Abstract
Introduction
The Lancet Commission on Global Surgery proposed 5000 operations/100,000 people annually as a benchmark for developing countries but did not define benchmarks for different age groups. We evaluated the operation rate for elderly patients (≥65 years) in Ghana and estimated the unmet surgical need for the elderly by comparison to a high-income country benchmark.
Methods
Data on operations performed for elderly patients over a 1-year period in 2014-5 were obtained from representative samples of 48/124 small district hospitals and 12/16 larger referral hospitals and scaled-up for nationwide estimates. Operations were categorized as essential (most cost-effective, highest population impact) versus other according to The World Bank’s Disease Control Priority project (DCP-3). Data from New Zealand’s National Minimum Dataset were used to derive a benchmark operation rate for the elderly.
Results
16,007 operations were performed for patients ≥65 years. The annual operation rate was 1744/100,000 (95% UI 1440–2048), only 12% of the New Zealand benchmark of 14,103/100,000. 74% of operations for the elderly were in the essential category. The most common procedures (15%) were for urinary obstruction. 58% of operations were performed at district hospitals; 54% of these did not have fully-trained surgeons. Referral hospitals more commonly performed operations outside the essential category.
Conclusion
The operation rate was well beneath the benchmark, indicating a potentially large unmet need for Ghana’s elderly population. Most operations for the elderly were in the essential category and delivered at district hospitals. Future global surgery benchmarking should consider specific benchmarks for different age groups.
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Acknowledgements
This study was funded by Grants R25-TW009345 and D43-TW007267 from the Fogarty International Center, US National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. The authors thank the dedicated volunteers for extracting data needed for the study and Chris Lewis of New Zealand Ministry of Health for providing us with the National Minimum Dataset.
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Study concept and design: Gyedu, Stewart, Gaskill, Mock, Donkor. Acquisition, analysis, or interpretation of data: Gyedu, Stewart, Salia, Wadie. Drafting of the manuscript: All authors Critical revision of the manuscript for important intellectual content: All authors Administrative, technical, or material support: All authors.
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Gyedu, A., Stewart, B., Gaskill, C. et al. Enumeration of Operations Performed for Elderly Patients in Ghana: An Opportunity to Improve Global Surgery Benchmarking. World J Surg 43, 1644–1652 (2019). https://doi.org/10.1007/s00268-019-04963-7
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DOI: https://doi.org/10.1007/s00268-019-04963-7