Surgical need in an aging population: A cluster-based household survey in Nepal.
BACKGROUND
With an aging global population comes an obligate and substantial burden of noncommunicable disease, especially in low- and middle-income countries. An unknown proportion of this burden is treatable with surgical expertise. For health system planning, this study aimed to estimate the operative needs of individuals older than 50 of age years in Nepal.


METHODS
A 2-stage, cluster randomized, community-based survey was performed in Nepal using the validated Surgeons OverSeas Surgical Assessment Survey (SOSAS). SOSAS collects household demographics and selects household members randomly for verbal, head-to-toe examinations for surgical conditions; moreover, SOSAS also completes a verbal autopsy for deaths in the preceding year. Only respondents older than 50 years were included in the analysis.


RESULTS
The survey sampled 1,350 households, totaling 2,695 individuals (97% response rate). Of these, 273 surgical conditions were reported by 507 persons ages ≥ 50 years. Extrapolating, there are potentially 2.1 million people older than 50 years of age with surgically treatable conditions who need care in Nepal (95% confidence interval 1.8-2.4 million; 46,000-62,600 per 100,000 persons). One in 5 deaths was potentially treatable or palliated by surgical care. Although growths or masses (including hernias and goiters) were the surgical condition reported most commonly (25%), injuries and fractures also were common and associated with the greatest disability. Literacy and distance to secondary and tertiary health facilities were associated with lack of care for operative conditions (P < .05).


CONCLUSIONS
There is a large, unmet surgical need among the elderly in Nepal. Low literacy and distance from a capable health facility are the greatest barriers to care. As the global population ages, there is an increasing need to improve surgical services and strengthen health systems to care for this group.
Department of Surgery, University of Washington, Seattle, WA. Electronic address: stewarb@uw.edu.
Barclay T
BT
Stewart
Surgeons OverSeas (SOS), New York, NY; Centre for Global Surgery, McGill University Health Centre, Montreal, QC, Canada.
Evan
E
Wong
Surgeons OverSeas (SOS), New York, NY; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.
Shailvi
S
Gupta
Manipal College of Medical Sciences, Pokhara, Nepal.
Santosh
S
Bastola
Department of Surgery, Nepal Medical College, Kathmandu, Nepal.
Sunil
S
Shrestha
Surgeons OverSeas (SOS), New York, NY; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Surgery, Columbia University, New York, NY.
Adam L
AL
Kushner
Surgeons OverSeas (SOS), New York, NY; Department of Pediatric Surgery, Nationwide Children's Hospital, Columbus, OH.
Benedict C
BC
Nwomeh
D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009390:Nepal; D013514:Surgical Procedures, Operative