Bakker Juul M, van Duinen Alex J, Patil Priti, Nathani Priyansh, Gyedu Adam, Adde Håvard A, Bhushan Pranav, Roy Nobhojit, Gadgil Anita, Bolkan Håkon A
Department of Public Health and Nursing, Norwegian University of Science and Technology (NTNU), Trondheim, Norway.
CapaCare, Trondheim, Norway.
Front Surg. 2025 Aug 15;12:1629828. doi: 10.3389/fsurg.2025.1629828. eCollection 2025.
The surgical volume indicator measures surgical activity within a population, but it does not fully untangle the details behind the statistical indicator. As health systems evolve and countries develop economically, the types of surgeries performed, providers, and levels of healthcare facilities may provide a richer understanding of changes in surgical activity. This research studied surgical activity in four diverse settings by analyzing initial data to assess trends in patient characteristics, surgical staff, case distribution, level of care, and anesthesia practices, forming the basis for a "surgical transition" framework.
We conducted a secondary analysis of surgical volume data from four studies in Sierra Leone, Liberia, Ghana, and India, to assess trends in surgical distribution. Descriptive statistics were used to compare surgical volumes by population subgroups, surgical providers, case distribution, level of care, and anesthesia.
Findings show that countries with higher GDP per capita had greater surgical volumes, more specialist providers, and a broader, more advanced case mix. Increases in surgical volume were most notable among older age groups, gender disparities in access diminished as systems developed. In lower-income settings, a large share of surgeries were cesarean sections or other procedures for women of reproductive age, while there were more surgeries in the older population in more advanced economies. The proportion of essential surgeries, including for example surgeries for obstetric complications, abdominal emergencies and injuries, remained stable between low- and lower-middle-income countries, decreasing only with further economic development. Specialist-performed procedures increased with economic growth, resulting in greater surgical variety and complexity.
Changes in surgical volume must be understood within the broader context of societal and economic development as well as the health system. The concept of "surgical transition" highlights how demographic and socioeconomic progress is reflected in the quantity, diversity, and complexity of surgical services. As countries advance, internal priorities, such as healthcare policies, financing, infrastructure, and service delivery mechanisms, also evolve. These factors influence surgical care delivery. Each phase of the surgical transition presents different challenges and needs. Recognizing the phase of surgical transition can help guide strategies and establish realistic interim targets for the global surgical indicators, making them more actionable tools for measuring progress and comparing systems.
手术量指标衡量的是特定人群中的手术活动情况，但它并不能完全厘清这一统计指标背后的详细情况。随着卫生系统的发展以及各国经济的增长，所开展的手术类型、手术提供者和医疗设施水平或许能让我们更深入地了解手术活动的变化。本研究通过分析初始数据，对四种不同环境下的手术活动进行了研究，以评估患者特征、手术人员、病例分布、护理水平和麻醉方式的变化趋势，从而形成了一个“手术转型”框架的基础。
我们对来自塞拉利昂、利比里亚、加纳和印度的四项研究中的手术量数据进行了二次分析，以评估手术分布的变化趋势。描述性统计用于比较不同人群亚组、手术提供者、病例分布、护理水平和麻醉方式的手术量。
研究结果表明，人均国内生产总值较高的国家手术量更大，专科手术提供者更多，病例组合更广泛、更复杂。手术量的增加在老年人群中最为显著，随着卫生系统的发展，手术可及性方面的性别差异有所减小。在低收入环境中，很大一部分手术是剖宫产或针对育龄妇女的其他手术，而在经济更发达的地区，老年人群的手术量更多。包括产科并发症、腹部急症和损伤手术等在内的基本手术比例在低收入国家和中低收入国家之间保持稳定，仅在经济进一步发展时才有所下降。随着经济增长，专科医生实施的手术增加，导致手术种类和复杂性更高。
必须在社会经济发展以及卫生系统的更广泛背景下理解手术量的变化。“手术转型”概念凸显了人口和社会经济进步如何体现在手术服务的数量、多样性和复杂性上。随着国家的发展，诸如医疗政策、融资、基础设施和服务提供机制等内部优先事项也在演变。这些因素会影响手术护理的提供。手术转型的每个阶段都面临不同的挑战和需求。认识到手术转型的阶段有助于指导战略制定，并为全球手术指标设定切实可行的中期目标，使其成为衡量进展和比较不同系统的更具可操作性的工具。
