Lack of access to surgery: a public health problem

Abstract

The report published in 2015 by the Lancet Commission on Global Surgery 1 considers the provision of surgical care an essential component of health systems and a major public health problem. The report defends the inclusion of access to surgical care on the health agenda, based on the principles of universal coverage, equity, and justice. Six indicators were selected, along with a structure for drafting a national plan to assess the current situation: access to timely essential surgery; specialist surgical workforce density; surgical volume; peri-operative mortality rate; risk of impoverishing expenditure; and risk of catastrophic expenditure.The application of these indicators in Brazil identified huge geographic inequality and regional differences in the supply of surgical care and the availability of qualified professionals, namely surgeons and anesthetists. Brazil's hospital network is considered inefficient, with 57% of hospitals having 50 or fewer beds and 35.72% of hospitals concentrated in the Southeast region 2 . The population in remote locations has to travel large distances to access a hospital that provides timely and effective care, including in emergency situations. Meanwhile, the number of beds in a hospital influences the quality of care provided, particularly surgical care, with a higher risk of adverse surgical events in small hospitals 3 . Studies suggest an inverse relationship between volume of high-risk surgical procedures and mortality 4 . The authors also emphasized the performance of simultaneous procedures by surgeons and anesthetists or by untrained professionals. Such practice definitely leads to negative results in the quality of surgical care and patient safety.The peculiarities of the Brazilian Unified National Health System (SUS) and the country's large territory affect the supply of low, medium, and high-complexity surgical procedures. As highlighted by the authors, planning for increases in the coverage of low and medium-complexity surgeries should consider outpatient surgeries. Outpatient surgical centers should be designed to perform low and medium-complexity procedures in patients with good clinical status and who do not require staying more than 12 hours in the health service, leading to a reduction in operating costs. Adverse events, including deaths, raise concerns over patient safety and the need for government regulation. Quality improvement efforts in outpatient surgical care should seek adherence by surgeons and anesthetists to Brazilian Federal Board of Medicine (CFM) Resolution 1,886/2008 5 , which sets minimum standards for functioning of medical offices and surgical centers for short-stay procedures. To guarantee that the patient can recover and be discharged within a reasonable time frame, standards

Prevalência e evitabilidade de eventos adversos cirúrgicos em hospital de ensino do Brasil

“…Despite the limitations inherent to the retrospective review of medical records, it allowed identifying the prevalence of potentially preventable surgical AEs in a single hospital setting. The results presented here raise reflection on the possible magnitude of the problem in Brazil, especially in less economically privileged regions, considering geographic and regional inequalities in the provision of surgical care, as well as the availability of qualified professionals 12 .…”

Surgical Treatment of the Five Most Common Types of Cancer in Brazil: 7 Years Analysis Overview

“…In general, the large territory of Brazil influences the delivery of low, medium, and high-complexity surgical procedures. 19 More specific to services related to cancer care, a study declared that they are concentrated in the south and southeastern Brazilian regions. 20 Our analysis found the same pattern: the southeast was the number one region in the incidence of oncological surgeries and the south the second.…”

Geographical Inequalities in Access to Bellwether Procedures in Brazil

“…Based on CS data, we determined that the North, one of Brazil's poorest regions, was the one that most performed this procedure in the emergency context. The difference in rates of CS compared with the other regions could be explained by the demographic and social context of the North, where there is low coverage of public health services [9], resulting in poor prenatal care and compromising the detection of early maternal-fetal disorders that contraindicate vaginal delivery, which increases CS in an emergency scenario. This region also has the highest mortality in emergency CS, which may also be related to the difficulty of accessing medical services.…”

“…Brazil is a developing Latin-American country that aspires to provide universal health coverage through Sistema U ´nico de Sau´de (SUS) or Unified Health System.This system is based on the principles of comprehensiveness, equality, and universality, with a strong emphasis on primary care [8]. Providing equal access to SUS is a major challenge for the public healthcare system, given that the country comprises five geographical regions with distinct socioeconomic and historical backgrounds [9]. In fact, Brazil was the world's most unequal country in the 1980s, and this regional inequality became more evident in historically excluded regions of the country, such as the Northeast, Midwest, and the North, where the supply of health services is lower than in the South and Southeast regions.…”

“…In fact, Brazil was the world's most unequal country in the 1980s, and this regional inequality became more evident in historically excluded regions of the country, such as the Northeast, Midwest, and the North, where the supply of health services is lower than in the South and Southeast regions. In those three regions, health facilities are usually located at a greater distance, making it difficult to access surgical care [9].…”