Henry Jaymie Ang, Bem Chris, Grimes Caris, Borgstein Eric, Mkandawire Nyengo, Thomas William E G, Gunn S William A, Lane Robert H S, Cotton Michael H
International Collaboration for Essential Surgery (ICES), New York, USA.
World J Surg. 2015 Apr;39(4):822-32. doi: 10.1007/s00268-014-2937-9.
Very little surgical care is performed in low- and middle-income countries (LMICs). An estimated two billion people in the world have no access to essential surgical care, and non-surgeons perform much of the surgery in remote and rural areas. Surgical care is as yet not recognized as an integral aspect of primary health care despite its self-demonstrated cost-effectiveness. We aimed to define the parameters of a public health approach to provide surgical care to areas in most need.
Consensus meetings were held, field experience was collected via targeted interviews, and a literature review on the current state of essential surgical care provision in Sub-Saharan Africa (SSA) was conducted. Comparisons were made across international recommendations for essential surgical interventions and a consensus-driven list was drawn up according to their relative simplicity, resource requirement, and capacity to provide the highest impact in terms of averted mortality or disability.
Essential Surgery consists of basic, low-cost surgical interventions, which save lives and prevent life-long disability or life-threatening complications and may be offered in any district hospital. Fifteen essential surgical interventions were deduced from various recommendations from international surgical bodies. Training in the realm of Essential Surgery is narrow and strict enough to be possible for non-physician clinicians (NPCs). This cadre is already active in many SSA countries in providing the bulk of surgical care.
A basic package of essential surgical care interventions is imperative to provide structure for scaling up training and building essential health services in remote and rural areas of LMICs. NPCs, a health cadre predominant in SSA, require training, mentoring, and monitoring. The cost of such training is vastly more efficient than the expensive training of a few polyvalent or specialist surgeons, who will not be sufficient in numbers within the next few generations. Moreover, these practitioners are used to working in the districts and are much less prone to gravitate elsewhere. The use of these NPCs performing "Essential Surgery" is a feasible route to deal with the almost total lack of primary surgical care in LMICs.
低收入和中等收入国家（LMICs）开展的外科护理极少。据估计，全球有20亿人无法获得基本外科护理，在偏远和农村地区，大部分手术由非外科医生实施。尽管外科护理已证明自身具有成本效益，但尚未被视为初级卫生保健的一个组成部分。我们旨在确定一种公共卫生方法的参数，以便为最需要的地区提供外科护理。
召开了共识会议，通过有针对性的访谈收集实地经验，并对撒哈拉以南非洲（SSA）基本外科护理的现状进行了文献综述。对基本外科干预措施的国际建议进行了比较，并根据其相对简单性、资源需求以及在避免死亡或残疾方面产生最大影响的能力，制定了一份由共识驱动的清单。
基本外科手术包括基本的低成本外科干预措施，这些措施可挽救生命、预防终身残疾或危及生命的并发症，并且可在任何地区医院进行。从国际外科机构的各种建议中推导出了15项基本外科干预措施。基本外科领域的培训范围狭窄且严格，非医师临床医生（NPCs）也有可能接受培训。这一群体已在许多撒哈拉以南非洲国家积极提供大部分外科护理。
一套基本的外科护理干预措施对于在低收入和中等收入国家的偏远和农村地区扩大培训规模及建设基本卫生服务体系至关重要。NPCs是撒哈拉以南非洲占主导地位的卫生群体，需要培训、指导和监督。这种培训的成本比培训少数全能或专科外科医生的高昂成本效率高得多，而在未来几代人中，这些专科外科医生的数量也将不足。此外，这些从业者习惯在地区工作，不太容易流向其他地方。利用这些NPCs开展“基本外科手术”是应对低收入和中等收入国家几乎完全缺乏初级外科护理的可行途径。
