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How will increasing surgical volume affect mortality in the Pacific, Papua New Guinea and Timor Leste?
Author(s) -
Nagra Sonal,
Kaur Balbindar,
Singh Sheetal,
Tangi Viliame,
Mccaig Eddie,
Stupart Douglas,
Moore Eileen M.,
Meara John G.,
Guest Glenn D.,
Watters David A.
Publication year - 2020
Publication title -
anz journal of surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.426
H-Index - 70
eISSN - 1445-2197
pISSN - 1445-1433
DOI - 10.1111/ans.15989
Subject(s) - medicine , perioperative , mortality rate , funnel plot , scale (ratio) , demography , statistic , surgery , geography , odds ratio , statistics , cartography , pathology , sociology , publication bias , mathematics
Abstract Background Nine South Pacific nations, Papua New Guinea and Timor Leste, have collaborated to report and publish their surgical metrics as recommended by the Lancet Commission on Global Surgery (LCoGS). Currently, these countries experience about 750 postoperative deaths per year, representing 1% of crude mortality in the region. Given that more than 400 000 annual procedures are needed in the nine nations to reach the LCoGS target of 5000/100 000, we aimed to calculate the potential contribution of perioperative mortality to national mortality where these procedures are performed. Methods We utilized reported surgical metrics with current rates for surgical volume (SV) and perioperative mortality (POMR), as well as World Bank/WHO mortality statistics, to predict the likely impact of surgical scale‐up to recommended targets by 2030. We tested correlations between SV and POMR in countries from our region using Pearson's r statistic. Funnel plots were used to evaluate the dataset for outliers. Results Surgical scale up would result in perioperative mortality contributing on average to 3.3% of all national crude mortality. This prediction assumes POMR stays the same, which is challenging to predict. In our region countries that achieved the LCoGS target ( n = 5) had a lower POMR than countries that did not ( n = 8). Conclusions Surgical volumes in the South Pacific region must increase to meet the LCoGS target. Postoperative mortality as a proportion of all mortality may increase with the surgical scale up, however, the overall number of premature deaths is expected to reduce with better access to timely and safe surgical care.