Identifying a Basket of Surgical Procedures to Standardize Global Surgical Metrics: An International Delphi Study

Annals of Surgery, Volume 274, No. 6, Year 2021

Interpretation

AI Digest

Study Justification:

The objective of this study was to establish a globally applicable list of surgical procedures, referred to as a “basket,” that can serve as a representation of a health system’s ability to provide surgical care. This is important because current indicators for assessing access to safe and timely surgical care lack clarity and focus on a limited range of procedures. By defining a standardized basket of surgical procedures, this study aims to improve the comparability and measurement of surgical capacity globally.

Highlights:

– The study conducted a three-round international expert Delphi exercise involving 331 respondents from 78 countries.
– The final basket of surgical procedures consists of 32 procedures representing various disease categories, including trauma, cancer, congenital anomalies, maternal/reproductive health, aging, and infection.
– These procedures were selected based on their importance in treating common conditions, well-defined nature, and significant clinical or functional benefits.
– The identified surgical basket provides a more standardized and comprehensive assessment of a country’s surgical system.
– Ongoing monitoring and evaluation using this basket can help improve and strengthen surgery and anesthesia care globally.

Recommendations:

– Implement the use of the identified basket of surgical procedures to assess surgical capacity in countries.
– Conduct further testing and refinement of the basket to ensure its accuracy and applicability across different healthcare settings.
– Use the basket as a guide for ongoing monitoring and evaluation of global surgery capacities.
– Strengthen surgical and anesthesia care by addressing gaps identified through the assessment using the surgical basket.

Key Role Players:

– Surgeons and surgical specialists
– Anesthesiologists
– Healthcare policymakers and administrators
– Public health officials
– Researchers and academics in the field of surgery and healthcare

Cost Items for Planning Recommendations:

– Training and education programs for healthcare professionals to ensure accurate implementation of the surgical basket assessment.
– Data collection and analysis tools and software.
– Research and evaluation activities to refine and improve the surgical basket.
– Development and implementation of policies and guidelines based on the assessment findings.
– Infrastructure and equipment upgrades to support improved surgical and anesthesia care.
– Collaboration and coordination efforts among healthcare institutions and organizations for effective implementation of the recommendations.

Strength of Evidence

N/A

Abstract

Objective:We aimed to define a globally applicable list of surgical procedures, or “basket,”which could represent a health system’s capacity to provide surgical care and standardize global surgical measurement.Summary of Background Data:Six indicators have been proposed to assess access to safe, affordable, timely surgical and anesthesia care, with a focus on laparotomy, cesarean section, and treatment of open fracture. However, comparability, particularly for these procedures, has been limited by a lack of definitional clarity and their overly broad scope.Methods:We conducted a 3 round international expert Delphi exercise between April and June 2019 using REDCap to identify a set of procedures representative of surgical capacity. To be included, procedures had to be important for treating common conditions, well-defined, and impactful (ie, well-recognized clinical or functional benefit). Procedures were eliminated or prioritized in each round, and those noted as “extremely”or “very important”by ≥50% of respondents in round 3 were included in the final “basket.”Results:Altogether 331 respondents from 78 countries participated in the Delphi process. A final basket of 32 procedures representing disease categories in trauma, cancer, congenital anomalies, maternal/reproductive health, aging, and infection were identified for inclusion to assess surgical capacity.Conclusions:This surgical basket facilitates a more standardized assessment of a country’s surgical system. Further testing and refinement will likely be needed, but this basket can be used immediately to guide ongoing monitoring and evaluation of global surgery capacities to improve and strengthen surgery and anesthesia care.

Materials

N/A

Innovations

The innovation described in the title and description is the development of a globally applicable list of surgical procedures, or “basket,” to standardize global surgical metrics. This innovation aims to improve access to maternal health by providing a standardized assessment of a country’s surgical system, which can guide ongoing monitoring and evaluation of global surgery capacities to improve and strengthen surgery and anesthesia care.

AI Innovations Description

The recommendation described in the provided information is to develop a globally applicable list of surgical procedures, or a “basket,” that can represent a health system’s capacity to provide surgical care. This recommendation aims to standardize global surgical measurement and improve access to maternal health.

The process involved conducting a three-round international expert Delphi exercise to identify a set of procedures that are representative of surgical capacity. The criteria for inclusion were that the procedures had to be important for treating common conditions, well-defined, and impactful in terms of clinical or functional benefit. Procedures were eliminated or prioritized in each round, and those considered “extremely” or “very important” by at least 50% of respondents in the final round were included in the final “basket.”

In total, 331 respondents from 78 countries participated in the Delphi process, resulting in a final basket of 32 procedures representing disease categories in trauma, cancer, congenital anomalies, maternal/reproductive health, aging, and infection. This basket of procedures can be used to assess surgical capacity and guide ongoing monitoring and evaluation of global surgery capacities to improve and strengthen surgery and anesthesia care.

It is important to note that further testing and refinement may be needed for this surgical basket, but it can be used immediately to guide efforts in improving access to maternal health and strengthening surgical and anesthesia care globally.

AI Innovations Methodology

The study titled “Identifying a Basket of Surgical Procedures to Standardize Global Surgical Metrics: An International Delphi Study” aims to define a globally applicable list of surgical procedures that can represent a health system’s capacity to provide surgical care and standardize global surgical measurement. The focus of the study is on laparotomy, cesarean section, and treatment of open fracture, which are important procedures for maternal health.

The methodology used in this study is a 3-round international expert Delphi exercise conducted between April and June 2019. The exercise involved 331 respondents from 78 countries. The Delphi process used the REDCap platform to gather input from experts. The goal was to identify a set of procedures that are representative of surgical capacity and meet certain criteria. These criteria include being important for treating common conditions, well-defined, and impactful in terms of clinical or functional benefit.

In each round of the Delphi exercise, procedures were eliminated or prioritized based on the input from the experts. In the final round, procedures that were noted as “extremely” or “very important” by at least 50% of the respondents were included in the final “basket” of surgical procedures. The final basket consisted of 32 procedures representing disease categories in trauma, cancer, congenital anomalies, maternal/reproductive health, aging, and infection.

The study concludes that this surgical basket can facilitate a more standardized assessment of a country’s surgical system. It can be used to guide ongoing monitoring and evaluation of global surgery capacities, with the aim of improving and strengthening surgery and anesthesia care. Further testing and refinement may be needed to ensure the accuracy and effectiveness of this basket of surgical procedures.

Authors & Co-Authors

Statistics:

Citations: 8

Authors: 9

Identifiers:

DOI: 10.1097/SLA.0000000000004611

ISSN: 00034932

Research Areas:

Cancer, Health System and Policy, Maternal and Child Health, Quality of Care, Sexual and Reproductive Health

Study Countries:

Mali