title: The role of facility-based surgical services in addressing the national burden of disease in New Zealand: An index of surgical incidence based on country-specific disease prevalence.
abstract: BACKGROUND
  Surgery is a crucial component of health systems, yet its contribution has been difficult to define. We linked national hospital service utilization with national epidemiologic data to describe the use of surgical procedures in the management of a broad spectrum of conditions.
  
  
  METHODS
  We compiled International Classification of Diseases-10-Australian Modification codes from the New Zealand National Minimum Dataset, 2008-2011. Using primary cause of admission, we aggregated hospitalizations into 119 disease states and 22 disease subcategories of the World Health Organization Global Health Estimate (GHE). We queried each hospitalization for any surgical procedure in a binary manner to determine the volume of surgery for each disease state. Surgical procedures were defined as requiring general or neuroaxial anesthesia. We then divided the volume of surgical cases by counts of disease prevalence from the Global Burden of Disease Study 2010 to determine annual surgical incidence.
  
  
  RESULTS
  Between 2008 and 2011, there were 1,108,653 hospital admissions with 275,570 associated surgical procedures per year. Surgical procedures were associated with admissions for all 22 GHE disease subcategories and 116 of 119 GHE disease states. The sub-categories with the largest surgical case volumes were Unintentional Injuries (48,073), Musculoskeletal Diseases (38,030), and Digestive Diseases (27,640). Surgical incidence ranged widely by individual disease states with the highest in: Other Neurological Conditions, Abortion, Appendicitis, Obstructed Labor, and Maternal Sepsis.
  
  
  CONCLUSIONS
  This study confirms that surgical care is required across the entire spectrum of GHE disease subcategories, illustrating a critical role in health systems. Surgical incidence might be useful as an index to estimate the need for surgical procedures in other populations.
authors.affiliation: Department of Population Health, University of Otago, Christchurch, New Zealand; Perioperative Mortality Review Committee, Health Quality and Safety Commission, New Zealand.
authors.forename: Phil
authors.initials: P
authors.lastname: Hider
authors.affiliation: Perioperative Mortality Review Committee, Health Quality and Safety Commission, New Zealand; Department of Anesthesia, Hutt Valley District Health Board, Lower Hutt, New Zealand.
authors.forename: Leona
authors.initials: L
authors.lastname: Wilson
authors.affiliation: Division of Pediatric Surgery, Rady Children's Hospital, University of California, San Diego, CA; Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA. Electronic address: jorose@ucsd.edu.
authors.forename: John
authors.initials: J
authors.lastname: Rose
authors.affiliation: Department of Surgery, Stanford University School of Medicine, Stanford, CA.
authors.forename: Thomas G
authors.initials: TG
authors.lastname: Weiser
authors.affiliation: National Trauma Research Institute, Monash University, Melbourne, Australia.
authors.forename: Russell
authors.initials: R
authors.lastname: Gruen
authors.affiliation: Division of Pediatric Surgery, Rady Children's Hospital, University of California, San Diego, CA.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Bickler
mesh_terms: D000208:Acute Disease / Q000453:epidemiology* / Q000628:therapy; D000328:Adult; D017281:Cost of Illness; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009520:New Zealand / Q000453:epidemiology; D015995:Prevalence; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*