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Proposed Minimum Rates of Surgery to Support Desirable Health Outcomes: An Observational Study Based on Three Strategies

Abstract

Background

The global volume of surgery is estimated at 312.9 million operations annually, but rates of surgery vary dramatically. Identifying surgical rates associated with improved health outcomes would be useful for benchmarking and targeted health system strengthening.

Methods

We identified rates of surgery associated with a life expectancy (LE) of 74–75 years, a maternal mortality ratio (MMR) of less than or equal to 100 per 100,000 live births, and the estimated need for surgery in the seven global burden of disease (GBD) super-regions based on the prevalence of surgical conditions. We compared our findings to surgical rates from Chile, China, Costa Rica, and Cuba (“4C”), countries with moderate resources but high health outcomes.

Results

The median surgical rates associated with LE of 74–75 years (N = 17) and MMR below 100 (N = 109) are 4392 (IQR 2897–4873) and 5028 (IQR 4139–6778) operations per 100,000 people annually, respectively. The mean surgical rate estimated for the seven super-regions was 4723 (95 % CI 3967–5478) operations per 100,000 people annually. The “4C” countries had a mean surgical rate of 4344 (95 % CI 2620–6068) operations per 100,000 people annually. Thirteen of the twenty-one GBD regions, accounting for 78 % of the world’s population, do not achieve rates of surgery at the lowest end of this range.

Conclusions

We identified a narrow range of surgical rates associated with important health indicators. This target range can be used for benchmarking of surgical services, and as part of a policy aimed at strengthening health care systems and surgical capacity.

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References

  1. Farmer P, Kim J (2008) Surgery and global health: a view from beyond the OR. World J Surg 32:533–536. doi:10.1007/s00268-008-9525-9

    PubMed Central  PubMed  Article  Google Scholar 

  2. Luboga S, Macfarlane S, von Schreeb J et al (2009) Increasing access to surgical services in sub-saharan Africa: priorities for national and international agencies recommended by the Bellagio Essential Surgery Group. PLoS Med 6:e1000200

    PubMed Central  PubMed  Article  Google Scholar 

  3. Wagstaff A, Claeson M, Hecht R, et al (2006) Millennium Development Goals for Health: What Will It Take to Accelerate Progress? In: Jamison DT, Breman JG, Measham AR, et al. (eds) Disease Control Priorities in Developing Countries. 2nd edn. Washington DC, World Bank: Chapter 9. (Available from: http://www.ncbi.nlm.nih.gov/books/NBK11716/)

  4. Meara J, Hagander L, Leather A et al (2014) Surgery and global health: a Lancet Commission. Lancet 383:12–13

    PubMed  Article  Google Scholar 

  5. Weiser T, Haynes A, Molina G, et al (2015) An estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes. [abstract accepted by Lancet Global Health, January 2015]

  6. Appropriate Technology For Birth (1985) Lancet 326:436–437

    Article  Google Scholar 

  7. Healthy people (2000) national health promotion and disease prevention objectives and healthy schools (1991). J Sch Health 61:298–328

    Google Scholar 

  8. De Brouwere V, Dubourg D, Richard F et al (2002) Need for caesarean sections in west Africa. Lancet 359:974–975

    PubMed  Article  Google Scholar 

  9. Dumont A, de Bernis L, Bouvier-olle M et al (2001) Caesarean section rate for maternal indication in sub-Saharan Africa: a systematic review. Lancet 358:1328–1333

    CAS  PubMed  Article  Google Scholar 

  10. The World Bank (2014) World Development Indicators. http://data.worldbank.org/indicator. Accessed 23 September 2014

  11. World Health Organization (2014) World Health Statistics. http://apps.who.int/gho/data. Accessed 10 September 2014

  12. United Nations Millenium Development Goals. Target 5.A: Reduce by three quarters, between 1990 and 2015, the maternal mortality ratio. (http://www.un.org/millenniumgoals/maternal.shtml)

  13. Rose J, Weiser T, Hider P, et al (2015) Estimated need for surgery worldwide based on prevalence of diseases and conditions: implications for public health planning of surgical services. [manuscript accepted by Lancet Global Health, January 2015]

  14. World Health Organization (2013) WHO methods and data sources for global burden of disease estimates 2000-2011. Available at: http://www.who.int/healthinfo/statistics/GlobalDALYmethods_2000_2011.pdf?ua=1

  15. Murray C, Ezzati M, Flaxman A et al (2012) GBD 2010: design, definitions, and metrics; supplementary appendix: comprehensive Systematic Analysis of Global Epidemiology: Definitions, Methods, Simplification of DALYs, and Comparative Results from the Global Burden of Disease Study 2010. Lancet 380:2063–2066

    PubMed  Article  Google Scholar 

  16. Jamison D, Summers L, Alleyne G et al (2013) Global health 2035: a world converging within a generation. Lancet 382:1898–1955

    PubMed  Article  Google Scholar 

  17. Greenland S (2001) Ecologic versus individual-level sources of bias in ecologic estimates of contextual health effects. Int J Epidemiol 30(6):1343–1350

    CAS  PubMed  Article  Google Scholar 

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Correspondence to Micaela M. Esquivel.

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Esquivel, M.M., Molina, G., Uribe-Leitz, T. et al. Proposed Minimum Rates of Surgery to Support Desirable Health Outcomes: An Observational Study Based on Three Strategies. World J Surg 39, 2126–2131 (2015). https://doi.org/10.1007/s00268-015-3092-7

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  • DOI: https://doi.org/10.1007/s00268-015-3092-7

Keywords

  • Life Expectancy
  • Maternal Mortality Ratio
  • Global Volume
  • Cesarean Delivery Rate
  • Desirable Health Outcome