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The global burden of surgical disease: past, present and future Rele Ologunde, Laksmi S Hashimoto-Govindasamy and Sayinthen Vivekanantham Trop Doct published online 18 September 2014 DOI: 10.1177/0049475514550065 The online version of this article can be found at: http://tdo.sagepub.com/content/early/2014/09/16/0049475514550065
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The global burden of surgical disease: past, present and future
Tropical Doctor 0(0) 1–2 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0049475514550065 tdo.sagepub.com
Rele Ologunde1, Laksmi S Hashimoto-Govindasamy2 and Sayinthen Vivekanantham1 The global burden of disease (GBD) study was the first, and remains the only, comprehensive attempt at quantifying disease burden worldwide.1 The initial GBD study in 1992 highlighted the burden of various diseases, and risk factors of disease,1 many of which remain poorly addressed.2 This study introduced a new metric, disability adjusted life years (DALYs), through which it became possible to calculate time lost through premature death and time lived with disability.2 Many of the disease groups identified in the GBD study (including malignancies and musculoskeletal disorders) are amenable to surgical correction and constitute a considerable proportion of the GBD.3,4 Revisions of the GBD study provide the international community with valuable data depicting trends in disease patterns from which health policy makers may base priority setting at both a national and an international level on public health issues, as well as informing future trends. Recently, considerable efforts have been made to define an internationally applicable standardised health metric to evaluate access to safe surgical care (incorporating disease burden and health system performance) in order to monitor trends and inform efforts in public health surveillance.4 Investment in improving disease monitoring and surveillance systems in low- and middle-income countries remains vital, as statistical undertakings in the developing world are inherently fraught. The limited inbuilt health infrastructure compromises capacity to collate adequate epidemiologic and vital statistics. Further regional descriptive epidemiology exploring the social determinants of health5 to improve the understanding of the heterogeneity in local perceptions of disease burden may also contribute to developing contextually appropriate measures to address local issues. Recent efforts to improve access to surgical care in low- and middle-income countries include the World Health Organization’s (WHO) Surgical Safety Checklist and the Global Initiative for Emergency and Essential Surgical Care Program. Despite compelling evidence of the benefit of surgical safety checklists in improving mortality and patient outcomes,5 a recent article by Urbach and colleagues6 suggested that implementation of the checklist in a Canadian hospital was
not associated with a significant reduction in operative mortality or complications. Although it cannot be assumed that the institution of a checklist will inevitably facilitate an improvement in patient outcomes, hospitals in high-income countries are perhaps less likely to show improvements as they are likely to already have protocols in place to minimise adverse surgical events.7 In many resource constrained countries the effect of a checklist will likely bring about marked reductions in patient mortality and thus the findings to the contrary should be interpreted with due caution. With the growing evidence-base and increasing compliance with the checklist its use remains a vital component in the delivery of safe surgical care globally. At the 135th executive board meeting of the WHO, in May 2014, ‘Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage’ was discussed as an agenda item for the first time.8 This marks a significant milestone in the efforts of countless surgeons, healthcare professionals, non-governmental organisations, academics, students and civil society over the years in advocating for surgical care to be recognised as a global health priority. However, much remains to be done to ensure that a WHO resolution on this agenda item is passed. Furthermore, in order to ensure that current efforts to increase awareness of the need for improved surgical care in low- and middle-income countries bring about improvements in population health critical challenges such as gaps in surgical services, including strengthening the surgical workforce and health system infrastructure must be addressed. These challenges combined with garnering political commitment are crucial to sustained improvements in surgical care globally. There also exists a need to frame global surgery objectives within the wider landscape of global 1 2
Imperial College London, UK University of New South Wales, Sydney, Australia
Corresponding author: Rele Ologunde, Imperial College School of Medicine, Imperial College London, Exhibition Road, London SW7 2AZ, UK. Email: [email protected]
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public health objectives; this may currently be hindered by the lack of universally accepted metrics to inform the debate on priority setting in global surgery and as such this should be a priority for current research efforts. Furthermore, continued efforts to advocate for improvements in surgical care and health system strengthening remain crucial to the future of any gains in population health.
