesarean delivery, laparotomy, and treatment of open fractures. World J Surg 40:2611–2619. https://doi.org/10.1007/s00268-016-3614-y CrossRefPubMedGoogle Scholar
- 7.Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG (2009) Research electronic data capture (REDCap)—a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform 42:377–381. https://doi.org/10.1016/j.jbi.2008.08.010 CrossRefPubMedGoogle Scholar
- 8.Jamison DT, Breman JG, Measham AR, Alleyne G, Claeson M, Evans DB, Jha P, Mills A, Musgrove P, Eds (2006) Referral hospitals. Disease Control Priorities in Developing Countries 2nd edn. World Bank, Washington, DCGoogle Scholar
- 10.Mock C, Cherian M, Juillard C, Donkor P, Bickler S, Jamison D, McQueen K (2010) Developing priorities for addressing surgical conditions globally: furthering the link between surgery and public health policy. World J Surg 34:381–385. https://doi.org/10.1007/s00268-009-0263-4 CrossRefPubMedGoogle Scholar
- 11.Burssa D, Teshome A, Iverson K, Ahearn O, Ashengo T, Barash D, Barringer E, Citron I, Garringer K, McKitrick V, Meara J, Mengistu A, Mukhopadhyay S, Reynolds C, Shrime M, Varghese A, Esseye S, Bekele A (2017) Safe surgery for all: early lessons from implementing a national government-driven surgical plan in Ethiopia. World J Surg 41:3038–3045. https://doi.org/10.1007/s00268-017-4271-5 CrossRefPubMedGoogle Scholar
- 17.Dewan MC, Rattani A, Mekary R, Glancz LJ, Yunusa I, Baticulon RE, Fieggen G, Wellons JC 3rd, Park KB, Warf BC (2018) Global hydrocephalus epidemiology and incidence: systematic review and meta-analysis. J Neurosurg. https://doi.org/10.3171/2017.10.JNS17439
- 18.Dewan MC, Naftel RP (2016) The global rise of endoscopic third ventriculostomy with choroid plexus cauterization in pediatric hydrocephalus. Pediatr Neurosurg 1–8. doi: https://doi.org/10.1159/000452809
- 19.Kulkarni AV, Schiff SJ, Mbabazi-Kabachelor E, Mugamba J, Ssenyonga P, Donnelly R, Levenbach J, Monga V, Peterson M, MacDonald M, Cherukuri V, Warf BC (2017) Endoscopic treatment versus shunting for infant hydrocephalus in Uganda. N Engl J Med 377:2456–2464. https://doi.org/10.1056/NEJMoa1707568 CrossRefPubMedPubMedCentralGoogle Scholar
- 20.Rudolfson N, Dewan MC, Park KB, Shrime MG, Meara JG, Alkire BC (2018) The economic consequences of neurosurgical disease in low- and middle-income countries. J Neurosurg. https://doi.org/10.3171/2017.12.JNS17281