Bellwether surgical procedures indicate access to surgical care in Ghana

Last Updated: 2016-06-30

By C. Vidya Shankar MD

NEW YORK (Reuters) - Data on three common surgical procedures -- open fracture repair, emergency laparotomy, and cesarean sections -- provide an estimate of overall availability of essential surgical care in Ghana, according to a new report.

More than three-fourths of first-level district hospitals could not perform these bellwether surgical procedures, while more than a third of the Ghanaians were unable to access essential surgical care within two hours, researchers reported online June 22 in JAMA Surgery.

"In Ghana, the study demonstrates that many people cannot access timely surgical care when needed, which leads to preventable deaths and disability," lead author Dr. Barclay Stewart from the University of Washington, Seattle, told Reuters Health by email.

"More broadly, the study is an example of how spatial analysis and surgical care capacity data can be synthesized to produce a more robust understanding of spatial access to care," he explained.

The World Bank's disease control priorities identified 44 common surgical procedures as essential. Though surgically treatable conditions account for nearly a sixth of the global disease burden, more than three-fourths of the global population does not have access to essential surgical care, the paper points out.

The research team validated the capacity of Ghana's 155 first-line district hospitals to perform the three surgical procedures and the proportion of population who are able to access this care within two hours.

They reviewed available surgical data and categorized hospitals into three groups: those performing none, 1-11, and 12 or more of each of these procedures during the year 2014. They then assessed if these numbers correlated with the hospitals performance of the complete list of 44 essential surgeries.

The proportion of population able to access essential surgical care within one to two hours was calculated using a cost-distance method, which determined the fastest route to the nearest first-level hospital from any location using spatial analysis software.

Of the 123 (79.4%) hospitals that responded, only four (3.3%) hospitals performed all of the three procedures on twelve or more occasions, 24 (19.5%) hospitals did so on 1-11 occasions, while 95 (77.2%) has no capability for these surgeries.

The hospitals who could carry out these three procedures also reported significantly greater procedure rates (p=0.03) for the 44 essential surgeries.

Only half of the population (49.8%) was within an hour and 71.4% with two hours travel to hospitals that performed the three bellwether procedures frequently. Based on their analysis they identified five hospitals that would benefit most from improvement to their surgical capabilities.

"Mapping potential geographic access is not synonymous with realized access or with good surgical outcomes," Drs. Andrew Leather, from King's College London, and Anna Dare, from St. Michael's Hospital, Toronto, Ontario, Canada, wrote in a related commentary. "A multitude of other nongeographic barriers can result in delays in seeking care," they pointed out.

"Bellwether capability is a useful metric for essential surgery more broadly," the researchers say.

Dr. Stewart concluded, "The findings from this and future studies can inform decisions regarding targeted capacity development initiatives, workforce postings, and pre-hospital care gaps, among other health system planning issues.

The Fogarty International Center funded this study. The authors made no disclosures.

SOURCE: http://bit.ly/296t2I8 and http://bit.ly/297Lp0w

JAMA Surg 2016.