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Global Access to Cardiac Surgery Centers: Distribution, Disparities, and Targets

  • Surgery in Low and Middle Income Countries
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

Background

Global data on cardiac surgery centers are outdated and survey-based. In 1995, there were 0.7 centers per million population, ranging from one per 120,000 in North America to one per 33 million in sub-Saharan Africa. This study analyzes the contemporary distribution of cardiac surgery centers and proposes targets relative to countries’ cardiovascular disease (CVD) burdens.

Methods

Medical databases, gray literature, and governmental reports were used to identify the most recent post-2010 data that describe the number of centers performing cardiac surgery in each nation. The 2019 Institute for Health Metrics and Evaluation Global Burden of Disease Results Tool provided national CVD burdens. One-third of the CVD burden was assumed to be surgical. Center targets were proposed as the average or half of the average of centers per million surgical CVD patients in high-income countries.

Results

5,111 cardiac surgery centers were identified across 230 nations and territories with available data, equaling 0.73 centers per million population. The median (interquartile range) number of centers ranged from 0 (0–0.06) per million in low-income countries to 0.75 (0–1.44) in high-income countries. Targets were 612.2 (optimistic) or 306.1 (conservative) centers per million surgical CVD incidence. In 2019, low-income, lower-middle-income, and upper-middle-income countries possessed 34.8, 149.0, and 271.9 centers per million surgical CVD incidence.

Conclusion

Little progress has been made to increase cardiac surgery centers per population despite growing CVD burdens. Today’s global cardiac surgical capacity remains insufficient, disproportionately affecting the world’s poorest regions.

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Abbreviations

DALYs:

Disability-adjusted life years

LMICs:

Low-and middle-income countries

NSOAPs:

National Surgical, Obstetric, and Anesthesia Plans

WHO:

World Health Organization

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Acknowledgements

DV is supported by the Canadian Institutes of Health Research (CIHR) Vanier Canada Graduate Scholarship for work outside this manuscript

Author information

Authors and Affiliations

  1. Institute of Health Policy, Management and Evaluation, University of Toronto, 155 College St, Toronto, ON, ON M5T 3M6, Canada

    Dominique Vervoort

  2. Division of Cardiac Surgery, University of Toronto, Toronto, ON, Canada

    Dominique Vervoort

  3. Dubai Medical College, Dubai, United Arab Emirates

    Maryam Salma Babar

  4. Department of Surgery, Massachusetts General Hospital, Boston, MA, USA

    Marlena E. Sabatino

  5. Punjab Medical College, Faisalabad, Pakistan

    Mehr Muhammad Adeel Riaz

  6. Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA

    Matthew T. Hey

  7. Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA

    Matthew T. Hey

  8. University of Arizona College of Medicine, Phoenix, AZ, USA

    Meghana P. H. Prakash

  9. Department of Cardiothoracic Surgery, Amsterdam University Medical Center, Amsterdam, The Netherlands

    Sulayman El Mathari

  10. Division of Cardiac Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Jacques Kpodonu

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  1. Dominique Vervoort
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Correspondence to Dominique Vervoort.

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Vervoort, D., Babar, M.S., Sabatino, M.E. et al. Global Access to Cardiac Surgery Centers: Distribution, Disparities, and Targets. World J Surg 47, 2909–2916 (2023). https://doi.org/10.1007/s00268-023-07130-1

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