title: Evaluation of surgical care in El Salvador using the WHO surgical vital statistics.
abstract: OBJECTIVE
  Vital statistics to assess surgical care worldwide have been published by the World Health Organization. These data have not been reported for any Latin American country. We sought to measure these metrics as a starting point for understanding how to improve the safety of surgery in El Salvador.
  
  
  METHODS
  We designed an institutional survey that was sent to 21 hospitals and used national administrative data sources to estimate the number of surgeons, anesthesia professionals, operating rooms, and annual surgical volume for El Salvador. We reviewed surgical and death logs for 12 Ministry of Health hospitals to calculate day-of-surgery and postoperative in-hospital mortality ratios for a 6-month period (October 2009-March 2010).
  
  
  RESULTS
  We estimate there to be 1,222 surgeons [95 % confidence interval (CI) 1,137-1,307], 539 anesthesia providers, 168 operating rooms (95 % CI 136-199), and 172,972 operations (95 % CI 171,961-173,983) annually in El Salvador. There were on average 1,197 annual cases per operating room and 436 annual cases per surgeon in the 21 hospitals we studied. The day-of-surgery mortality ratio was 0.42 % (95 % CI 0.35-0.5), whereas the postoperative in-hospital mortality ratio was 1.58 % (95 % CI 1.44-1.72). The postoperative in-hospital mortality ratio was higher for hospitals with a greater number of hospital beds (p = 0.01) and operating rooms (p = 0.02).
  
  
  CONCLUSIONS
  Despite the challenges that El Salvador faces to provide surgical care, national collection of surgical vital statistics is feasible. Collection of additional process and outcome measures may be insightful for improving the surgical safety in El Salvador and elsewhere.
authors.affiliation: Harvard Medical School, Boston, MA, USA. gmolina@partners.org
authors.forename: George
authors.initials: G
authors.lastname: Molina
authors.forename: Luke M
authors.initials: LM
authors.lastname: Funk
authors.forename: Virginia
authors.initials: V
authors.lastname: Rodriguez
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Atul
authors.initials: A
authors.lastname: Gawande
mesh_terms: D004544:El Salvador / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D013514:Surgical Procedures, Operative / Q000401:mortality* / Q000592:standards*; D011795:Surveys and Questionnaires; D014798:Vital Statistics; D014944:World Health Organization