title: Projections for Achieving the Lancet Commission Recommended Surgical Rate of 5000 Operations per 100,000 Population by Region-Specific Surgical Rate Estimates.
abstract: BACKGROUND
  We previously identified a range of 4344-5028 annual operations per 100,000 people to be related to desirable health outcomes. From this and other evidence, the Lancet Commission on Global Surgery recommends a minimum rate of 5000 operations per 100,000 people. We evaluate rates of growth and estimate the time it will take to reach this minimum surgical rate threshold.
  
  
  METHODS
  We aggregated country-level surgical rate estimates from 2004 to 2012 into the twenty-one Global Burden of Disease (GBD) regions. We calculated mean rates of surgery proportional to population size for each year and assessed the rate of growth over time. We then extrapolated the time it will take each region to reach a surgical rate of 5000 operations per 100,000 population based on linear rates of change.
  
  
  RESULTS
  All but two regions experienced growth in their surgical rates during the past 8 years. Fourteen regions did not meet the recommended threshold in 2012. If surgical capacity continues to grow at current rates, seven regions will not meet the threshold by 2035. Eastern Sub-Saharan Africa will not reach the recommended threshold until 2124.
  
  
  CONCLUSIONS
  The rates of growth in surgical service delivery are exceedingly variable. At current rates of surgical and population growth, 6.2 billion people (73% of the world's population) will be living in countries below the minimum recommended rate of surgical care in 2035. A strategy for strengthening surgical capacity is essential if these targets are to be met in a timely fashion as part of the integrated health system development.
authors.affiliation: Department of Surgery, Stanford University, School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA, pturibe@stanford.edu.
authors.forename: Tarsicio
authors.initials: T
authors.lastname: Uribe-Leitz
authors.forename: Micaela M
authors.initials: MM
authors.lastname: Esquivel
authors.forename: George
authors.initials: G
authors.lastname: Molina
authors.forename: Stuart R
authors.initials: SR
authors.lastname: Lipsitz
authors.forename: Stéphane
authors.initials: S
authors.lastname: Verguet
authors.forename: John
authors.initials: J
authors.lastname: Rose
authors.forename: Stephen W
authors.initials: SW
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: D000349:Africa; D000569:Americas; D001208:Asia; D057191:Capacity Building; D003695:Delivery of Health Care / Q000458:organization & administration / Q000639:trends*; D005060:Europe; D005544:Forecasting; D006801:Humans; D044349:Oceania; D011156:Population Density; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data / Q000639:trends*; D013997:Time Factors