Adam Gyedu1, Barclay Stewart2,3, Cameron Gaskill2, Emmanuella Lebasaana Salia4, Raymond Wadie4, Peter Donkor5, Charles Mock2,6,7. 1. Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana. drgyedu@gmail.com. 2. Department of Surgery, University of Washington, Seattle, WA, USA. 3. Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa. 4. School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana. 5. Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana. 6. Harborview Injury Prevention & Research Center, Seattle, WA, USA. 7. Department of Global Health, University of Washington, Seattle, WA, USA.
Abstract
INTRODUCTION: The Lancet Commission on Global Surgery proposed 5000 operations/100,000 people annually as a benchmark for developing countries but did not define benchmarks for different age groups. We evaluated the operation rate for elderly patients (≥65 years) in Ghana and estimated the unmet surgical need for the elderly by comparison to a high-income country benchmark. METHODS: Data on operations performed for elderly patients over a 1-year period in 2014-5 were obtained from representative samples of 48/124 small district hospitals and 12/16 larger referral hospitals and scaled-up for nationwide estimates. Operations were categorized as essential (most cost-effective, highest population impact) versus other according to The World Bank's Disease Control Priority project (DCP-3). Data from New Zealand's National Minimum Dataset were used to derive a benchmark operation rate for the elderly. RESULTS: 16,007 operations were performed for patients ≥65 years. The annual operation rate was 1744/100,000 (95% UI 1440-2048), only 12% of the New Zealand benchmark of 14,103/100,000. 74% of operations for the elderly were in the essential category. The most common procedures (15%) were for urinary obstruction. 58% of operations were performed at district hospitals; 54% of these did not have fully-trained surgeons. Referral hospitals more commonly performed operations outside the essential category. CONCLUSION: The operation rate was well beneath the benchmark, indicating a potentially large unmet need for Ghana's elderly population. Most operations for the elderly were in the essential category and delivered at district hospitals. Future global surgery benchmarking should consider specific benchmarks for different age groups.
INTRODUCTION: The Lancet Commission on Global Surgery proposed 5000 operations/100,000 people annually as a benchmark for developing countries but did not define benchmarks for different age groups. We evaluated the operation rate for elderly patients (≥65 years) in Ghana and estimated the unmet surgical need for the elderly by comparison to a high-income country benchmark. METHODS: Data on operations performed for elderly patients over a 1-year period in 2014-5 were obtained from representative samples of 48/124 small district hospitals and 12/16 larger referral hospitals and scaled-up for nationwide estimates. Operations were categorized as essential (most cost-effective, highest population impact) versus other according to The World Bank's Disease Control Priority project (DCP-3). Data from New Zealand's National Minimum Dataset were used to derive a benchmark operation rate for the elderly. RESULTS: 16,007 operations were performed for patients ≥65 years. The annual operation rate was 1744/100,000 (95% UI 1440-2048), only 12% of the New Zealand benchmark of 14,103/100,000. 74% of operations for the elderly were in the essential category. The most common procedures (15%) were for urinary obstruction. 58% of operations were performed at district hospitals; 54% of these did not have fully-trained surgeons. Referral hospitals more commonly performed operations outside the essential category. CONCLUSION: The operation rate was well beneath the benchmark, indicating a potentially large unmet need for Ghana's elderly population. Most operations for the elderly were in the essential category and delivered at district hospitals. Future global surgery benchmarking should consider specific benchmarks for different age groups.
Authors: Dean T Jamison; Lawrence H Summers; George Alleyne; Kenneth J Arrow; Seth Berkley; Agnes Binagwaho; Flavia Bustreo; David Evans; Richard G A Feachem; Julio Frenk; Gargee Ghosh; Sue J Goldie; Yan Guo; Sanjeev Gupta; Richard Horton; Margaret E Kruk; Adel Mahmoud; Linah K Mohohlo; Mthuli Ncube; Ariel Pablos-Mendez; K Srinath Reddy; Helen Saxenian; Agnes Soucat; Karen H Ulltveit-Moe; Karene H Ulltveit-Moe; Gavin Yamey Journal: Lancet Date: 2013-12-03 Impact factor: 79.321
Authors: Barclay T Stewart; Robert Quansah; Adam Gyedu; James Ankomah; Peter Donkor; Charles Mock Journal: World J Surg Date: 2015-10 Impact factor: 3.352
Authors: John G Meara; Andrew J M Leather; Lars Hagander; Blake C Alkire; Nivaldo Alonso; Emmanuel A Ameh; Stephen W Bickler; Lesong Conteh; Anna J Dare; Justine Davies; Eunice Dérivois Mérisier; Shenaaz El-Halabi; Paul E Farmer; Atul Gawande; Rowan Gillies; Sarah L M Greenberg; Caris E Grimes; Russell L Gruen; Edna Adan Ismail; Thaim Buya Kamara; Chris Lavy; Lundeg Ganbold; Nyengo C Mkandawire; Nakul P Raykar; Johanna N Riesel; Edgar Rodas; John Rose; Nobhojit Roy; Mark G Shrime; Richard Sullivan; Stéphane Verguet; David Watters; Thomas G Weiser; Iain H Wilson; Gavin Yamey; Winnie Yip Journal: Surgery Date: 2015-05-16 Impact factor: 3.982
Authors: Adam Gyedu; Barclay Stewart; Cameron Gaskill; Godfred Boakye; Ebenezer Appiah-Denkyira; Peter Donkor; Ronald Maier; Robert Quansah; Charles Mock Journal: Ann Surg Date: 2018-08 Impact factor: 12.969
Authors: John Rose; Thomas G Weiser; Phil Hider; Leona Wilson; Russell L Gruen; Stephen W Bickler Journal: Lancet Glob Health Date: 2015-04-27 Impact factor: 26.763
Authors: Shelly Choo; Henry Perry; Afua A J Hesse; Francis Abantanga; Elias Sory; Hayley Osen; Charles Fleischer-Djoleto; Rachel Moresky; Colin W McCord; Meena Cherian; Fizan Abdullah Journal: Trop Med Int Health Date: 2010-07-14 Impact factor: 2.622
Authors: Adam Gyedu; Sam Debrah; Kwabena Agbedinu; Stephanie K Goodman; Jacob Plange-Rhule; Peter Donkor; Charles Mock Journal: World J Surg Date: 2019-03 Impact factor: 3.352
Authors: Adam Gyedu; Emmanuel Gyasi Baah; Godfred Boakye; Michael Ohene-Yeboah; Easmon Otupiri; Barclay T Stewart Journal: Int J Surg Date: 2015-02-04 Impact factor: 6.071