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Bellwether Procedures for Monitoring and Planning Essential Surgical Care in Low- and Middle-Income Countries: Caesarean Delivery, Laparotomy, and Treatment of Open Fractures

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Abstract

Background

Surgical conditions represent a significant proportion of the global burden of disease, and therefore, surgery is an essential component of health systems. Achieving universal health coverage requires effective monitoring of access to surgery. However, there is no widely accepted standard for the required capabilities of a first-level hospital. We aimed to determine whether a group of operations could be used to describe the delivery of essential surgical care.

Methods

We convened an expert panel to identify procedures that might indicate the presence of resources needed to treat an appropriate range of surgical conditions at first-level hospitals. Using data from the World Health Organization Emergency and Essential Surgical Care Global database, collected using the WHO Situational Analysis Tool (SAT), we analysed whether the ability to perform each of these procedures—which we term “bellwether procedures”—was associated with performing a full range of essential surgical procedures.

Findings

The ability to perform caesarean delivery, laparotomy, and treatment of open fracture was closely associated with performing all obstetric, general, basic, emergency, and orthopaedic procedures (p < 0.001) in the population that responded to the WHO SAT Survey. Procedures including cleft lip, cataract, and neonatal surgery did not correlate with performing the bellwether procedures.

Interpretation

Caesarean delivery, laparotomy, and treatment of open fractures should be standard procedures performed at first-level hospitals. With further validation in other populations, local managers and health ministries may find this useful as a benchmark for what first-level hospitals can and should be able to perform on a 24/7 basis in order to ensure delivery of emergency and essential surgical care to their population. Those procedures which did not correlate with the bellwether procedures can be referred to a specialized centre or collected for treatment by a visiting specialist team.

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References

  1. Bickler S, Weiser T, Kassenbaum N, Higashi H, Chang DC, Barendregt JJ, Noormadhomed EV, Vos T (2015) Chapter 2: global burden of surgical conditions. Disease control priorities, 3rd Edition: economic evaluation for health. Oxford University Press, New York

    Google Scholar 

  2. Funk LM, Weiser TG, Berry WR, Lipsitz SR, Merry AF, Enright AC, Wilson IH, Dziekan G, Gawande AA (2010) Global operating theatre distribution and pulse oximetry supply: an estimation from reported data. Lancet 376(9746):1055–1061

    Article  PubMed  Google Scholar 

  3. Meara JG, Leather A, Hagander L, Alkire BC, Alonso N, Ameh EA, Bickler SW, Conteh L, Dare AJ, Davies J, Derivois Merisier E, El-Halabi S, Farmer PE, Gawande A, Gillies RG, Greenberg SL, Grimes CE, Gruen RL, Ismail EA, Kamara TB, Lavy C, Lundeg G, Mkandawire NC, Raykr NP, Riesel JN, Rodas E, Rose J, Roy N, Shrime MG, Sullivan R, Verguet S, Watters D, Weiser TG, Wilson IH, Yamey G, Yip W (2015) Global surgery 2030: evidence and solutions for achieving health, welfare and economic development. Lancet 386(9993):569–624

    Article  PubMed  Google Scholar 

  4. Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage: Report by the Secretariat. WHO Executive Board. EB135/3. May 16, 2014. http://apps.who.int/gb/ebwha/pdf_files/EB135/B135_3-en.pdf

  5. Hensher M, Price M, Adomakoh S. Disease control priorities in developing countries, 2nd edn. Chapter 66: Referral Hospitals, p 1230, Table 66.1 [cited 2015 March 9]. http://www.ncbi.nlm.nih.gov/books/NBK11737/

  6. Surgical Care at the District Hospital. WHO 2003. [cited 2015 March 1]. http://www.who.int/surgery/publications/en/SCDH.pdf?ua=1

  7. Primary Surgical Care Package (PSCP). The World Health Organization. [cited 2015 March 1]. http://www.who.int/surgery/publications/s16378e.pdf?ua=1

  8. Debas H, Gosselin R, McCord C, Thind A (2006) Surgery. In: Jamison DT (ed) Disease control priorities in developing countries, 2nd edn. Oxford University Press, New York City, pp 1245–1260

    Google Scholar 

  9. Mock CCM, Juillard C, Donkor P, Bickler S, Jamison D, McQueen K (2010) Developing priorities for addressing surgical conditions globally: furthering the link between surgery and public health policy. World J Surg 34(3):381–385

    Article  PubMed  Google Scholar 

  10. Mock CN, Donkor P, Gawande A, Jamison DT, Kruk ME, Debas HT (2015) Essential surgery: key messages from disease control priorities, 3rd edition. Lancet S0140–6736(15):60091–60095

    Google Scholar 

  11. Markin A, Barbero R, Leow JJ, Groen RS, Skow EJ, Apelgren KN, Kushner AL, Nwomeh BC (2013) A quantitative analysis of surgical capacity in Santa Cruz, Bolivia. J Surg Res 185(1):190–197

    Article  PubMed  Google Scholar 

  12. Chao TE, Burdic M, Ganjawalla K, Derbew M, Keshian C, Meara J, McQueen K (2012) Survey of surgery and infrastructure in Ethiopia. World J Surg 36(11):2545–2553

    Article  PubMed  Google Scholar 

  13. Markin A, Barbero R, Leow JJ, Groen RS, Perlman G, Habermann EB, Apelgren KN, Kushner AL, Nwomeh BC (2014) Inter-rater reliability of the PIPES tool: validation of a surgical capacity index for use in resource-limited settings. World J Surg 38(9):2195–2199