3.
4.
5.
Conflict of interest 6.
None declared.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References
7.
8.
1. Murray CJ and Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997; 349: 1269–1276. 2. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions,
1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2197–2223. Ologunde R, Maruthappu M, Shanmugarajah K and Shalhoub J. Surgical care in low and middle-income countries: Burden and barriers. Int J Surg 2014; 12: 858–863. Weiser TG, Makary MA, Haynes AB, et al. Standardised metrics for global surgical surveillance. Lancet 2009; 374: 1113–1117. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009; 360: 491–499. Urbach DR, Govindarajan A, Saskin R, Wilton AS and Baxter NN. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med 2014; 370: 1029–1038. Aveling EL, McCulloch P and Dixon-Woods M. A qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low-income countries. BMJ Open 2013; 3: e003039. World Health Organization. Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage. Geneva: WHO, 2014. Available at: http://apps.who.int/gb/ebwha/pdf_files/EB135/B135_ 3-en.pdf (accessed 30 July 2014).
Downloaded from tdo.sagepub.com at MCMASTER UNIV LIBRARY on December 9, 2014
The global burden of surgical disease: past, present and future Rele Ologunde, Laksmi S Hashimoto-Govindasamy and Sayinthen Vivekanantham Trop Doct published online 18 September 2014 DOI: 10.1177/0049475514550065 The online version of this article can be found at: http://tdo.sagepub.com/content/early/2014/09/16/0049475514550065
Published by: http://www.sagepublications.com
On behalf of: THET
Additional services and information for Tropical Doctor can be found at: Email Alerts: http://tdo.sagepub.com/cgi/alerts Subscriptions: http://tdo.sagepub.com/subscriptions Reprints: http://www.sagepub.com/journalsReprints.nav Permissions: http://www.sagepub.com/journalsPermissions.nav
>> OnlineFirst Version of Record - Sep 18, 2014 What is This?
Downloaded from tdo.sagepub.com at MCMASTER UNIV LIBRARY on December 9, 2014
XML Template (2014) [10.9.2014–4:23pm] //blrnas3/cenpro/ApplicationFiles/Journals/SAGE/3B2/TDOJ/Vol00000/140043/APPFile/SG-TDOJ140043.3d
(TDO)
[1–2] [PREPRINTER stage]
Trop Doct OnlineFirst, published on September 18, 2014 as doi:10.1177/0049475514550065
Correspondance
The global burden of surgical disease: past, present and future
Tropical Doctor 0(0) 1–2 ! The Author(s) 2014 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0049475514550065 tdo.sagepub.com
Rele Ologunde1, Laksmi S Hashimoto-Govindasamy2 and Sayinthen Vivekanantham1 The global burden of disease (GBD) study was the first, and remains the only, comprehensive attempt at quantifying disease burden worldwide.1 The initial GBD study in 1992 highlighted the burden of various diseases, and risk factors of disease,1 many of which remain poorly addressed.2 This study introduced a new metric, disability adjusted life years (DALYs), through which it became possible to calculate time lost through premature death and time lived with disability.2 Many of the disease groups identified in the GBD study (including malignancies and musculoskeletal disorders) are amenable to surgical correction and constitute a considerable proportion of the GBD.3,4 Revisions of the GBD study provide the international community with valuable data depicting trends in disease patterns from which health policy makers may base priority setting at both a national and an international level on public health issues, as well as informing future trends. Recently, considerable efforts have been made to define an internationally applicable standardised health metric to evaluate access to safe surgical care (incorporating disease burden and health system performance) in order to monitor trends and inform efforts in public health surveillance.4 Investment in improving disease monitoring and surveillance systems in low- and middle-income countries remains vital, as statistical undertakings in the developing world are inherently fraught. The limited inbuilt health infrastructure compromises capacity to collate adequate epidemiologic and vital statistics. Further regional descriptive epidemiology exploring the social determinants of health5 to improve the understanding of the heterogeneity in local perceptions of disease burden may also contribute to developing contextually appropriate measures to address local issues. Recent efforts to improve access to surgical care in low- and middle-income countries include the World Health Organization’s (WHO) Surgical Safety Checklist and the Global Initiative for Emergency and Essential Surgical Care Program. Despite compelling evidence of the benefit of surgical safety checklists in improving mortality and patient outcomes,5 a recent article by Urbach and colleagues6 suggested that implementation of the checklist in a Canadian hospital was
