Reply from author: Bridging the public–private divide

Vervoort, Dominique

doi:10.1016/j.jtcvs.2021.03.054

Cited by 1 publication

(1 citation statement)

References 5 publications

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“…The United States, for example, has among the highest densities of cardiac surgery centers with too many centers respective to their catchment areas, suggesting opportunities for consolidation to optimize outcomes and costs with limited geographical barriers [13, 14]. Conversely, LMICs, similar to single‐payer health systems, are inherently more inclined to adopt regionalization models as a result of resource constraints and the need to optimize volume, outcomes, purchase, and procedural costs [15, 16].…”

Section: Discussionmentioning

confidence: 99%

Global Access to Cardiac Surgery Centers: Distribution, Disparities, and Targets

et al. 2023

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Background Global data on cardiac surgery centers are outdated and survey-based. In 1995, there were 0.7 centers per million population, ranging from one per 120,000 in North America to one per 33 million in sub-Saharan Africa. This study analyzes the contemporary distribution of cardiac surgery centers and proposes targets relative to countries' cardiovascular disease (CVD) burdens. Methods Medical databases, gray literature, and governmental reports were used to identify the most recent post-2010 data that describe the number of centers performing cardiac surgery in each nation. The 2019 Institute for Health Metrics and Evaluation Global Burden of Disease Results Tool provided national CVD burdens. One-third of the CVD burden was assumed to be surgical. Center targets were proposed as the average or half of the average of centers per million surgical CVD patients in high-income countries. Results 5,111 cardiac surgery centers were identified across 230 nations and territories with available data, equaling 0.73 centers per million population. The median (interquartile range) number of centers ranged from 0 (0-0.06) per million in low-income countries to 0.75 (0-1.44) in high-income countries. Targets were 612.2 (optimistic) or 306.1 (conservative) centers per million surgical CVD incidence. In 2019, low-income, lower-middle-income, and uppermiddle-income countries possessed 34.8, 149.0, and 271.9 centers per million surgical CVD incidence. Conclusion Little progress has been made to increase cardiac surgery centers per population despite growing CVD burdens. Today's global cardiac surgical capacity remains insufficient, disproportionately affecting the world's poorest regions.

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