Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2023 Aug;47(8):1930-1939.
doi: 10.1007/s00268-023-07029-x. Epub 2023 May 16.

Are LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A Systematic Review

Priti Patil  1 , Priyansh Nathani  2 , Juul M Bakker  3 , Alex J van Duinen  4 , Pranav Bhushan  5 , Minal Shukla  6 , Samir Chalise  3 , Nobhojit Roy  7   8 , Anita Gadgil  9   10
Affiliations

Are LMICs Achieving the Lancet Commission Global Benchmark for Surgical Volumes? A Systematic Review

Priti Patil et al. World J Surg. 2023 Aug.

Abstract

Introduction: The Lancet Commission on Global Surgery (LCoGS) set the benchmark of 5000 procedures per 100,000 population annually to meet surgical needs adequately. This systematic review provides an overview of the last ten years of surgical volumes in Low and Middle- Income-Countries (LMICs).

Methodology: We searched PubMed, Web of Science, Scopus, Cochrane, and EMBASE databases for studies from LMICs addressing surgical volume. The number of surgeries performed per 100,000 population was estimated. We used cesarean sections, hernia, and laparotomies as index cases for the surgical capacities of the country. Their proportions to total surgical volumes were estimated. The association of country-specific surgical volumes and the proportion of index cases with its Gross Domestic Product (GDP) per capita was analyzed.

Results: A total of 26 articles were included in this review. In LMICs, on average, 877 surgeries were performed per 100,000 population. The proportion of cesarean sections was found to be high in all LMICs, with an average of 30.1% of the total surgeries, followed by hernia (16.4%) and laparotomy (5.1%). The overall surgical volumes increased as the GDP per capita increased. The proportions of cesarean section and hernia to total surgical volumes decreased with increased GDP per capita. Significant heterogeneity was found in the methodologies to assess surgical volumes, and inconsistent reporting hindered comparison between countries.

Conclusion: Most LMICs have surgical volumes below the LCoGS benchmark of 5000 procedures per 100,000 population, with an average of 877 surgeries. The surgical volume increased while the proportions of hernia and cesarean sections reduced with increased GDP per capita. In the future, it's essential to apply uniform and reproducible data collection methods for obtaining multinational data that can be more accurately compared.

PubMed Disclaimer

Conflict of interest statement

The authors declare that they have no conflicts of interest.

Figures

Fig. 1
Fig. 1
PRISMA diagram
Fig. 2
Fig. 2
Association of surgical volume with per capita GDP
Fig. 3
Fig. 3
Comparison of percentage of index surgeries out of total surgeries with study year-specific GDP per capita in LMICs
See this image and copyright information in PMC

References

    1. World Health Organization. (2015) Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage Report by the Secretariat. Provisional agenda item 5.1 [Internet]. (May), 16–18. Available from:http://apps.who.int/medicinedocs/documents/s21904en/s21904en.pdf%0Ahttp:....
    1. Price R, Makasa E, Hollands M. World health assembly resolution wha68.15: strengthening emergency and essential surgical care and anesthesia as a component of universal health coverage–addressing the public health gaps arising from lack of safe, affordable and accessible surgical a. World J Surg. 2015;39:2115–2125. doi: 10.1007/s00268-015-3153-y. - DOI - PubMed
    1. Shrime MG, Bickler SW, Alkire BC, Mock C. Global burden of surgical disease: an estimation from the provider perspective. Lancet Glob Heal. 2015;3(S2):S8–S9. doi: 10.1016/S2214-109X(14)70384-5. - DOI - PubMed
    1. Bickler SW, Weiser TG, Kassebaum N, Higashi H, Chang DC, Barendregt JJ, Vos T. Global burden of surgical conditions. Disease control priorities. 2015;1:19–40.
    1. Debas T. Haile, Richard Gosselin, Colin McCord and AT. (2006) Surgery. In: Jamison TL, Breman JG, Measham AR et al (eds) Disease control priorities in developing countries 2nd edition. Oxford Univ. Press. New York, pp 1245–1261.1293–1307

Publication types