not associated with a significant reduction in operative mortality or complications. Although it cannot be assumed that the institution of a checklist will inevitably facilitate an improvement in patient outcomes, hospitals in high-income countries are perhaps less likely to show improvements as they are likely to already have protocols in place to minimise adverse surgical events.7 In many resource constrained countries the effect of a checklist will likely bring about marked reductions in patient mortality and thus the findings to the contrary should be interpreted with due caution. With the growing evidence-base and increasing compliance with the checklist its use remains a vital component in the delivery of safe surgical care globally. At the 135th executive board meeting of the WHO, in May 2014, ‘Strengthening Emergency and Essential Surgical Care and Anaesthesia as a Component of Universal Health Coverage’ was discussed as an agenda item for the first time.8 This marks a significant milestone in the efforts of countless surgeons, healthcare professionals, non-governmental organisations, academics, students and civil society over the years in advocating for surgical care to be recognised as a global health priority. However, much remains to be done to ensure that a WHO resolution on this agenda item is passed. Furthermore, in order to ensure that current efforts to increase awareness of the need for improved surgical care in low- and middle-income countries bring about improvements in population health critical challenges such as gaps in surgical services, including strengthening the surgical workforce and health system infrastructure must be addressed. These challenges combined with garnering political commitment are crucial to sustained improvements in surgical care globally. There also exists a need to frame global surgery objectives within the wider landscape of global 1 2
Imperial College London, UK University of New South Wales, Sydney, Australia
Corresponding author: Rele Ologunde, Imperial College School of Medicine, Imperial College London, Exhibition Road, London SW7 2AZ, UK. Email: [email protected]
Downloaded from tdo.sagepub.com at MCMASTER UNIV LIBRARY on December 9, 2014
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(TDO)
[1–2] [PREPRINTER stage]
2
Tropical Doctor 0(0)
public health objectives; this may currently be hindered by the lack of universally accepted metrics to inform the debate on priority setting in global surgery and as such this should be a priority for current research efforts. Furthermore, continued efforts to advocate for improvements in surgical care and health system strengthening remain crucial to the future of any gains in population health.
3.
4.
5.
Conflict of interest 6.
None declared.
Funding This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.
References
7.
8.
1. Murray CJ and Lopez AD. Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet 1997; 349: 1269–1276. 2. Murray CJ, Vos T, Lozano R, et al. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions,
1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 2012; 380: 2197–2223. Ologunde R, Maruthappu M, Shanmugarajah K and Shalhoub J. Surgical care in low and middle-income countries: Burden and barriers. Int J Surg 2014; 12: 858–863. Weiser TG, Makary MA, Haynes AB, et al. Standardised metrics for global surgical surveillance. Lancet 2009; 374: 1113–1117. Haynes AB, Weiser TG, Berry WR, et al. A surgical safety checklist to reduce morbidity and mortality in a global population. N Engl J Med 2009; 360: 491–499. Urbach DR, Govindarajan A, Saskin R, Wilton AS and Baxter NN. Introduction of surgical safety checklists in Ontario, Canada. N Engl J Med 2014; 370: 1029–1038. Aveling EL, McCulloch P and Dixon-Woods M. A qualitative study comparing experiences of the surgical safety checklist in hospitals in high-income and low-income countries. BMJ Open 2013; 3: e003039. World Health Organization. Strengthening emergency and essential surgical care and anaesthesia as a component of universal health coverage. Geneva: WHO, 2014. Available at: http://apps.who.int/gb/ebwha/pdf_files/EB135/B135_ 3-en.pdf (accessed 30 July 2014).
Downloaded from tdo.sagepub.com at MCMASTER UNIV LIBRARY on December 9, 2014
