Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change

Abstract

OBJECTIVE Worldwide disparities in the provision of surgical care result in otherwise preventable disability and death. There is a growing need to quantify the global burden of neurosurgical disease specifically, and the workforce necessary to meet this demand. METHODS Results from a multinational collaborative effort to describe the global neurosurgical burden were aggregated and summarized. First, country registries, third-party modeled data, and meta-analyzed published data were combined to generate incidence and volume figures for 10 common neurosurgical conditions. Next, a global mapping survey was performed to identify the number and location of neurosurgeons in each country. Finally, a practitioner survey was conducted to quantify the proportion of disease requiring surgery, as well as the median number of neurosurgical cases per annum. The neurosurgical case deficit was calculated as the difference between the volume of essential neurosurgical cases and the existing neurosurgical workforce capacity. RESULTS Every year, an estimated 22.6 million patients suffer from neurological disorders or injuries that warrant the expertise of a neurosurgeon, of whom 13.8 million require surgery. Traumatic brain injury, stroke-related conditions, tumors, hydrocephalus, and epilepsy constitute the majority of essential neurosurgical care worldwide. Approximately 23,300 additional neurosurgeons are needed to address more than 5 million essential neurosurgical cases-all in low- and middle-income countries-that go unmet each year. There exists a gross disparity in the allocation of the surgical workforce, leaving large geographic treatment gaps, particularly in Africa and Southeast Asia. CONCLUSIONS Each year, more than 5 million individuals suffering from treatable neurosurgical conditions will never undergo therapeutic surgical intervention. Populations in Africa and Southeast Asia, where the proportion of neurosurgeons to neurosurgical disease is critically low, are especially at risk. Increasing access to essential neurosurgical care in low- and middle-income countries via neurosurgical workforce expansion as part of surgical system strengthening is necessary to prevent severe disability and death for millions with neurological disease.

Global cardiac surgery: lessons learnt from the global neurosurgery movement

“…Recently, the team at the Global Neurosurgery Initiative (GNI) of the Program in Global Surgery and Social Change (PGSSC) at Harvard Medical School reported that 5 million emergency and essential neurosurgical operations are unmet each year, requiring 23 300 additional neurosurgeons 5. Further, the WFNS and PGSSC have been able to map the availability of neurosurgical facilities, workforce and essential equipment in a geospatial manner, allowing for visualisation of the areas in critical need.…”

Global neurosurgery: current and potential impact of neurosurgeons at the World Health Organization and the World Health Assembly. Executive summary of the World Federation of Neurosurgical Societies–World Health Organization Liaison Committee at the 71st World Health Assembly

“…Dewan et al recently reported the estimate of the global volume of neurosurgical diseases, as well as the number and the distribution of neurosurgeons worldwide. 6 They calculated an operative deficit of 5 million neurosurgical cases per annum, with traumatic brain injury, stroke-related conditions, tumors, hydrocephalus, and epilepsy comprising the majority of the global neurosurgical disease burden. 4,5,[7][8][9][10]14,15,18 They further estimated that 23,300 additional neurosurgeons are needed to address the deficit, mostly in Africa and Southeast Asia.…”

Surgically-induced brain injury: where are we now?

“…Every year, 13.8 million patients around the globe require surgery due to traumatic brain injury (TBI), stroke-related conditions, tumors, hydrocephalus, and epilepsy [11]. Millions of these surgical cases are in low-and middle-income countries where acute care is hard to come by.…”