Bellwether Procedures for Monitoring and Planning Essential Surgical Care in Low- and Middle-Income Countries: Caesarean Delivery, Laparotomy, and Treatment of Open Fractures

  title={Bellwether Procedures for Monitoring and Planning Essential Surgical Care in Low- and Middle-Income Countries: Caesarean Delivery, Laparotomy, and Treatment of Open Fractures},
  author={Kathleen M. O'Neill and Sarah L. M. Greenberg and Meena Nathan Cherian and Rowan D. Gillies and Kimberly M. Daniels and Nobhojit Roy and Nakul P. Raykar and Johanna N. Riesel and David Spiegel and David A K Watters and Russell Lindsay Gruen},
  journal={World Journal of Surgery},
BackgroundSurgical conditions represent a significant proportion of the global burden of disease, and therefore, surgery is an essential component of health systems. [] Key MethodFindingsThe ability to perform caesarean delivery, laparotomy, and treatment of open fracture was closely associated with performing all obstetric, general, basic, emergency, and orthopaedic procedures (p < 0.001) in the population that responded to the WHO SAT Survey. Procedures including cleft lip, cataract, and neonatal surgery…
Bellwethers versus Baskets: Operative Capacity and the Metrics of Global Surgery
  • T. Weiser
  • Medicine
    World Journal of Surgery
  • 2020
In this issue of the Journal, Truche and colleagues report on the postoperative mortality rate, or POMR, of the emergency Bellwether procedures in Brazil, and whether using a smaller sampling of operations can inform the understanding of post operative mortality throughout the country.
Evaluating the decision-to-delivery interval in category 1 emergency caesarean sections at a tertiary referral hospital
The study demonstrated that achieving a DDI of 30 minutes within the current organisational structure, institutional policies and staffing pattern is very rare, however, units should still benchmark against the internationally recommended 30-minute target as an indicator of unit efficiency and to improve quality of care.
Access delays to essential surgical care using the Three Delays Framework and Bellwether procedures at Timor Leste’s national referral hospital
Substantial delays were observed for all three stages and each Bellwether procedure in low/middle-income countries, although the actual reasons for delay may vary between regions and countries and would require a qualitative study.
Identifying a Basket of Surgical Procedures to Standardize Global Surgical Metrics
A globally applicable list of surgical procedures, or “basket,” which could represent a health system's capacity to provide surgical care and standardize global surgical measurement is defined to facilitate a more standardized assessment of a country's surgical system.
Assessment of surgical capacity in Chiapas, Mexico: a cross-sectional study of the public and private sector
Assessment of surgical capacity in Chiapas, Mexico finds capacity limitations are greater in public hospitals compared with private hospitals, however, the cost of care in the private sector is significantly higher than the public sector and may result in catastrophic expenditures.
Bellwether Procedures for Monitoring Subnational Variation of All-cause Perioperative Mortality in Brazil
Background All-cause perioperative mortality rate (POMR) is a commonly reported metric to assess surgical quality. Benchmarking POMR remains difficult due to differences in surgical volume and case
Safety and Feasibility of a Ketamine Package to Support Emergency and Essential Surgery in Kenya when No Anesthetist is Available: An Analysis of 1216 Consecutive Operative Procedures
The ESM-Ketamine package appears safe and feasible and is capable of expanding access to emergency and essential surgeries in rural Kenya when no anesthetist is available.
Provision of Surgical Care for Children Across Somaliland: Challenges and Policy Guidance
Hospital-level surgical infrastructure, workforce, and care delivery reflects a severely resource-constrained health system in Somaliland and a profound lack of surgical capacity for children is found.
Global Surgery System Strengthening: It Is All About the Right Metrics.
Progress toward the metrics being included in core indicator lists by the World Health Organization and the World Bank are discussed and how they have been, or may be, used to inform National Surgical Plans in low- and middle-income countries to scale-up the delivery of safe, affordable, and timely surgical and anesthesia care to all who need it.
Age at Primary Cleft Lip Repair: A Potential Bellwether Indicator for Pediatric Surgery
The findings suggest that age at CL repair has potential to serve as a bellwether indicator for pediatric surgical capacity in Lower- and Middle-income Countries.


Global operating theatre distribution and pulse oximetry supply: an estimation from reported data
Deficiencies in the Availability of Essential Musculoskeletal Surgical Services at 883 Health Facilities in 24 Low- and Lower-Middle-Income Countries
Strengthening the delivery of essential surgical services, including orthopedics, at the primary referral level must be prioritized if the authors are to reduce the burden of death and disability from a variety of emergent health conditions.
Survey of Surgery and Anesthesia Infrastructure in Ethiopia
This survey of Ethiopia’s hospital resources attempts to identify specific areas of need where resources, education, and development can be targeted and increasing accessibility through infrastructure development would likely provide a major improvement in surgical morbidity and mortality rates.
Developing Priorities for Addressing Surgical Conditions Globally: Furthering the Link Between Surgery and Public Health Policy
Preliminary ideas on how priorities for surgical care could be better defined are introduced, especially as regards the interface between the surgical and public health worlds.
A quantitative analysis of surgical capacity in Santa Cruz, Bolivia.
The Role of Surgery in Global Health: Analysis of United States Inpatient Procedure Frequency by Condition Using the Global Burden of Disease 2010 Framework
Surgical care cuts across the entire spectrum of GBD disease categories, challenging dichotomous traditional classifications of ‘surgical’ versus ‘nons surgical’ diseases.
Validation of the World Health Organization Tool for Situational Analysis to Assess Emergency and Essential Surgical Care at District Hospitals in Ghana
Consistent and high correlations calculated from the field testing within the present analysis suggest that the WHO Tool for Situational Analysis is a reliable tool where it measures structure and setting, but it should be revised for measuring process of care.
Inter-Rater Reliability of the PIPES Tool: Validation of a Surgical Capacity Index for Use in Resource-Limited Settings
Reliability of the PIPES tool was moderate for the infrastructure and procedures sections, fair for the equipment section, and poor for supplies section when comparing surgeons' responses to nurses’ responses—an extremely rigorous test of reliability.