World Journal of Surgery

, Volume 41, Issue 12, pp 3055–3065 | Cite as

Impact of Surgical Lighting on Intraoperative Safety in Low-Resource Settings: A Cross-Sectional Survey of Surgical Providers

  • Jared A. ForresterEmail author
  • Nicholas J. Boyd
  • J. Edward F. Fitzgerald
  • Iain H. Wilson
  • Abebe Bekele
  • Thomas G. Weiser
Original Scientific Report



Safe surgery requires high-quality, reliable lighting of the surgical field. Little is reported on the quality or potential safety impact of surgical lighting in low-resource settings, where power failures are common and equipment and resources are limited.


Members of the Lifebox Foundation created a novel, non-mandatory, 18-item survey tool using an iterative process. This was distributed to surgical providers practicing in low-resource settings through surgical societies and mailing lists.


We received 100 complete responses, representing a range of surgical centres from 39 countries. Poor-quality surgical field lighting was reported by 40% of respondents, with 32% reporting delayed or cancelled operations due to poor lighting and 48% reporting electrical power failures at least once per week. Eighty per cent reported the quality of their surgical lighting presents a patient safety risk with 18% having direct experience of poor-quality lighting leading to negative patient outcomes. When power outages occur, 58% of surgeons rely on a backup generator and 29% operate by mobile phone light. Only 9% of respondents regularly use a surgical headlight, with the most common barriers reported as unaffordability and poor in-country suppliers.


In our survey of surgeons working in low-resource settings, a majority report poor surgical lighting as a major risk to patient safety and nearly one-third report delayed or cancelled operations due to poor lighting. Developing and distributing robust, affordable, high-quality surgical headlights could provide an ideal solution to this significant surgical safety issue.



The authors would like to thank the survey respondents; Luca Koritsanzky, Sibonile Mathe, and Sarah Kessler for their coordination of efforts within the Lifebox Foundation; and Rosemary Mugwe, Chief Executive Officer of COSECSA, for help in the questionnaire distribution.

Compliance with ethical standards

Conflict of interest

All authors have been involved in Lifebox activities. JAF is a current Lifebox fellow; NJB and JEFF were former fellows; JEFF is currently an honorary clinical fellow; IHW and TGW are trustees of Lifebox UK and US, respectively; AB is the Ethiopia Lead for Clean Cut, a Lifebox programme to improve surgical safety. There was no funding for this project.


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Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Jared A. Forrester
    • 1
    Email author
  • Nicholas J. Boyd
    • 2
  • J. Edward F. Fitzgerald
    • 3
  • Iain H. Wilson
    • 4
  • Abebe Bekele
    • 5
  • Thomas G. Weiser
    • 1
    • 6
    • 7
  1. 1.Department of Surgery, Section of Trauma & Critical CareStanford UniversityStanfordUSA
  2. 2.Great Ormond Street Hospital For Children NHS TrustLondonUK
  3. 3.Kings Centre for Global HealthKings College LondonLondonUK
  4. 4.Lifebox FoundationLondonUK
  5. 5.Department of Surgery, School of MedicineAddis Ababa UniversityAddis AbabaEthiopia
  6. 6.Lifebox FoundationBostonUSA
  7. 7.Department of Clinical Surgery, Royal Infirmary of EdinburghUniversity of EdinburghEdinburghUK

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