Global access to surgical care: a modelling study

Abstract

Summary Background More than 2 billion people are unable to receive surgical care based on operating theatre density alone. The vision of the Lancet Commission on Global Surgery is universal access to safe, affordable surgical and anaesthesia care when needed. We aimed to estimate the number of individuals worldwide without access to surgical services as defined by the Commission’s vision. Methods We modelled access to surgical services in 196 countries with respect to four dimensions: timeliness, surgical capacity, safety, and affordability. We built a chance tree for each country to model the probability of surgical access with respect to each dimension, and from this we constructed a statistical model to estimate the proportion of the population in each country that does not have access to surgical services. We accounted for uncertainty with one-way sensitivity analyses, multiple imputation for missing data, and probabilistic sensitivity analysis. Findings At least 4·8 billion people (95% posterior credible interval 4·6–5·0 [67%, 64–70]) of the world’s population do not have access to surgery. The proportion of the population without access varied widely when stratified by epidemiological region: greater than 95% of the population in south Asia and central, eastern, and western sub-Saharan Africa do not have access to care, whereas less than 5% of the population in Australasia, high-income North America, and western Europe lack access. Interpretation Most of the world’s population does not have access to surgical care, and access is inequitably distributed. The near absence of access in many low-income and middle-income countries represents a crisis, and as the global health community continues to support the advancement of universal health coverage, increasing access to surgical services will play a central role in ensuring health care for all. Funding None.

Critical care admission following elective surgery was not associated with survival benefit: prospective analysis of data from 27 countries

“…3 University of Queensland, Brisbane, Australia. 4 Papageorgiou General Hospital, Thessaloniki, Greece. 5 Auckland City Hospital, Auckland, New Zealand.…”

“…Findings from epidemiological studies suggest that 4.8 billion people are unable to access safe surgical treatments [4], and the commission has recommended that at least 143 million additional procedures are required each year, primarily in low and middle income countries [5]. However, as healthcare systems develop to improve access to surgical treatments, and more complex procedures are offered, the number of patients who suffer postoperative complications will also increase [1,4].…”

Experience of collaboration between a Dutch surgical team in a Ghanaian Orthopaedic Teaching Hospital

“…Many countries in the developing world face a significant challenge in providing effective primary healthcare 1,2 . Surgery is an indivisible, indispensable part of healthcare 3,4,5,6,7 .…”

“…In Africa, surgery may be thought of as the neglected stepchild of global public health. There are fewer physicians per population on this continent than on any other; surgeons are rarer 2,8 . In the last 20 to 30 years African medical treatment, education, and training have made improvement.…”

The Role of Augmented Reality Telesurgery in Promoting Equity in Global Surgery

“…The worldwide unmet surgical need is estimated at 143 million additional procedures per year, with the greatest per capita deficiency found in sub-Saharan Africa [9]. In western sub-Saharan Africa current surgical volume is 13% of the estimated need, with an additional 5625 procedures per year per 100,000 population required; yet spare surgical capacity does not exist given Sierra Leone's surgeon-population ratio is 1:850000 [1,10].…”