Half a billion surgical cases: Aligning surgical delivery with best-performing health systems

  • Mark G. Shrime
    Reprint requests: Mark G. Shrime, MD, MPH, FACS, Harvard Interfaculty Initiative in Health Policy, 14 Story Street, 4th Floor, Cambridge, MA 02138.
    Department of Global Health and Population, Harvard School of Public Health, Boston, MA

    Department of Otology and Laryngology, Harvard Medical School, Boston, MA

    Office of Global Surgery, Massachusetts Eye and Ear Infirmary, Boston, MA

    Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA
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  • Kimberly M. Daniels
    Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
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  • John G. Meara
    Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA

    Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
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Published:April 28, 2015DOI:


      Surgical delivery varies 200-fold across countries. No direct correlation exists, however, between surgical delivery and health outcomes, making it difficult to pinpoint a goal for surgical scale-up. This report determines the amount of surgery that would be delivered worldwide if the world aligned itself with countries providing the best health outcomes.


      Annual rates of surgical delivery have been published previously for 129 countries. Five health outcomes were plotted against reported surgical delivery. Univariate and multivariate polynomial regression curves were fit, and the optimal point on each regression curve was determined by solving for first-order conditions. The country closest to the optimum for each health outcome was taken as representative of the best-performing health system. Monetary inputs to and surgical procedures provided by these systems were scaled to the global population.


      For 3 of the 5 health outcomes, optima could be found. Globally, 315 million procedures currently are provided annually. If global delivery mirrored the 3 best-performing countries, between 360 million and 460 million cases would be provided annually. With population growth, this will increase to approximately half a billion cases by 2030. Health systems delivering these outcomes spend approximately 10% of their GDP on health.


      This is the first study to provide empirical evidence for the surgical output that an ideal health system would provide. Our results project ideal delivery worldwide of approximately 550 million annual surgical cases by 2030.
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