title: Proposed Minimum Rates of Surgery to Support Desirable Health Outcomes: An Observational Study Based on Three Strategies.
abstract: BACKGROUND
  The global volume of surgery is estimated at 312.9 million operations annually, but rates of surgery vary dramatically. Identifying surgical rates associated with improved health outcomes would be useful for benchmarking and targeted health system strengthening.
  
  
  METHODS
  We identified rates of surgery associated with a life expectancy (LE) of 74-75 years, a maternal mortality ratio (MMR) of less than or equal to 100 per 100,000 live births, and the estimated need for surgery in the seven global burden of disease (GBD) super-regions based on the prevalence of surgical conditions. We compared our findings to surgical rates from Chile, China, Costa Rica, and Cuba ("4C"), countries with moderate resources but high health outcomes.
  
  
  RESULTS
  The median surgical rates associated with LE of 74-75 years (N = 17) and MMR below 100 (N = 109) are 4392 (IQR 2897-4873) and 5028 (IQR 4139-6778) operations per 100,000 people annually, respectively. The mean surgical rate estimated for the seven super-regions was 4723 (95% CI 3967-5478) operations per 100,000 people annually. The "4C" countries had a mean surgical rate of 4344 (95% CI 2620-6068) operations per 100,000 people annually. Thirteen of the twenty-one GBD regions, accounting for 78% of the world's population, do not achieve rates of surgery at the lowest end of this range.
  
  
  CONCLUSIONS
  We identified a narrow range of surgical rates associated with important health indicators. This target range can be used for benchmarking of surgical services, and as part of a policy aimed at strengthening health care systems and surgical capacity.
authors.affiliation: Department of Surgery, Stanford University Medical Center, 300 Pasteur Drive, S067, H-3691, Stanford, CA, 94305, USA, mesquive@stanford.edu.
authors.forename: Micaela M
authors.initials: MM
authors.lastname: Esquivel
authors.forename: George
authors.initials: G
authors.lastname: Molina
authors.forename: Tarsicio
authors.initials: T
authors.lastname: Uribe-Leitz
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: John
authors.initials: J
authors.lastname: Rose
authors.forename: Stephen
authors.initials: S
authors.lastname: Bickler
authors.forename: Atul A
authors.initials: AA
authors.lastname: Gawande
authors.forename: Alex B
authors.initials: AB
authors.lastname: Haynes
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Weiser
mesh_terms: D019985:Benchmarking; D002677:Chile; D002681:China; D003364:Costa Rica; D003462:Cuba; D003695:Delivery of Health Care / Q000592:standards*; D005260:Female; D014943:Global Health; D006801:Humans; D008017:Life Expectancy; D050498:Live Birth; D008428:Maternal Mortality; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*