Global Surgery Research Articles

Beyond the Limits to Become a Leading Force in Global Spine Surgery: Present and Future of Spine Surgery in Asia-Pacific.

Beyond the Limits to Become a Leading Force in Global Spine Surgery: Present and Future of Spine Surgery in Asia-Pacific.

Fractional curve following adult idiopathic scoliosis correction: impact of curve magnitude on postoperative outcomes.

The goal of this study was to assess the impact of fractional curve (FC) severity on curve progression and postoperative outcomes in patients undergoing adult idiopathic scoliosis (AdIS) correction. Patients with AdIS who had preoperative coronal plane deformity and who had undergone thoracolumbar fusion with a lowermost instrumented vertebra (LIV) between L1 and L4 were included. Patients were stratified by 6-week postoperative FC severity (small FC, ≤ 40th percentile, large FC, ≥ 60th percentile of the entire cohort; calculated as the Cobb angle between LIV and S1) and age groups. Preoperative to 2-year postoperative changes in FC were evaluated using Student t-tests. Demographics, spinopelvic alignment, patient-reported outcome measures (PROMs), and complications were compared using chi-square tests for categorical variables and Student t-tests for quantitative variables. Multivariate regression analyses, accounting for age, sex, frailty, and 6-week postoperative LIV, were also performed when feasible to assess the impact of FC on 2-year postoperative outcomes. In total, 86 patients, with 34 in the group with small FCs and 34 in the group with large FCs, were examined (18 were in the group with medium FC). The mean age (36.4 years for those with small FCs vs 36.0 years for those with large FCs, p > 0.05) was similar. Preoperatively, spinopelvic parameters and PROMs were comparable (p > 0.05). Two years postoperatively, higher postoperative FC was associated with larger thoracolumbar deformity (i.e., higher thoracolumbar/lumbar/lumbosacral Cobb angles) and lower perceived lumbar stiffness (p < 0.05); however, other PROMs and complications, including revisions, were comparable (p > 0.05). Bidirectional change in postoperative FC was associated with a lower C7 pelvic angle and lower C7 plumb line (R2 = -0.03, 95% CI -0.05 to 0.00, p = 0.050). Across all patients, the mean FC improved from baseline to 6 weeks postoperatively (from 18.1° to 6.5°, p < 0.001) but changed minimally from 6 weeks to 2 years postoperatively (from 6.5° to 6.5°, p = 0.942). After stratification, the cohort with small FCs exhibited a relative increase (from 1.6° to 3.5°, p < 0.001), whereas the cohort with large FCs noted a nonsignificant change (from 11.9° to 9.8°, p = 0.121) in FC over time. Following surgery for AdIS, larger residual lumbosacral FCs were not correlated with adverse events or poor outcomes at 2 years postoperatively. FCs may improve or worsen over time to drive improvement in global coronal balance surgery, but are not associated with adverse outcomes or reoperation during the first 2 years after surgery.

Injury and violence in the context of sustainable development: The first Bethune Round Table in Africa, Bethune Round Table 2024, Conference on Global Surgery, May 16-18, 2024, Addis Ababa, Ethiopia.

Injury and violence in the context of sustainable development: The first Bethune Round Table in Africa, Bethune Round Table 2024, Conference on Global Surgery, May 16-18, 2024, Addis Ababa, Ethiopia.

The state of global surgery assessment and data collection tools: A scoping review.

There has been a proliferation of global surgery assessment tools designed for use in low- and middle-income countries. This scoping review sought to categorize and organize the breadth of global surgery assessment tools in the literature. The search was conducted using PubMed from October 2022 to April 2023 according to PRISMA extension for scoping review guidelines. The search terms were (("global surgery"[All Fields]) AND ("assessment"[All Fields]) OR (data collection)). Only tools published in English that detailed surgical assessment tools designed for low- and middle-income countries were included. The search resulted in 963 papers and 46 texts described unique tools that were included for the final review. Of these, 30 (65%) tools were quantitative, 1 (2%) qualitative, and 15 (33%) employed mixed-methods. 25 (54%) tools evaluated surgery in general, whereas 21 (46%) were focused on various surgical subspecialties. Qualitatively, major themes among the tools were noted. There was significant overlap of many tools. Nonspecialty surgery was represented more than any specialty surgery and many specialties had little or no representation in the literature. Ideally, local leadership should be involved in surgical assessment tools. Different methodologies, such as checklists and observational studies, aimed to target varying aspects of surgery and had distinct strengths and weaknesses. Further efforts should focus on expanding tools in neglected specialties.

'Show me the money': An analysis of US global health funding from 1995 to 2019.

