Are LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A Systematic Review

Abstract

Introduction The Lancet Commission on Global Surgery (LCoGS) set the benchmark of 5000 procedures per 100,000 population annually to meet surgical needs adequately. This systematic review provides an overview of the last ten years of surgical volumes in Low and Middle- Income-Countries (LMICs). Methodology We searched PubMed, Web of Science, Scopus, Cochrane, and EMBASE databases for studies from LMICs addressing surgical volume. The number of surgeries performed per 100,000 population was estimated. We used cesarean sections, hernia, and laparotomies as index cases for the surgical capacities of the country. Their proportions to total surgical volumes were estimated. The association of country-specific surgical volumes and the proportion of index cases with its Gross Domestic Product (GDP) per capita was analyzed. Results A total of 26 articles were included in this review. In LMICs, on average, 877 surgeries were performed per 100,000 population. The proportion of cesarean sections was found to be high in all LMICs, with an average of 30.1% of the total surgeries, followed by hernia (16.4%) and laparotomy (5.1%). The overall surgical volumes increased as the GDP per capita increased. The proportions of cesarean section and hernia to total surgical volumes decreased with increased GDP per capita. Significant heterogeneity was found in the methodologies to assess surgical volumes, and inconsistent reporting hindered comparison between countries. Conclusion Most LMICs have surgical volumes below the LCoGS benchmark of 5000 procedures per 100,000 population, with an average of 877 surgeries. The surgical volume increased while the proportions of hernia and cesarean sections reduced with increased GDP per capita. In the future, it's essential to apply uniform and reproducible data collection methods for obtaining multinational data that can be more accurately compared.

Perioperative capacity and contextual challenges in teaching hospitals of southern Ethiopia: explanatory sequential mixed-methods research

“…Patil et al’s (2023) systematic review found that in LMICs, an average of 877 surgeries per 100,000 population increased with gross domestic product per capita. India and Brazil reported volumes close to the LCoGS benchmark (Patil et al 2023 ). The study suggests that weak healthcare infrastructure, rising medical supply and equipment costs, supply chain disruptions, and health system issues may contribute to low surgical productivity and income levels.…”

Authors’ Reply: Are LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A Systematic Review

“…We would like to thank Siddhesh Zadey for reading our article with great interest; however, we disagree with Zadey [1] and take this opportunity to provide further information on our systematic review [2].…”

Inequities in global cancer surgery: Challenges and solutions

“…A systematic review of surgical volumes across LMICs found substantial heterogeneity in data collection, including inconsistencies in the nomenclature and definitions of surgeries, and variations in methods used to measure surgical volumes. 24 Whereas the Lancet Commission 2020 listed postoperative mortality rate (POMR) as one of the six key indicators for safe surgery, a review of the published literature of POMR reporting from LMICs showed multiple limitations such as unclear outcome definitions, inconsistent timeframes for outcome reporting and variable denominators for number of surgeries, with studies from upper MICs having more precise reporting than lower MICs or LICs. 25 Another study looking at morbidity after surgical management of cervical cancer found that reliable, high-quality data was not available for the majority of LICs where cervical cancer is highly prevalent.…”

“…Many LMICs lack the resources needed to collect routine information on health‐related services and activities, resulting in inadequate information on baseline health indicators and dearth of basic quality assurance systems. A systematic review of surgical volumes across LMICs found substantial heterogeneity in data collection, including inconsistencies in the nomenclature and definitions of surgeries, and variations in methods used to measure surgical volumes 24 . Whereas the Lancet Commission 2020 listed postoperative mortality rate (POMR) as one of the six key indicators for safe surgery, a review of the published literature of POMR reporting from LMICs showed multiple limitations such as unclear outcome definitions, inconsistent timeframes for outcome reporting and variable denominators for number of surgeries, with studies from upper MICs having more precise reporting than lower MICs or LICs 25 .…”