Department of Public Health, University of California, San Diego, CA, USA.
World J Surg. 2013 Nov;37(11):2507-11. doi: 10.1007/s00268-013-2182-7.
In recent years, surgical providers and advocates have engaged in a growing effort to establish metrics to estimate capacity for surgical services as well the burden of surgical diseases in resource-limited settings. The burden of disease (BoD) studies have established the disability-adjusted life year (DALY) as the primary metric to measure both disability and premature mortality. Nonetheless, DALY-based approaches present methodological challenges, some of which are unique to surgical conditions, not fully addressed through the multiple iterations of the BoD studies, including the most recent study.
This paper examines these challenges in detail, including issues around age-weighting and discounting, and estimates of disability-weights for specific conditions. Surgical burden measurements of specific conditions, or through the assessment of hospital wards as platforms for service delivery, still have unresolved methodological hurdles. The 2010 BoD study addresses some of these issues, but many questions still remain. Other methods estimating surgical prevalence, backlogs in treatment, and disability incurred by delays in care may provide more practical approaches to disease burden that can be useful tools for clinicians and health advocates.
These approaches warrant further exploration in LMICs and these debates require active engagement by surgical providers and advocates globally.
近年来，外科医生和倡导者一直在努力建立衡量标准，以估计资源有限环境下外科服务能力和外科疾病负担。疾病负担（BoD）研究已经确定了残疾调整生命年（DALY）作为衡量残疾和过早死亡的主要指标。然而，基于 DALY 的方法存在方法学挑战，其中一些是外科疾病特有的，尚未通过 BoD 研究的多次迭代（包括最近的研究）完全解决，包括年龄加权和贴现问题，以及特定条件的残疾权重估计。特定疾病的外科负担测量，或通过评估医院病房作为服务提供平台，仍然存在未解决的方法学障碍。2010 年 BoD 研究解决了其中的一些问题，但仍有许多问题悬而未决。其他估计手术流行率、治疗积压以及因延迟治疗而导致的残疾的方法可能为疾病负担提供更实用的方法，这些方法可能是临床医生和卫生倡导者的有用工具。
这些方法值得在中低收入国家进一步探讨，这些争论需要全球外科医生和倡导者的积极参与。
