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



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.

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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.

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Corresponding author

Correspondence to Jared A. Forrester.

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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.

Appendix: Lifebox surgical lighting survey

Appendix: Lifebox surgical lighting survey


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Forrester, J.A., Boyd, N.J., Fitzgerald, J.E.F. et al. Impact of Surgical Lighting on Intraoperative Safety in Low-Resource Settings: A Cross-Sectional Survey of Surgical Providers. World J Surg 41, 3055–3065 (2017).

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