Assessing the Brazilian surgical system with six surgical indicators: a descriptive and modelling study

Abstract

BackgroundBrazil boasts a health scheme that aspires to provide universal coverage, but its surgical system has rarely been analysed. In an effort to strengthen surgical systems worldwide, the Lancet Commission on Global Surgery proposed a collection of 6 standardised indicators: 2-hour access to surgery, surgical workforce density, surgical volume, perioperative mortality rate (POMR) and protection against impoverishing and catastrophic expenditure. This study aims to characterise the Brazilian surgical health system with these newly devised indicators while gaining understanding on the complexity of the indicators themselves.MethodsUsing Brazil's national healthcare database, commonly reported healthcare variables were used to calculate or simulate the 6 surgical indicators. Access to surgery was calculated using hospital locations, surgical workforce density was calculated using locations of surgeons, anaesthesiologists and obstetricians (SAO), and surgical volume and POMR were identified with surgical procedure codes. The rates of protection against impoverishing and catastrophic expenditure were modelled using cost of surgical inpatient hospitalisations and a γ distribution of incomes based on Gini and gross domestic product/capita.FindingsIn 2014, SAO density was 34.7/100 000 population, surgical volume was 4433 procedures/100 000 people and POMR was 1.71%. 79.4% of surgical patients were protected against impoverishing expenditure and 84.6% were protected against catastrophic expenditure due to surgery each year. 2-hour access to surgery was not able to be calculated from national health data, but a proxy measure suggested that 97.2% of the population has 2-hour access to a hospital that may be able to provide surgery. Geographic disparities were seen in all indicators.InterpretationBrazil's public surgical system meets several key benchmarks. Geographic disparities, however, are substantial and raise concerns of equity. Policies should focus on stimulating appropriate geographic allocation of the surgical workforce and better distribution of surgical volume. In some cases, where benchmarks for each indicator are met, supplemental analysis can further inform our understanding of health systems. This measured and systematic evaluation should be encouraged for all nations seeking to better understand their surgical systems.

Evaluating the collection, comparability and findings of six global surgery indicators

“…The data collection interval was 2010–2016, and publication of the Commission report in 2015 and other global initiatives to improve access to safe affordable surgical care in that year were an incentive to collect data. Indeed, data collection is ongoing (frequently driven by professional societies and researchers rather than governments and multilateral organizations) and, in some instances, new data have been published since data collection for this study ended. New data are not always nationally representative, and have increased availability only marginally; challenges to comparability and utility also remain.…”

Care of infants with gastroschisis in low-resource settings

“…The ability to assess institutional capacity and access to surgical services is vital for global health planning. The Lancet Commission bellwether procedures have been used to map 2-hour access to emergency and essential surgical care globally [82][83][84][85] . This helps to identify areas to prioritise global health funding and efforts to help reach the target of 80% coverage of essential surgical and anaesthetic care per country by 2030 81 .…”

Tendência de internações e mortalidade por causas cirúrgicas no Brasil, 2008 a 2016.

“…This results in loss of productive lives and reduction of the population's well-being, interfering in the countries' economic development 1 . In addition, there are iniquities of access to anesthetic and surgical care among countries, since in developed countries the guarantee of access to surgery is greater than in low-and middle-income countries, especially in the population belonging to the poorest social strata 1,8,9 . In Brazilian literature, there is a shortage of studies that discuss epidemiological data on access to surgical care [10][11][12] . Among the few, there is a pioneer work covering a period of 13 years (1995-2007), which showed an increasing trend in the number of surgical interventions, related expenses and surgical mortality 10 .…”

“…Among the few, there is a pioneer work covering a period of 13 years (1995-2007), which showed an increasing trend in the number of surgical interventions, related expenses and surgical mortality 10 . Another, more recent, study produced essential information for understanding this topic, focusing on geographic regions, though with analysis limited to the year 2014 12 we selected the procedures group ("grupo de procedimentos"), and than the option corresponding only to surgical procedures 13 .…”