Low Value Surgical Care: Are We Choosing Wisely?

Sharma, Dhananjaya; Agarwal, Pawan; Agrawal, Vikesh; Bajaj, Jitin; Yadav, Sanjay Kumar

doi:10.1007/s12262-023-03739-7

Cited by 4 publications

(2 citation statements)

References 29 publications

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“…Quality of surgical care in LMICs can be improved with the help of locally developed low-cost affordable surgical solutions/innovations, in response to their unique challenges 3,25 . These evidence-based solutions can easily replace those with disproportionately high cost and can be incorporated into standard surgical pathways 26,27 . To paraphrase U.S. President Abraham Lincoln's Gettysburg Address these global surgery solutions are 'of the people, by the people, for the people'.…”

Section: Walk the Talkmentioning

confidence: 99%

Ten lessons for global surgery researchers

Sharma

2024

BJSA

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Global surgery is an area of study, research; practice and advocacy that seeks to improve health outcomes and achieve health equity for all people who require surgical care, with a special emphasis on underserved populations. Researchers and institutions in LMICs (Low and Middle Income Countries) are the major stakeholders in this and have to provide the academic leadership in this emerging field.I am a lifelong activist and campaigner for appropriate technology and affordable low-cost surgical solutions to achieve equitable surgical care for underserved populations. It gives me great pleasure to share our successful ideas which made a difference and which become our vade mecum over the years, as lessons for global surgery researchers from LMICs.

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Section: Walk the Talkmentioning

confidence: 99%

Ten lessons for global surgery researchers

Sharma

2024

BJSA

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“… 20 Several LMICs, including Brazil, India, Iran, and some sub-Saharan African countries, are adapting and implementing the campaign. 20 , 21 , 22 Country-specific scoping reviews of the evidence are emerging, 23 , 24 , 25 , 26 and workshops at the 2019 and 2022 International Preventing Overdiagnosis conferences called for more research and actions addressing overuse of surgical procedures in LMICs, including a new global network. 27 , 28 A WHO official has said that as the world moves toward universal health coverage, it is critical to address “the waste and the inadvertent iatrogenic harm” caused by the wider problems of overuse and overdiagnosis.…”

Section: Introductionmentioning

confidence: 99%

Low-Value Surgical Procedures in Low- and Middle-Income Countries

Albarqouni,

Abukmail,

MohammedAli

et al. 2023

JAMA Netw Open

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ImportanceOveruse of surgical procedures is increasing around the world and harms both individuals and health care systems by using resources that could otherwise be allocated to addressing the underuse of effective health care interventions. In low- and middle-income countries (LMICs), there is some limited country-specific evidence showing that overuse of surgical procedures is increasing, at least for certain procedures.ObjectivesTo assess factors associated with, extent and consequences of, and potential solutions for low-value surgical procedures in LMICs.Evidence ReviewWe searched 4 electronic databases (PubMed, Embase, PsycINFO, and Global Index Medicus) for studies published from database inception until April 27, 2022, with no restrictions on date or language. A combination of MeSH terms and free-text words about the overuse of surgical procedures was used. Studies examining the problem of overuse of surgical procedures in LMICs were included and categorized by major focus: the extent of overuse, associated factors, consequences, and solutions.FindingsOf 4276 unique records identified, 133 studies across 63 countries were included, reporting on more than 9.1 million surgical procedures (median per study, 894 [IQR, 97-4259]) and with more than 11.4 million participants (median per study, 989 [IQR, 257-6857]). Fourteen studies (10.5%) were multinational. Of the 119 studies (89.5%) originating from single countries, 69 (58.0%) were from upper-middle–income countries and 30 (25.2%) were from East Asia and the Pacific. Of the 42 studies (31.6%) reporting extent of overuse of surgical procedures, most (36 [85.7%]) reported on unnecessary cesarean delivery, with estimated rates in LMICs ranging from 12% to 81%. Evidence on other surgical procedures was limited and included abdominal and percutaneous cardiovascular surgical procedures. Consequences of low-value surgical procedures included harms and costs, such as an estimated US $3.29 billion annual cost of unnecessary cesarean deliveries in China. Associated factors included private financing, and solutions included social media campaigns and multifaceted interventions such as audits, feedback, and reminders.Conclusions and RelevanceThis systematic review found growing evidence of overuse of surgical procedures in LMICs, which may generate significant harm and waste of limited resources; the majority of studies reporting overuse were about unnecessary cesarean delivery. Therefore, a better understanding of the problems in other surgical procedures and a robust evaluation of solutions are needed.

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Can we nudge to reduce the perioperative low value care? Decision making factors influencing safe practice implementation

Paz-Martin,

Arnal-Velasco

2023

Current Opinion in Anaesthesiology

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Purpose of the review Highlight sources of low-value care (LVC) during the perioperative period help understanding the decision making behind its persistence, the barriers for change, and the potential implementation strategies to reduce it. Recent findings The behavioural economics science spread of use through aligned strategies or nudge units offer an opportunity to improve success in the LVC reduction. Summary LVC, such as unneeded surgeries, or preanaesthesia tests for low-risk surgeries in low-risk patients, is a relevant source of waste and preventable harm, most especially in the perioperative period. Despite the international focus on it, initial efforts to reduce it in the last decade have not clearly shown a sustainable improvement. Understanding the shared decision-making process and the barriers to be expected when tackling LVC is the first step to build the change. Applying a structured strategy based on the behavioural science principles may be the path to increasing high value care in an effective an efficient way. It is time to foster nudge units at different healthcare system levels.

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Low Value Surgical Care: Are We Choosing Wisely?

Cited by 4 publications

References 29 publications

Ten lessons for global surgery researchers

Ten lessons for global surgery researchers

Low-Value Surgical Procedures in Low- and Middle-Income Countries

Can we nudge to reduce the perioperative low value care? Decision making factors influencing safe practice implementation

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