Tiffany E. Chao

Estimate of the global volume of surgery in 2012: an assessment supporting improved health outcomes.

BACKGROUND It was previously estimated that 234·2 million operations were performed worldwide in 2004. The association between surgical rates and population health outcomes is not clear. We re-estimated global surgical volume to track changes over time and assess rates associated with healthy populations. METHODS We gathered demographic, health, and economic data for 194 WHO member states. Surgical volumes were obtained from published studies and other reports from 2005 onwards. We estimated rates of surgery for all countries without available data based on health expenditure in 2012 and assessed the proportion of surgery comprised by caesarean delivery. The rate of surgery was plotted against life expectancy to describe the association between surgical care and this health indicator. FINDINGS We identified 66 countries reporting surgical data between 2005 and 2013. We estimate that 312·9 million operations (95% CI 266·2-359·5) took place in 2012-a 33·6% increase over 8 years; the largest proportional increase occurred in countries spending US

Cost-effectiveness of surgery and its policy implications for global health: a systematic review and analysis

400 or less per capita on health care. Caesarean delivery comprised 29·8% (5·8 million operations) of the total surgical volume in poor health expenditure countries compared with 10·8% (7·8 million operations) in low health expenditure countries and 2·7% (5·1 million operations) in high health expenditure countries. We noted a correlation between increased life expectancy and increased surgical rates up to 1533 operations per 100 000 people, with significant but less dramatic improvement above this rate. INTERPRETATION Surgical volume is large and continues to grow in all economic environments. A single procedure-caesarean delivery-comprised almost a third of surgical volume in the most resource-limited settings. Surgical care is an essential part of health care and is associated with increased life expectancy, yet many low-income countries fail to achieve basic levels of service. Improvements in capacity and delivery of surgical services must be a major component of health system strengthening. FUNDING None.

Prioritizing essential surgery and safe anesthesia for the Post-2015 Development Agenda: operative capacities of 78 district hospitals in 7 low- and middle-income countries.

BACKGROUND The perception of surgery as expensive and complex might be a barrier to its widespread acceptance in global health efforts. We did a systematic review and analysis of cost-effectiveness studies that assess surgical interventions in low-income and middle-income countries to help quantify the potential value of surgery. METHODS We searched Medline for all relevant articles published between Jan 1, 1996 and Jan 31, 2013, and searched the reference lists of retrieved articles. We converted all results to 2012 US

Size and distribution of the global volume of surgery in 2012

. We extracted cost-effectiveness ratios (CERs) and appraised economic assessments for their methodological quality using the 10-point Drummond checklist. FINDINGS Of the 584 identified studies, 26 met full inclusion criteria. Together, these studies gave 121 independent CERs in seven categories of surgical interventions. The median CER of circumcision (

Survey of Surgery and Anesthesia Infrastructure in Ethiopia

13·78 per disability-adjusted life year [DALY]) was similar to that of standard vaccinations (

Building a global surgery initiative through evaluation, collaboration, and training: the Massachusetts General Hospital experience.

12·96-25·93 per DALY) and bednets for malaria prevention (

Cost-Effectiveness in Global Surgery: Pearls, Pitfalls, and a Checklist

6·48-22·04 per DALY). Median CERs of cleft lip or palate repair (

A Geospatial Evaluation of Timely Access to Surgical Care in Seven Countries/Evaluation Geospatiale De L'acces En Temps Voulu Aux Soins Chirurgicaux Dans Sept pays/Una Evaluacion Geoespacial del Acceso Oportuno a la Atencion Quirurgica En Siete Paises

47·74 per DALY), general surgery (

The impact of intellectual property regulation on global medical technology innovation

82·32 per DALY), hydrocephalus surgery (

Systematic review of laparoscopic surgery in low- and middle-income countries: benefits, challenges, and strategies

108·74 per DALY), and ophthalmic surgery (