Global operating theatre distribution and pulse oximetry supply: an estimation from reported data

Funk, Luke M.; Weiser, Thomas; Berry, William R.; Lipsitz, Stuart R.; Merry, Alan; Enright, Angela; Wilson, Iain; Dziekan, Gerald; Gawande, Atul A.

doi:10.1016/s0140-6736(10)60392-3

Cited by 358 publications

(259 citation statements)

References 14 publications

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“…In lower income countries and many middle income 7 countries, access to safe and optimal surgical services for cancer is poor [18]. The median waiting time for malignancies in our study cohort is 20 days.…”

Section: Discussionmentioning

confidence: 87%

A prospective study to evaluate access to elective surgical services in a urology unit of Sri Lanka

et al. 2018

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IntroductionOne of the core indicators of monitoring universal access to safe, affordable surgical care is access to timely, essential surgery. Analysing the waiting time for elective operations is one way to determine access to surgical services in a country. Aims of this study were to determine the access to surgical services in a urology unit of Sri Lanka by analysing waiting time for elective surgical operations and to determine whether waiting time is related to income categories and social classes.

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Section: Discussionmentioning

confidence: 87%

A prospective study to evaluate access to elective surgical services in a urology unit of Sri Lanka

et al. 2018

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“…Investigations of costeffective surgical interventions relative to neglected tropical diseases across sub Saharan Africa found that basic surgical services, emergency obstetric surgery, and surgical management of fractures, softtissue trauma and some cancers were relatively costeffective compared with other prioritised interventions in the region. [6] Researchers have demonstrated that surgical management of acute appendicitis represents relatively good value for money in SA, at approximately USD1 700 per lifeyear saved. [7] Additional costeffectiveness research is required, especially with regard to the availability and utilisation of elective surgical procedures as a treatment option, the availability of which is often linked with socioeconomic status (SES).…”

Section: In Practicementioning

confidence: 99%

'Best buys' for surgery in South Africa

2017

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A new era in surgery has emerged.[1] A discipline faced with multi ple challenges in the universal health coverage environment is discovering how to integrate surgical care provision into the global health agenda. The traditional perception that surgery is less cost effective than other available interventions, such as medicines or public health interventions, is being challenged by new emerg ing evidence suggesting that surgery can represent good value for money.[2] Surgical care is not a pathologybased intervention, but rather a dynamic system that has a crucial role to play in managing the burden of disease, including communicable and non communicable diseases.Several recent developments have highlighted the crucial role of surgery in the health system. The 2015 World Health Assembly resolution 68.15 outlined the importance of 'Strengthening emergency and essential surgery and anaesthesia care as a component of universal health coverage. ' [3] In addition, the Lancet Commission on Global Surgery 2030 synthesised much of the evidence supporting the role of surgery and modelled a number of scenarios.[4] Key messages from these developments reflecting the role of surgery globally and the consequence of failure to address the unmet surgical need are:• 5 billion people cannot access safe surgery when needed • 33 million individuals face catastrophic expenditures paying for surgery and anaesthesia annually • Investing in surgery is affordable, saves lives, and promotes economic growth.In South Africa (SA), there is a need to develop a care package for the different levels of service delivery in the public health system, including a package for district hospitals. Developing these packages requires an understanding of the economic implications of intervention implementation. The content of these packages could then inform the development of a national surgical plan.The success of an initiative focused on developing and implemen ting surgical care packages at different levels of care will be deter mined by many factors, including the ability of educational institu tions to facilitate the skills transfer of appropriate competencies, and the availability of appropriate infrastructure and systems to allow the delivery of the different care packages. Surgical care is strongly linked to technology. There is a flood of new technologies and innovation in the surgical care environment, and determining the appropriate intervention for the right setting requires an evidencebased evaluation of the technologies. The spectrum of interventions that could be considered appropriate ranges from lowtechnologydriven procedures with a wide reach that can be offered to patients at primary care level, to highend technologies that can only be performed at tertiary care level.So what surgical options should we offer? This question is at the heart of priority setting, which draws on the best traditions of evidencebased medicine, health economics and medical ethics, and can help us to identify what health interventions and technologies can an...

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“…Pulse oximetry is a mandatory monitor in all countries that have published standards of anaesthesia care [6], it is included in the World Federation of Societies of Anaesthesiologists (WFSA) 'International Standards for Safe Practice of Anaesthesia 2010' and the WHO Standards for Safe Surgery [7,8]. However, pulse oximeters are still not available in operating theatres in many low-income countries [6,9].…”

Section: Introductionmentioning

confidence: 99%

“…However, pulse oximeters are still not available in operating theatres in many low-income countries [6,9].…”

Section: Introductionmentioning

confidence: 99%

Lifebox pulse oximeter implementation in Malawi: evaluation of educational outcomes and impact on oxygen desaturation episodes during anaesthesia

et al. 2017

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Pulse oximetry is an essential monitor for safe anaesthesia but is often not available in low-income countries. The aim of this study was to determine whether the introduction of pulse oximetry with training was feasible and could reduce the incidence of oxygen desaturation during anaesthesia in a low-income country. Pulse oximeters were donated, with training, to 83 non-physician anaesthetists in Malawi. Knowledge was tested immediately before and after training and at follow-up. Providers were asked to record the lowest peripheral oxygen saturation (SpO 2 ) for the first 100 cases anaesthetised after training. The primary clinical outcome was the proportion of cases with an oxygen desaturation event (SpO 2 < 90%). Seventy-seven of 83 (93%) participants completed all pre-and post-training tests. Pulse oximetry knowledge improved after training from a median (IQR [range]) score of 39 (37-42 [28-48]) to 44 (42-46 [35-50]) and this knowledge was maintained for 8 months (p < 0.001). Oxygen saturation data and provider responses were recorded for 4772 cases. The proportion of oxygen desaturation episodes decreased from 17.2% to 6.5%, representing a 36% reduction in the odds of an oxygen desaturation event in the second 50 cases compared with the first 50 (OR 0.64, 95% CI 0.50-0.82, p < 0.001). We conclude that donation of pulse oximeters, with training, in Malawi was feasible, improved knowledge and reduced the incidence of oxygen desaturation events.

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Global operating theatre distribution and pulse oximetry supply: an estimation from reported data

Cited by 358 publications

References 14 publications

A prospective study to evaluate access to elective surgical services in a urology unit of Sri Lanka

A prospective study to evaluate access to elective surgical services in a urology unit of Sri Lanka

'Best buys' for surgery in South Africa

Lifebox pulse oximeter implementation in Malawi: evaluation of educational outcomes and impact on oxygen desaturation episodes during anaesthesia

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