Towards defining the surgical workforce for children: a geospatial analysis in Brazil

Rocha, Thiago Augusto Hernandes; Vissoci, J.R.N.; Rocha, Núbia Cristina da Silva; Poenaru, Dan; Shrime, Mark G.; Smith, Emily R.; Rice, Henry E.

doi:10.1136/bmjopen-2019-034253

Cited by 13 publications

(8 citation statements)

References 23 publications

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“…In Brazil, there is an entrenched asymmetrical distribution of HCWs across the country, skewed towards municipalities with higher technological and socioeconomic status. South and Southeast regions have higher density of HCWs (surgeons, anaesthesiologists, and obstetricians) than North and Northeast (the poorest regions in Brazil) 26 . Another key-disparity is the distribution of HCWs between public and private systems.…”

Section: Discussionmentioning

confidence: 99%

The disruption of elective procedures due to COVID-19 in Brazil in 2020

Frio

Russo

Albuquerque

et al. 2022

Sci Rep

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Elective procedures were temporarily suspended several times over the course of the pandemic of COVID-19. Monthly data from the Unified Health System (SUS) were used for the period between January 2008 and December 2020 and the interrupted time series method was used to estimate the effect of the pandemic on the number of elective surgeries and elective procedures that were not performed. Considering a 9-month period, a reduction of 46% in the number of elective procedures carried out in the SUS could be attributed to COVID-19, corresponding to about 828,429 elective procedures cancelled, ranging from 549,921 to 1,106,936. To a full recovery of pre-pandemic performance, SUS would need to increase about 21,362 hospital beds, ranging from 12,370 to 36,392 hospital beds during a 6 month-period. This effort would represent an increase of 8.48% (ranging from 4.91 to 14.45%) in relation to the total number of SUS’s hospital beds in 2019. As a result, the pandemic will leave a large number of elective procedures to be carried out, which will require efforts by health agencies to meet this demand.

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Section: Discussionmentioning

confidence: 99%

The disruption of elective procedures due to COVID-19 in Brazil in 2020

Frio

Russo

Albuquerque

et al. 2022

Sci Rep

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“…This inequalities have been reported before and have a close relationship with the GDP/ capita 14 . Another study correlates the Brazilian unequal PSWD with mortality for children under 5 years 11 . Clearly, there is a need of governmental policies to address these disparities and to direct the allocation of surgical resources commensurate with local population needs.…”

Section: Discussionmentioning

confidence: 99%

An Evaluation of The Regional Distribution of Pediatric Surgery Workforce and Surgical Load in Brazil

Bustorff‐Silva¹,

Miranda²,

Rosendo³

et al. 2022

Preprint

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AimThe purpose of this study is to present data on the regional distribution of the pediatric surgical workforce and the expected local demand of pediatric operations in Brazil.MethodsWe collected data on the pediatric surgical workforce, surgical workload, GDP/capita and mortality for gastrointestinal tract malformations (MGITM) across the different regions of Brazil for 2019.FindingsData from CFM reported the existence of 1515 pediatric surgery registries in Brazil, corresponding to 1414 individual pediatric surgeons (some pediatric surgeons are registered in more than one State), or 2.4 pediatric surgeons per 100.000 children< 14 years. There were 828 male and 586 female with a M/F ratio of 1.14:1. Mean age was 51.5±12.8 years and mean time from graduation was 3,4±5,7years. Regional distribution showed a higher concentration of pediatric surgeons on the wealthier Central-West, South and Southeast regions. Individual workload ranged from 88 to 245 operations/year (average 146 operations/year) depending on the region. Only 9 (6.1%) of these were high complexity (including neonatal) operations. MGITM tended to be higher on the poorer North and Northeast regions of BrazilConclusionsWe found wide disparities in the surgical workforce and workload across Brazil, related to socioeconomic status. Areas of increased surgical workforce were associated with lower MGITM. The average number of complex operations performed yearly by the individual pediatric surgeon was considerably low. Strategic investment and definition of health policies may be needed to improve the quality of care in the different regions of Brazil.Level of EvidenceRetrospective review. Level III

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“…Similarly, though there are many non-surgical causes of pediatric mortality, our results demonstrated the PSWD strongly correlated with neonatal, infant, and under 5 mortality. Rocha and colleagues also demonstrated that areas of increased surgical workforce density correlated with reduced childhood mortality, though the analysis was not specific to PSWD and was limited to Brazil only [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

A critical threshold for global pediatric surgical workforce density

et al. 2021

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Purpose 1.7 billion children lack access to surgical care, particularly in low- and middle-income countries (LMIC). The pediatric surgical workforce density (PSWD), an indicator of surgical access, correlates with survival of complex pediatric surgical problems. To determine if PSWD also correlates with population-level health outcomes for children, we compared PSWD with pediatric-specific mortality rates and determined the PSWD associated with improved survival. Methods Using medical licensing registries, pediatric surgeons practicing in 26 countries between 2015 and 2019 were identified. Countries’ PSWD was calculated as the ratio of pediatric surgeons per 100,000 children. The correlation between neonatal, infant and under 5 mortality rates and PSWD was assessed using Spearman’s correlations and piecewise linear regression models. Results Four LIC, eight L-MIC, ten UMIC and four HIC countries, containing 420 million children, were analyzed. The median PSWD by income group was 0.03 (LIC), 0.12 (L-MIC), 1.34 (UMIC) and 2.13 (HIC). PSWD strongly correlated with neonatal (0.78, p < 0.001), infant (0.82, p < 0.001) and under 5 (0.83, p < 0.001) mortality rates. Survival improved with increasing PSWD to a threshold of 0.37. Conclusion PSWD correlates with pediatric population mortality rates, with significant improvements in survival with PSWD > 0.37. Currently, PSWD in LMICs is inadequate to meet UN Sustainable Development Goal 3.2 for child mortality.

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Towards defining the surgical workforce for children: a geospatial analysis in Brazil

Cited by 13 publications

References 23 publications

The disruption of elective procedures due to COVID-19 in Brazil in 2020

The disruption of elective procedures due to COVID-19 in Brazil in 2020

An Evaluation of The Regional Distribution of Pediatric Surgery Workforce and Surgical Load in Brazil

A critical threshold for global pediatric surgical workforce density

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