Open AccessEnumeration of Operations Performed for Elderly Patients in Ghana: An Opportunity to Improve Global Surgery Benchmarking
Author(s) -
Gyedu Adam,
Stewart Barclay,
Gaskill Cameron,
Salia Emmanuella Lebasaana,
Wadie Raymond,
Donkor Peter,
Mock Charles
Publication year - 2019
Publication title -
world journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.115
H-Index - 148
eISSN - 1432-2323
pISSN - 0364-2313
DOI - 10.1007/s00268-019-04963-7
Subject(s) - benchmarking , medicine , referral , benchmark (surveying) , commission , population , cardiac surgery , cardiothoracic surgery , vascular surgery , operations management , surgery , family medicine , environmental health , business , finance , geography , geodesy , marketing , economics
Abstract Introduction The Lancet Commission on Global Surgery proposed 5000 operations/100,000 people annually as a benchmark for developing countries but did not define benchmarks for different age groups. We evaluated the operation rate for elderly patients (≥65 years) in Ghana and estimated the unmet surgical need for the elderly by comparison to a high‐income country benchmark. Methods Data on operations performed for elderly patients over a 1‐year period in 2014‐5 were obtained from representative samples of 48/124 small district hospitals and 12/16 larger referral hospitals and scaled‐up for nationwide estimates. Operations were categorized as essential (most cost‐effective, highest population impact) versus other according to The World Bank’s Disease Control Priority project (DCP‐3). Data from New Zealand’s National Minimum Dataset were used to derive a benchmark operation rate for the elderly. Results 16,007 operations were performed for patients ≥65 years. The annual operation rate was 1744/100,000 (95% UI 1440–2048), only 12% of the New Zealand benchmark of 14,103/100,000. 74% of operations for the elderly were in the essential category. The most common procedures (15%) were for urinary obstruction. 58% of operations were performed at district hospitals; 54% of these did not have fully‐trained surgeons. Referral hospitals more commonly performed operations outside the essential category. Conclusion The operation rate was well beneath the benchmark, indicating a potentially large unmet need for Ghana’s elderly population. Most operations for the elderly were in the essential category and delivered at district hospitals. Future global surgery benchmarking should consider specific benchmarks for different age groups.