TY - JOUR
T1 - Elective surgery system strengthening
T2 - development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries
AU - NIHR Global Health Unit on Global Surgery
AU - COVIDSurg Collaborative
AU - COVIDSurg Collaborative
AU - NIHR Global Health Unit on Global Surgery
AU - Glasbey, James C.
AU - Abbott, Tom EF
AU - Ademuyiwa, Adesoji
AU - Adisa, Adewale
AU - Alameer, Ehab
AU - Alshryda, Sattar
AU - Arnaud, Alexis P.
AU - Bankhead-Kendall, Brittany
AU - Abou Chaar, M. K.
AU - Chaudhry, Daoud
AU - Costas-Chavarri, Ainhoa
AU - Cunha, Miguel F.
AU - Davies, Justine I.
AU - Desai, Anant
AU - Elhadi, Muhammed
AU - Fiore, Marco
AU - Fitzgerald, James Edward
AU - Fourtounas, Maria
AU - Fowler, Alex James
AU - Futaba, Kay
AU - Gallo, Gaetano
AU - Ghosh, Dhruva
AU - Gujjuri, Rohan R.
AU - Hamilton, Rebecca
AU - Haque, Parvez
AU - Harrison, Ewen M.
AU - Hutchinson, Peter
AU - Hyman, Gabriella
AU - Isik, Arda
AU - Jayarajah, Umesh
AU - Kaafarani, Haytham MA
AU - Kadir, Bryar
AU - Lawani, Ismail
AU - Lederhuber, Hans
AU - Li, Elizabeth
AU - Löffler, Markus W.
AU - Lorena, Maria Aguilera
AU - Mann, Harvinder
AU - Martin, Janet
AU - Mazingi, Dennis
AU - McClain, Craig D.
AU - McLean, Kenneth A.
AU - Meara, John G.
AU - Ramos-De La Medina, Antonio
AU - Tantri, Aida R.
AU - Chandra, Susilo
AU - Soenarto, Ratna F.
AU - Ramlan, Andi A.W.
AU - Harzif, Achmad K.
AU - Surya, Ilham Utama
AU - Manggala, Sidharta Kusuma
N1 - Funding Information:
This work was supported by a National Institute for Health Research (NIHR) Global Health Research Unit Grant (NIHR 16.136.79), the Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic. JG was supported by an NIHR Doctoral Research Fellowship (NIHR300175). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the UK Department of Health and Social Care. We thank the Royal College of Surgeons of England COVID-19 recovery research group for their support. Editorial note: The Lancet Group takes a neutral position with respect to territorial claims in published maps and institutional affiliations.
Funding Information:
This work was supported by a National Institute for Health Research (NIHR) Global Health Research Unit Grant (NIHR 16.136.79), the Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic. JG was supported by an NIHR Doctoral Research Fellowship (NIHR300175). The views expressed are those of the authors and not necessarily those of the National Health Service, the NIHR, or the UK Department of Health and Social Care. We thank the Royal College of Surgeons of England COVID-19 recovery research group for their support.
Publisher Copyright:
© 2022 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license
PY - 2022/11/5
Y1 - 2022/11/5
N2 - Background: The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods: First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings: In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1–84·9), which varied between HIC (88·5 [89·0–88·0]), MIC (81·8 [82·5–81·1]), and LIC (66·8 [64·9–68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0–4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1–5·5]; p<0·0001), MIC (2·8 [2·0–3·7]; p<0·0001), and LIC (3·8 [1·3–6·7%]; p<0·0001) settings. Interpretation: The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs. Funding: National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic.
AB - Background: The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs. Methods: First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score. Findings: In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1–84·9), which varied between HIC (88·5 [89·0–88·0]), MIC (81·8 [82·5–81·1]), and LIC (66·8 [64·9–68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0–4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1–5·5]; p<0·0001), MIC (2·8 [2·0–3·7]; p<0·0001), and LIC (3·8 [1·3–6·7%]; p<0·0001) settings. Interpretation: The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs. Funding: National Institute for Health Research (NIHR) Global Health Research Unit on Global Surgery, NIHR Academy, Association of Coloproctology of Great Britain and Ireland, Bowel Research UK, British Association of Surgical Oncology, British Gynaecological Cancer Society, and Medtronic.
UR - http://www.scopus.com/inward/record.url?scp=85141287010&partnerID=8YFLogxK
U2 - 10.1016/S0140-6736(22)01846-3
DO - 10.1016/S0140-6736(22)01846-3
M3 - Article
C2 - 36328042
AN - SCOPUS:85141287010
SN - 0140-6736
VL - 400
SP - 1607
EP - 1617
JO - The Lancet
JF - The Lancet
IS - 10363
ER -