From the Royal Australasian College of Surgeons, Melbourne, Victoria, Australia.
University Hospital Geelong, Geelong, Victoria, Australia.
Anesth Analg. 2018 Apr;126(4):1329-1339. doi: 10.1213/ANE.0000000000002771.
Progress in achieving "universal access to safe, affordable surgery, and anesthesia care when needed" is dependent on consensus not only about the key messages but also on what metrics should be used to set goals and measure progress. The Lancet Commission on Global Surgery not only achieved consensus on key messages but also recommended 6 key metrics to inform national surgical plans and monitor scale-up toward 2030. These metrics measure access to surgery, as well as its timeliness, safety, and affordability: (1) Two-hour access to the 3 Bellwether procedures (cesarean delivery, emergency laparotomy, and management of an open fracture); (2) Surgeon, Anesthetist, and Obstetrician workforce >20/100,000; (3) Surgical volume of 5000 procedures/100,000; (4) Reporting of perioperative mortality rate; and (5 and 6) Risk rates of catastrophic expenditure and impoverishment when requiring surgery. This article discusses the definition, validity, feasibility, relevance, and progress with each of these metrics. The authors share their experience of introducing the metrics in the Pacific and sub-Saharan Africa. We identify appropriate messages for each potential stakeholder-the patients, practitioners, providers (health services and hospitals), public (community), politicians, policymakers, and payers. We discuss progress toward the metrics being included in core indicator lists by the World Health Organization and the World Bank and how they have been, or may be, used to inform National Surgical Plans in low- and middle-income countries to scale-up the delivery of safe, affordable, and timely surgical and anesthesia care to all who need it.
实现“普遍获得安全、负担得起的手术和麻醉护理”的进展不仅取决于对关键信息的共识，还取决于应该使用哪些指标来设定目标和衡量进展。《柳叶刀全球手术委员会》不仅就关键信息达成了共识，还建议了 6 项关键指标，以指导国家手术计划，并监测 2030 年之前的扩大规模情况。这些指标衡量了手术的可及性，以及其及时性、安全性和可负担性：（1）在 2 小时内获得 3 项基准手术（剖宫产、紧急剖腹手术和开放性骨折处理）；（2）外科医生、麻醉师和产科医生的劳动力>20/100000；（3）手术量为 5000 例/100000；（4）报告围手术期死亡率；以及（5 和 6）需要手术时发生灾难性支出和贫困的风险率。本文讨论了这些指标的定义、有效性、可行性、相关性和进展情况。作者分享了他们在太平洋和撒哈拉以南非洲引入这些指标的经验。我们为每个潜在利益相关者（患者、从业者、提供者（卫生服务和医院）、公众（社区）、政治家、政策制定者和付款人）确定了适当的信息。我们讨论了这些指标被世界卫生组织和世界银行列入核心指标清单的进展情况，以及它们如何被用来为中低收入国家的国家手术计划提供信息，以扩大安全、负担得起且及时的手术和麻醉护理的提供，以满足所有有需要的人。
