Could global surgery overcome a decline in surgical cases?

Laverty, Robert B; Jindal, Rahul M.

doi:10.1016/j.amsu.2022.103704

Cited by 3 publications

(4 citation statements)

References 17 publications

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“…We observed an uneven distribution of benefits with pan-capital accumulation by the Global North personnel and institutions across multiple domains of global surgery: service delivery, research and education and training. Capital extraction includes both material benefits, such as funding, education and training,17 55 57 76 and symbolic benefits, such as authorship, credit and prestige 11–13 68 70…”

Section: Categories Of Non-merit Inequalities In Global Surgerymentioning

confidence: 99%

Colonisation and its aftermath: reimagining global surgery

Qin,

Alayande,

Okolo

et al. 2024

BMJ Glob Health

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Coloniality in global health manifests as systemic inequalities, not based on merit, that benefit one group at the expense of another. Global surgery seeks to advance equity by inserting surgery into the global health agenda; however, it inherits the biases in global health. As a diverse group of global surgery practitioners, we aimed to examine inequities in global surgery. Using a structured, iterative, group Delphi consensus-building process drawing on the literature and our lived experiences, we identified five categories of non-merit inequalities in global surgery. These include Western epistemology, geographies of inequity, unequal participation, resource extraction, and asymmetric power and control. We observed that global surgery is dominated by Western biomedicine, characterised by the lack of interprofessional and interspecialty collaboration, incorporation of Indigenous medical systems, and social, cultural, and environmental contexts. Global surgery is Western-centric and exclusive, with a unidirectional flow of personnel from the Global North to the Global South. There is unequal participation by location (Global South), gender (female), specialty (obstetrics and anaesthesia) and profession (‘non-specialists’, non-clinicians, patients and communities). Benefits, such as funding, authorship and education, mostly flow towards the Global North. Institutions in the Global North have disproportionate control over priority setting, knowledge production, funding and standards creation. This naturalises inequities and masks upstream resource extraction. Guided by these five categories, we concluded that shifting global surgery towards equity entails building inclusive, pluralist, polycentric models of surgical care by providers who represent the community, with resource controlled and governance driven by communities in each setting.

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Section: Categories Of Non-merit Inequalities In Global Surgerymentioning

confidence: 99%

Colonisation and its aftermath: reimagining global surgery

Qin,

Alayande,

Okolo

et al. 2024

BMJ Glob Health

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“…Taken together, the COVID-19 pandemic resulted globally in alterations and disruptions to the value chain within the healthcare sector, impacting surgical key areas of hospitals [17]. Due to the corresponding changes at the structural, material, personnel, and functional levels of the highly complex OR, and considering the unknown sustainable effects on surgical processes, we therefore proposed the provoking hypothesis, that the COVID-19 pandemic-induced surgical restrictions have led to a long-term reduction in surgical performance at the University Hospital level.…”

Section: Introductionmentioning

confidence: 99%

Impact of COVID-19 pandemic-induced surgical restrictions on operational performance: a case study at the University Hospital of Ulm

Datzmann,

Dörfer,

Freude

et al. 2024

Eur J Trauma Emerg Surg

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Introduction The operating room (OR) is a high-cost and high-revenue area in a hospital comprising extremely complex process steps to treat patients. The perioperative process quality can be optimized through an efficiency-oriented central OR management based on performance indices. However, during the COVID-19 pandemic with the corresponding OR restrictions, there was a significant nation- and worldwide decline in the performance, which may have a lasting impact. Therefore, we proposed the hypothesis that COVID-19 pandemic-related OR restrictions could reduce operative performance in the long term. Methods A retrospective, descriptive analysis of perioperative processing times was conducted exemplarily at the University Hospital Ulm using a pre-post design, examining the corresponding second quarters of 2019 to 2022. In total, n = 18,489 operations with n = 314,313 individual time intervals were analyzed. The statistical analyses included the Kruskal–Wallis test adjusted for multiple testing, and the significance level was set at p < 0.01. Results The results revealed not only a significant decrease in the case volume by 31% (2020) and 23% (2021) during the COVID-19 crisis years, but also significant time delays in various process steps; e.g. the median patient’s OR occupancy time (column time) rose from 65 min (2019) to 87 min (2020) and remained elevated (72 min in 2021 and 74 min in 2022, respectively). Even in 2022, beyond the pandemic, the net anaesthesia time was permanently enhanced by 9 min per case. Furthermore, both, the incision-to-closure time and surgeon attachment time were each significantly prolonged by 7 additional minutes, and the time from the end of anaesthesia to the release of the next patient was extended by 4 min. Selected standardized index operations showed only a trend towards these changes, even with a decrease in the incision-to-closure time over time. Conclusion Overall, long-term changes were found in essential perioperative process times even after retraction of the COVID-19 restrictions, indicating some processual “slow down” after the Covid-19-induced “shut down”. Further analyses are needed to determine the appropriate targeted control measures to improve processing times and increase the process quality.

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“…Short term surgical missions and electives from organizations in high-income countries (HIC) who travel to low-middle-income countries (LMIC) have been criticized as ‘parachute’ missions and a form of colonization with no or minimal reciprocity to trainees in LMIC [ 5 , 6 ]. We suggest a two-fold solution.…”

Section: Introductionmentioning

confidence: 99%

“…First, these aid organizations should undergo a radical restructuring by splitting into smaller units to make them more transparent and responsive to local needs. Secondly, unconditional cash transfer should be initiated to beneficiaries bypassing entrenched bureaucracy after appropriate community consultation [ 6 ].…”

Section: Introductionmentioning

confidence: 99%