    Article  PubMed  Google Scholar 

  14. Osen H, Chang D, Choo S, Perry H, Hesse A, Abantanga F, McCord C, Chrouser K, Abdullah F (2011) Validation of the World Health Organization tool for situational analysis to assess emergency and essential surgical care at district hospitals in Ghana. World J Surg 35(3):500–504

    Article  PubMed  Google Scholar 

  15. Shrime MG, Bickler SW, Alkire BC, Mock C (2015) Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health 3(Suppl 2):S8–S9

    Article  PubMed  Google Scholar 

  16. Murray CJ et al (2012) Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380(9859):2197–2223

    Article  PubMed  Google Scholar 

  17. Open Working Group proposal for Sustainable Development Goals. The United Nations. [cited 2015 Feb 23]. https://sustainabledevelopment.un.org/focussdgs.html

  18. Monitoring progress towards universal health coverage at country and global levels: Framework, measures, targets. May 2014. World Health Organization and International Bank for Reconstruction and Development/The World Bank. [cited 2015 Feb 12]. http://apps.who.int/iris/bitstream/10665/112824/1/WHO_HIS_HIA_14.1_eng.pdf

  19. Rose J, Chang DC, Weiser TG, Kassebaum NJ, Bickler SW (2014) The role of surgery in global health: analysis of United States inpatient procedure frequency by condition using the Global Burden of Disease 2010 framework. PLoS ONE 9(2):e89693

    Article  PubMed  PubMed Central  Google Scholar 

  20. Spiegel DA, Nduaguba A, Cherian MN, Monono M, Kelley ET (2015) Deficiencies in the availability of essential musculoskeletal surgical services at 883 health facilities in 24 low- and lower-middle-income countries. World J Surg 39(6):1421–1432

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

Funding was provided by Boston Children’s Hospital. The authors acknowledge the Lancet Commission on Global Surgery. RLG was supported by a Practitioner Fellowship from the Australian National Health and Medical Research Council.

Author contribution

Because this project required international collaboration, many were involved with the conception and design of the study, analysis of the data, and production of the final manuscript. In particular, KMO, SLMG, MC, RDG, NR, NPR, JNR, DS, DW, and RLG were all intimately involved with the conception and design of the project. KMO, SLMG, MC, RDG, and NPR were critical for the acquisition of the data. KMD was critically important for the analysis and interpretation of the data. All authors contributed to editing of the final manuscript and gave final approval of this submission.

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Authors and Affiliations

  1. Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA, 02115, USA

    Kathleen M. O’Neill, Sarah L. M. Greenberg, Kimberly M. Daniels, Nakul P. Raykar & Johanna N. Riesel

  2. Department of Surgery, Yale New Haven Hospital, 1245 Chapel Street Apt 503, New Haven, CT, 06510, USA

    Kathleen M. O’Neill

  3. Department of Surgery, Medical College of Wisconsin, 8701 W Watertown Plank Rd, Milwaukee, WI, 53226, USA

    Sarah L. M. Greenberg

  4. WHO Emergency and Essential Surgical Care Programme, The World Health Organization, Headquarters, Geneva, Switzerland

    Meena Cherian

  5. Royal North Shore Hospital, Plastic, Reconstructive and Burns, Reserve Rd, St Leonards, NSW, 2065, Australia

    Rowan D. Gillies

  6. Department of Plastic and Oral Surgery, Boston Children’s Hospital, 300 Longwood Avenue, Boston, MA, 02115, USA

    Kimberly M. Daniels

  7. Department of Surgery, Bhabha Atomic Research Center (BARC) Hospital, Mumbai, 94, India

    Nobhojit Roy

  8. Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden

    Nobhojit Roy

  9. Beth Israel Deaconess Medical Center, 330 Brookline Ave, Boston, MA, 02215, USA

    Nakul P. Raykar

  10. The Harvard Program in Plastic Surgery, Boston, MA, 02114, USA

    Johanna N. Riesel

  11. Department of Orthopedics, Children’s Hospital of Philadelphia, Philadelphia, PA, USA

    David Spiegel

  12. Royal Australasian College of Surgeons, East Melbourne, VIC, Australia

    David A. Watters

  13. School of Medicine, Faculty of Health, Barwon Health, Deakin University, Geelong, VIC, Australia

    David A. Watters

  14. The Alfred Hospital and Monash University, Melbourne, VIC, 3051, Australia

    Russell L. Gruen

  15. Nanyang Technological University, 50 Nanyang Drive, Research Techno Plaza, Level 4 X-Frontiers Block, Singapore, 637553, Singapore

    Russell L. Gruen

Authors
  1. Kathleen M. O’Neill
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  2. Sarah L. M. Greenberg
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  3. Meena Cherian
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  4. Rowan D. Gillies
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  5. Kimberly M. Daniels
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  6. Nobhojit Roy
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  7. Nakul P. Raykar
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  8. Johanna N. Riesel
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  9. David Spiegel
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  10. David A. Watters
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  11. Russell L. Gruen
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Corresponding author

Correspondence to Kathleen M. O’Neill.

Additional information

Disclaimer: The authors include WHO staff. The views expressed in this publication reflect their views and not necessarily that of WHO.

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O’Neill, K.M., Greenberg, S.L.M., Cherian, M. et al. Bellwether Procedures for Monitoring and Planning Essential Surgical Care in Low- and Middle-Income Countries: Caesarean Delivery, Laparotomy, and Treatment of Open Fractures. World J Surg 40, 2611–2619 (2016). https://doi.org/10.1007/s00268-016-3614-y

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  • DOI: https://doi.org/10.1007/s00268-016-3614-y

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