Global Surgery, Obstetric, and Anesthesia Indicator Definitions and Reporting: An Utstein Consensus Report

Abstract

Background Indicators to evaluate progress towards timely access to safe surgical, anaesthesia, and obstetric (SAO) care were proposed in 2015 by the Lancet Commission on Global Surgery. Despite being rapidly taken up by practitioners, datapoints from which to derive them were not defined, limiting comparability across time or settings. We convened global experts to evaluate and explicitly define - for the first time - the indicators to improve comparability and support achievement of 2030 goals to improve access to safe affordable surgical and anaesthesia care. Methods and findings The Utstein process for developing and reporting guidelines through a consensus building process was followed. In-person discussions at a two day meeting were followed by an iterative process conducted by email and virtual group meetings until consensus was reached. Participants consisted of experts in surgery, anaesthesia, and obstetric care, data science, and health indicators from high, middle, and low income countries. Considering each of the six indicators in turn, we refined overarching descriptions and agreed upon data points needed for construction of each indicator at current time (basic data points), and as each evolves over 2-5 (intermediate) and >5 year (full) timeframes. We removed one of the original six indicators (one of two financial risk protection indicators was eliminated) and refined descriptions and defined data points required to construct the 5 remaining indicators: geospatial access, workforce, surgical volume, perioperative mortality, and catastrophic expenditure. Conclusions To track global progress toward timely access to quality SAO care, these indicators – at the basic level - should be implemented universally. Intermediate and full evolutions will assist in developing national surgical plans, and collecting data for research studies.

Estimating the Specialist Surgical Workforce Density in South Africa

“…However, we acknowledge that without other cadres, such as nurses, midlevel providers, and non-surgeon physicians (such as family physicians), surgical delivery could not occur. Even the LCGS has realised that measuring the specialist surgical workforce underestimates the true surgical workforce in most LMICs where non-specialists provide essential surgical care and has proposed an updated metric with other cadres included as well [27]. Measuring their densities is difficult because we do not have an accurate way to capture which of these providers are contributing to surgical care in South Africa (i.e., not all family physicians provide surgical care and not all nurses are perioperative nurses).…”

Defining Feasibility as a Criterion for Essential Surgery: A Qualitative Study with Global Children's Surgery Experts

“…Efforts to improve the delivery of surgical care around the world rely on metrics to assess healthcare system infrastructure, human resources, capacity, and other resources. Bellwether or ''proxy'' surgical procedures-which include cesarean delivery, laparotomy, and treatment of an open fracture [1]-are meant to serve as indicators of institutional capacity to provide a wide range of emergency and essential obstetric, gynecological, general surgical, and orthopedic surgical procedures at first-level hospitals [2,3]. However, these bellwether procedures do not correlate with capacity to manage surgical needs of children [3].…”