Maria L Odland1, Dmitri Nepogodiev2, Dion Morton2, Janet Martin3, Abebe Bekele4, Dhruva Ghosh5, Adesoji O Ademuyiwa6, Justine I Davies1,7, Thomas G Weiser8,9. 1. Institute of Applied Health Research, College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK. 2. National Institute for Health Research Global Health Research Unit on Global Surgery, University of Birmingham, Birmingham, UK. 3. Departments of Anesthesia & Perioperative Medicine and Epidemiology & Biostatistics, MEDICI Centre, Schulich School of Medicine & Dentistry, London, Canada. 4. University of Global Health Equity, Kigali, Rwanda. 5. Department of Pediatric Surgery, Christian Medical College & Hospital, Ludhiana. 6. Department of Surgery, College of Medicine, University of Lagos & Pediatric Surgery Unit, Lagos University Teaching Hospital, P.M.B., Lagos, Nigeria. 7. MRC/Wits Rural Public Health & Health Transitions Research Unit (Agincourt), University of the Witwatersrand, Johannesburg, South Africa. 8. Stanford University School of Medicine, Department of Surgery Division of General Surgery, Section of Trauma & Critical Care, Stanford, CA. 9. Department of Clinical Surgery, University of Edinburgh, Edinburgh, UK.
Abstract
OBJECTIVE: We aimed to define a globally applicable list of surgical procedures, or "basket," which could represent a health system's capacity to provide surgical care and standardize global surgical measurement. SUMMARY OF BACKGROUND DATA: Six indicators have been proposed to assess access to safe, affordable, timely surgical and anesthesia care, with a focus on laparotomy, cesarean section, and treatment of open fracture. However, comparability, particularly for these procedures, has been limited by a lack of definitional clarity and their overly broad scope. METHODS: We conducted a 3 round international expert Delphi exercise between April and June 2019 using REDCap to identify a set of procedures representative of surgical capacity. To be included, procedures had to be important for treating common conditions, well-defined, and impactful (ie, well-recognized clinical or functional benefit). Procedures were eliminated or prioritized in each round, and those noted as "extremely" or "very important" by ≥50% of respondents in round 3 were included in the final "basket." RESULTS: Altogether 331 respondents from 78 countries participated in the Delphi process. A final basket of 32 procedures representing disease categories in trauma, cancer, congenital anomalies, maternal/reproductive health, aging, and infection were identified for inclusion to assess surgical capacity. CONCLUSIONS: This surgical basket facilitates a more standardized assessment of a country's surgical system. Further testing and refinement will likely be needed, but this basket can be used immediately to guide ongoing monitoring and evaluation of global surgery capacities to improve and strengthen surgery and anesthesia care.
OBJECTIVE: We aimed to define a globally applicable list of surgical procedures, or "basket," which could represent a health system's capacity to provide surgical care and standardize global surgical measurement. SUMMARY OF BACKGROUND DATA: Six indicators have been proposed to assess access to safe, affordable, timely surgical and anesthesia care, with a focus on laparotomy, cesarean section, and treatment of open fracture. However, comparability, particularly for these procedures, has been limited by a lack of definitional clarity and their overly broad scope. METHODS: We conducted a 3 round international expert Delphi exercise between April and June 2019 using REDCap to identify a set of procedures representative of surgical capacity. To be included, procedures had to be important for treating common conditions, well-defined, and impactful (ie, well-recognized clinical or functional benefit). Procedures were eliminated or prioritized in each round, and those noted as "extremely" or "very important" by ≥50% of respondents in round 3 were included in the final "basket." RESULTS: Altogether 331 respondents from 78 countries participated in the Delphi process. A final basket of 32 procedures representing disease categories in trauma, cancer, congenital anomalies, maternal/reproductive health, aging, and infection were identified for inclusion to assess surgical capacity. CONCLUSIONS: This surgical basket facilitates a more standardized assessment of a country's surgical system. Further testing and refinement will likely be needed, but this basket can be used immediately to guide ongoing monitoring and evaluation of global surgery capacities to improve and strengthen surgery and anesthesia care.
Authors: Elizabeth K Tissingh; Leonard Marais; Antonio Loro; Deepa Bose; Nilo T Paner; Jamie Ferguson; Mario Morgensten; Martin McNally Journal: EFORT Open Rev Date: 2022-05-31