Global shortcomings in life-saving surgery highlighted

The world is far off-track in meeting targets for safe and affordable surgical care for all. This is contained in a study with contributions from the University of Cape Town’s (UCT) Professor Bruce Biccard at the Department of Anaesthesia and Perioperative Medicine.

Professor Biccard is one of 60 health experts across 20 countries behind the study titled “Surgical Health Policy 2025–2035: Strengthening Essential Services for Tomorrow’s Needs”. UCT is therefore at the forefront of a major international drive to address the global surgical care crisis that is leaving over 160 million people without access to life-saving procedures each year.

The research, which was published in The Lancet and led by the University of Birmingham’s NIHR Global Health Research Unit on Global Surgery, reveals that low- and middle-income countries (LMICs) carry the heaviest burden to provide safe and affordable surgical care for all.

“We must prepare surgical systems for an increasingly unpredictable world.”

“As an example, sub-Saharan Africa has the largest gap between demand and capacity to provide caesarean sections, despite this being the most common operation in Africa. Surgery is a key contributor to antimicrobial resistance [AMR], with up to 96% of infected wounds in LMICs being linked to AMR,” said Biccard.

The study found that only 26% of LMICs are on track to meet the global target for patients to access essential surgery within two hours. No country in this group is achieving the recommended surgical volume of 5 000 procedures per 100 000 people per year.

Innovative funding models

Other areas of concern include the fact that 3.5 million adults die within 30 days of surgery every year, more than HIV/AIDS, tuberculosis, and malaria combined. Furthermore, 50 million patients worldwide experience postoperative complications annually, surgical site infections are the most common issue, and AMR is a rising threat.

Authors also advanced critical government and health system interventions, which include developing innovative funding models for surgery; currently, half of the patients undergoing cancer surgery in LMICs make out-of-pocket payments, which can result in catastrophic expenditure and poverty, as well as focusing efforts on making surgical services more resilient to future emergencies, including pandemics, climate change, natural disasters, and armed conflict.

“We must continue to secure funding to expand access to surgery while maintaining quality.”

The report links surgical access directly to progress on several Sustainable Development Goals (SDGs), including improved health, stronger economies and national stability.

“We must continue to secure funding to expand access to surgery while maintaining quality. At the same time, we must prepare surgical systems for an increasingly unpredictable world. Pandemics, climate change, and armed conflict all threaten to disrupt care in the future, but most countries have made little progress in their preparedness since the COVID-19 pandemic,” co-lead author, Dr Dmitri Nepogodiev, from the University of Birmingham said.