title: The burden of waiting: DALYs accrued from delayed access to pediatric surgery in Kenya and Canada.
abstract: BACKGROUND
  Disability-adjusted life years (DALYs) have become the standard metric for estimating burden of disease (BoD), but have not yet been applied to delayed access to surgical procedures. This study estimates the DALYs accrued from delayed access to surgical care in two pediatric surgical units in Kenya and Canada.
  
  
  METHODS
  Records of operations for 13 congenital health states in a Kenyan and a Canadian hospital were prospectively collected for 2012. DALYs caused by delayed presentation were estimated using disability weights and ideal and actual age at surgery.
  
  
  RESULTS
  1208 first-time procedures in general surgery, neurosurgery, plastic surgery, and urology were included. Delays were longest in general surgery and longer in Kenya than in Canada in all specialties. The longest delays in Kenya were for orchidopexy (72 months) and anorectoplasty (PSARP) (74 months), and in Canada for orchidopexy (40 months). Corresponding total delayed BoD was highest in general surgery and neurosurgery and higher again in Kenya than in Canada (484 cf. 84 DALYs).
  
  
  CONCLUSIONS
  Estimating BoD resulting from delayed surgery is feasible and reflects both late presentation and limited access to care. Further exploration of these factors can make delayed DALYs a useful measure of health care coverage and waitlist prioritization.
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada L8S 4K1; BethanyKids at Myung Sung Christian Medical Center, Addis Ababa, Ethiopia. Electronic address: dpoenaru@gmail.com.
authors.forename: Dan
authors.initials: D
authors.lastname: Poenaru
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada L8S 4K1; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, Ontario, Canada L8S 4K1.
authors.forename: Julia
authors.initials: J
authors.lastname: Pemberton
authors.affiliation: McMaster Pediatric Surgery Research Collaborative, Department of Surgery, McMaster University, Hamilton, Ontario, Canada L8S 4K1; McMaster Children's Hospital, Hamilton Health Sciences, Hamilton, Ontario, Canada L8N 3Z5.
authors.forename: Brian H
authors.initials: BH
authors.lastname: Cameron
mesh_terms: D002170:Canada / Q000453:epidemiology; D000013:Congenital Abnormalities / Q000401:mortality / Q000601:surgery*; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007630:Kenya / Q000453:epidemiology; D008297:Male; D019057:Quality-Adjusted Life Years; D013514:Surgical Procedures, Operative / Q000401:mortality*; D014850:Waiting Lists / Q000401:mortality*
keywords: Burden of disease; Congenital anomalies; Disability weights; Health state valuation; Waiting times