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

  • Mark G. Shrime
    Correspondence
    Reprint requests: Mark G. Shrime, MD, MPH, FACS, Harvard Interfaculty Initiative in Health Policy, 14 Story Street, 4th Floor, Cambridge, MA 02138.
    Affiliations
    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
    Affiliations
    Department of Plastic and Oral Surgery, Boston Children's Hospital, Boston, MA
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  • John G. Meara
    Affiliations
    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:https://doi.org/10.1016/j.surg.2015.03.025

      Background

      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.

      Methods

      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.

      Results

      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.

      Conclusion

      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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      References

        • Shrime M.G.
        • Verguet S.
        • Johansson K.A.
        • Jamison D.T.
        • Kruk M.E.
        Task-shifting, universal public finance, or both for the expansion of surgical access in rural Ethiopia: an extended cost-effectiveness analysis.
        in: Jamison D.T. Disease control priorities in developing countries. 3rd ed. World Bank, Washington (DC)2014
      1. Shrime MG, Bickler SW, Alkire BC, Mock C. Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Health 2015. 3:S8-S9.

        • Farmer P.E.
        • Kim J.Y.
        Surgery and global health: a view from the OR.
        World J Surg. 2008; 32: 533-536
        • Weiser T.G.
        • Regenbogen S.E.
        • Thompson K.D.
        • et al.
        An estimation of the global volume of surgery: a modelling strategy based on available data.
        Lancet. 2008; 372: 139-144
      2. Kim JY. Opening remarks, The Lancet Commission on Global Surgery 2014. Available from: http://www.globalsurgery.info/wp-content/uploads/2014/01/Jim-Kim-Global-Surgery-Transcribed.pdf.

        • Vega J.
        Universal health coverage: the post-2015 development agenda.
        Lancet. 2013; 381: 179-180
      3. World Health Organization. Everybody's business: strengthening health systems to improve health outcomes: WHO's framework for action 2007. Available from: http://www.who.int/healthsystems/strategy/everybodys_business.pdf.

        • Gosselin R.A.
        • Gialamas G.
        • Atkin D.M.
        Comparing the cost-effectiveness of short orthopedic missions in elective and relief situations in developing countries.
        World J Surg. 2011; 35: 951-955
        • Hoang Lan N.
        • Laohasiriwong W.
        • Stewart J.F.
        • Tung N.D.
        • Coyte P.C.
        Cost of treatment for breast cancer in central Vietnam.
        Glob Health Action. 2013; 6: 18872
        • Hodges A.M.
        • Hodges S.C.
        A rural cleft project in Uganda.
        Br J Plast Surg. 2000; 53: 7-11
        • Magee W.P.
        • Vander Burg R.
        • Hatcher K.W.
        Cleft lip and palate as a cost-effective health care treatment in the developing world.
        World J Surg. 2010; 34: 420-427
      4. Weiser TG, Haynes AB, Molina G, et al. The global volume of surgery in 2012: an assessment supporting improved health outcomes. Lancet, in press.

        • World Bank
        World Development Indicators, Health expenditure per capita.
        (Available from:)
        • World Bank
        World Development Indicators, Health expenditure, total (% of GDP).
        (Available from:)
        • World Bank
        World Development Indicators, Life expectancy at birth, total.
        (Available from:)
        • World Bank
        World Development Indicators, Mortality rate, under-5 (per 1,000 live births).
        (Available from:)
        • World Bank
        World Development Indicators, Maternal mortality ratio (modeled estimate, per 100,000 live births).
        (Available from:)
      5. United Nations Department of Economic and Social Affairs. World population prospects: The 2012 revision 2013. Available from: http://www.unfpa.org/webdav/site/global/shared/documents/news/2013/KEY FINDINGS WPP2012_FINAL-2.pdf.

        • Box G.E.P.
        • Cox D.R.
        An analysis of transformations.
        J Roy Stat Soc Ser B. 1964; 26: 211-252
        • Hughes C.D.
        • Babigian A.
        • McCormack S.
        • et al.
        The clinical and economic impact of a sustained program in global plastic surgery: valuing cleft care in resource-poor settings.
        Plast Reconstr Surg. 2012; 130: 87e-94e
        • Moon W.
        • Perry H.
        • Baek R.M.
        Is international volunteer surgery for cleft lip and cleft palate a cost-effective and justifiable intervention? A case study from East Asia.
        World J Surg. 2012; 36: 2819-2830
        • Omran A.R.
        The epidemiologic transition theory revisited thirty years later.
        World Health Stat Q. 1998; 51: 99-119
        • Boutayeb A.
        The double burden of communicable and non-communicable diseases in developing countries.
        Trans R Soc Trop Med Hyg. 2006; 100: 191-199
        • Gupta S.
        • Verhoeven M.
        • Tiongson E.
        Does higher government spending buy better results in education and health care.
        IMF Working Papers: International Monetary Fund, Washington, DC1999