中低收入国家手术量的测量：系统评价。

Measurements of Surgical Volume in Low- and Middle-Income Countries, a Systematic Review.

机构信息

Johns Hopkins University, Department of Surgery, 1800 Orleans St, Baltimore MD 21287, US.

Addis Ababa University, Department of Surgery, Cardiothoracic Unit, Zambia Street, Addis Ababa, ET.

出版信息

Ann Glob Health. 2023 Oct 11;89(1):70. doi: 10.5334/aogh.4251. eCollection 2023.

DOI:10.5334/aogh.4251

PMID:37841804

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10573813/

Abstract

BACKGROUND

Surgical volume is a surgical indicator that was described in the Lancet Commission on Global Surgery (LCoGS) and the World Bank World Development Indicators as an important metric for tracking the delivery of surgical care.

OBJECTIVES

We aimed to characterize the reports on surgical volume (SV) in the existing literature by using a systematic review to assess studies that examine surgical procedures as a ratio of a population (procedures/100,000 population).

METHODS

The PRISMA guideline was employed in the systematic review of articles that addressed the measurement of SV in low- and middle-income countries (LMICs), with the primary outcome of surgical procedures/100,000 population.

FINDINGS

The search result consisted of 6,657 preliminary studies. Following the title and abstract screening, 6,464 articles were excluded, and the remaining 193 were included in the full text review. From the full text review of the 193, only 26 of these articles defined SV as the ratio of number of procedures per population of the catchment/geographical area. The reported SV was a mean of 765, with an SD of 1260 operations per 100,000. The median SV was 180 (min = 0.900, max = 4470).

CONCLUSION

Our findings support the LCoGS assessment of the gap in surgical care. The target for SV is 5000 per 100,000 population, compared to the average of 765 per 100,000 population as found in this review. The challenges for assessing surgical volume gaps are vast, including the nature of written records, which limits SV reports to an absolute number of procedures per year without a reference to the catchment population. For the purpose of tracking SV, we recommend using proxies that account for the capacity of facilities to deliver care regardless of the catchment population.

摘要

背景

手术量是一个手术指标，在柳叶刀全球手术委员会（LCoGS）和世界银行世界发展指标中被描述为跟踪手术护理提供情况的一个重要指标。

目的

我们旨在通过系统评价来描述现有文献中关于手术量（SV）的报告，评估以人口为基数的手术比例（每 10 万人手术例数/手术例数）的研究。

方法

我们采用 PRISMA 指南对涉及中低收入国家（LMICs）SV 测量的文章进行系统评价，主要结局为每 10 万人手术例数。

发现

搜索结果包括 6657 篇初步研究。经过标题和摘要筛选，排除了 6464 篇文章，剩余的 193 篇文章进行了全文审查。在对这 193 篇文章进行全文审查后，只有 26 篇文章将 SV 定义为手术例数与服务人群/地理区域人口的比值。报告的 SV 平均值为 765，标准差为 1260 例/每 10 万人。中位数 SV 为 180（最小值=0.900，最大值=4470）。

结论

我们的研究结果支持 LCoGS 对手术护理差距的评估。SV 的目标值为每 10 万人 5000 例，而本综述中发现的平均每 10 万人 765 例。评估手术量差距的挑战是巨大的，包括书面记录的性质，这限制了 SV 报告为每年实施的绝对手术例数，而没有参考服务人群。为了跟踪 SV，我们建议使用代理指标，无论服务人群如何，都要考虑到医疗机构提供护理的能力。