Institute for Evidence-Based Healthcare, Faculty of Health Sciences and Medicine, Bond University, Gold Coast, Australia.
Medicine & Health Sciences Faculty, Department of Medicine, An-Najah National University, Nablus, Palestine.
JAMA Netw Open. 2023 Nov 1;6(11):e2342215. doi: 10.1001/jamanetworkopen.2023.42215.
Overuse of surgical procedures is increasing around the world and harms both individuals and health care systems by using resources that could otherwise be allocated to addressing the underuse of effective health care interventions. In low- and middle-income countries (LMICs), there is some limited country-specific evidence showing that overuse of surgical procedures is increasing, at least for certain procedures.
To assess factors associated with, extent and consequences of, and potential solutions for low-value surgical procedures in LMICs.
We searched 4 electronic databases (PubMed, Embase, PsycINFO, and Global Index Medicus) for studies published from database inception until April 27, 2022, with no restrictions on date or language. A combination of MeSH terms and free-text words about the overuse of surgical procedures was used. Studies examining the problem of overuse of surgical procedures in LMICs were included and categorized by major focus: the extent of overuse, associated factors, consequences, and solutions.
Of 4276 unique records identified, 133 studies across 63 countries were included, reporting on more than 9.1 million surgical procedures (median per study, 894 [IQR, 97-4259]) and with more than 11.4 million participants (median per study, 989 [IQR, 257-6857]). Fourteen studies (10.5%) were multinational. Of the 119 studies (89.5%) originating from single countries, 69 (58.0%) were from upper-middle-income countries and 30 (25.2%) were from East Asia and the Pacific. Of the 42 studies (31.6%) reporting extent of overuse of surgical procedures, most (36 [85.7%]) reported on unnecessary cesarean delivery, with estimated rates in LMICs ranging from 12% to 81%. Evidence on other surgical procedures was limited and included abdominal and percutaneous cardiovascular surgical procedures. Consequences of low-value surgical procedures included harms and costs, such as an estimated US $3.29 billion annual cost of unnecessary cesarean deliveries in China. Associated factors included private financing, and solutions included social media campaigns and multifaceted interventions such as audits, feedback, and reminders.
This systematic review found growing evidence of overuse of surgical procedures in LMICs, which may generate significant harm and waste of limited resources; the majority of studies reporting overuse were about unnecessary cesarean delivery. Therefore, a better understanding of the problems in other surgical procedures and a robust evaluation of solutions are needed.
全球范围内手术程序的过度使用正在增加，通过使用本可以用于解决有效医疗干预措施使用不足的资源，对个人和医疗保健系统都造成了伤害。在低收入和中等收入国家（LMICs），有一些有限的特定于国家的证据表明，至少对于某些程序，手术程序的过度使用正在增加。
评估 LMICs 中低价值手术程序过度使用的相关因素、程度和后果，以及潜在的解决方案。
我们在四个电子数据库（PubMed、Embase、PsycINFO 和 Global Index Medicus）中搜索了从数据库成立到 2022 年 4 月 27 日发表的研究，对日期和语言没有任何限制。使用了与手术程序过度使用相关的 MeSH 术语和自由文本词的组合。纳入了研究 LMICs 中手术程序过度使用问题的研究，并按主要重点进行分类：过度使用的程度、相关因素、后果和解决方案。
在 4276 条独特记录中，有 133 项来自 63 个国家的研究被纳入，报告了超过 910 万例手术（中位数/研究，894 [IQR，97-4259]）和超过 1140 万参与者（中位数/研究，989 [IQR，257-6857]）。有 14 项研究（10.5%）是跨国的。在 119 项（89.5%）来自单一国家的研究中，有 69 项（58.0%）来自中上收入国家，30 项（25.2%）来自东亚和太平洋地区。在 42 项（31.6%）报告手术程序过度使用程度的研究中，大多数（36 [85.7%]）报告了不必要的剖腹产，估计 LMICs 的剖腹产率在 12%至 81%之间。关于其他手术程序的证据有限，包括腹部和经皮心血管手术程序。低价值手术程序的后果包括伤害和成本，例如中国每年不必要的剖腹产造成的估计 32.9 亿美元的成本。相关因素包括私人融资，解决方案包括社交媒体活动和多方面的干预措施，如审计、反馈和提醒。
本系统评价发现，LMICs 中手术程序过度使用的证据不断增加，这可能会产生重大伤害和浪费有限资源；大多数报告过度使用的研究都是关于不必要的剖腹产。因此，需要更好地了解其他手术程序中的问题，并对解决方案进行强有力的评估。
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