Historically, the US has been the largest contributor to development assistance for health (DAH), although its allocation has shifted in response to outside forces. This included, for example, the establishment of the Millennium Development Goals (MDGs) in 2000, which emphasised child mortality, maternal health, HIV/AIDS, and malaria. This led to funds being earmarked for disease-specific interventions rather than health system strengthening (HSS). In 2007, the World Health Organization (WHO) published six health system building blocks, representing essential components of strong health systems. In 2015, the MDGs were replaced by the Sustainable Development Goals (SDGs), which emphasised capacity-building as opposed to specific health problems. The Lancet Commission on Global Surgery, meanwhile, highlighted surgical capacity building as essential to achieving Universal Health Coverage (UHC). Given the renewed emphasis on a comprehensive approach rather than disease-specific interventions, one might anticipate the US aligning with this rhetoric in its allocation of DAH. However, we hypothesise that this is not the case. We queried the Organization for Economic Co-operation and Development (OECD) database for allocation of US DAH to low- and middle-income countries between 1995 and 2019, thereby excluding data after 2019 to avoid the influence of the coronavirus disease 2019 pandemic. OECD entries were assigned to health systems strengthening (HSS) or disease-specific interventions categories. The WHO building blocks were used as a framework for health systems strengthening. From 1995 to 1999, US DAH allocated to HSS decreased from 42% to 34%. The allocation decreased further from 34% in 2000 to 4% in 2007; correspondingly, DAH allocated to disease-specific interventions increased from 67% to 96%. Between 2008 and 2019, the distribution of US DAH remained relatively stable, with funds allocated to HSS versus disease-specific interventions ranging from 3-12% and 88-98% respectively. While total US DAH contributions in the 1990s and early 2000s were significantly lower compared to the decade that followed, the distribution of these funds was more evenly divided between HSS and disease-specific interventions. Despite attempts by the WHO and United Nations to redirect attention to HSS as the path to achieving UHC, the US continues to largely support disease-specific interventions and overlook the importance of HSS, including surgical capacity building.

Embracing The “global” In Global Surgery: A Consensus Statement On Conference Equity From The Association Of Academic Global Surgery

Embracing The “global” In Global Surgery: A Consensus Statement On Conference Equity From The Association Of Academic Global Surgery

A Scoping Review on the Utilization of Augmented Reality Platforms for Global Surgery in Low-to Middle-Income Countries

A Scoping Review on the Utilization of Augmented Reality Platforms for Global Surgery in Low-to Middle-Income Countries

Ethics in Global Plastic Surgery Missions.

Delivering ethical care in global plastic surgery is challenging due to the unique complexities of resource-limited settings. Additionally, the rise of medical tourism has highlighted the importance of informed consent and awareness of the potential risks that are associated with seeking medical care in foreign countries. This article aims to consider core medical ethics principles and apply them in the context of delivering global plastic surgery. This article examines the application of the four core medical ethics principles in a framework set forth by Beauchamp and Childress, namely autonomy, beneficence, nonmaleficence, and justice, in the context of delivering plastic surgery in international settings. A literature review was performed, where all potential global plastic surgery articles were reviewed to better understand the application of the four core medical ethics framework in this context. Increased communication between visiting surgeons and local healthcare providers; heightened education of surgeons traveling to low-to-middle-income countries regarding local medical practices, resource availability, and cultural norms before providing surgical education; and a greater emphasis on collecting and publishing data analyzing short- and long-term outcomes in low-to-middle-income countries are all likely to improve the success of international medical missions, ensuring that all patients receive medical treatment in a manner that upholds Beauchamp and Childress' four core medical ethics principles. Providing plastic and reconstructive surgery abroad can be done ethically if the four main principles of medical ethics (respect for autonomy, beneficence, nonmaleficence, and justice) are used.

Defining blood deserts and access to blood products for 660 million people: a geospatial analysis of eight states in Northern India

IntroductionBlood transfusion is crucial, but low-income and middle-income countries like India face a severe shortage of banked blood. This study focuses on the Empowered Action Group (EAG) states in India,...

Implementing a Global Mentoring Program: A Call to Action for Mentorship in Surgery

BackgroundThe Gender Equity Initiative in Global Surgery organization launched a mentorship program to address the limited opportunities available in low-and-middle-income countries (LMICs). We aimed to evaluate the utility of the virtual program in bridging this critical gap. MethodsA retrospective review of program surveys containing quantitative and qualitative questions from 2022-2023 was performed. ResultsOf n=193 applicants, 81.3% (157/193) identified as women, and 69.4% (134/193) reported no prior mentorship. Applicants were from 41 countries (35 LMICs). The most requested specialties were general surgery (27.9%, 54/193), neurosurgery (18.1%, 35/193), and cardiothoracic surgery (11.4%, 22/193). 55.9% (108/193) preferred mentors from other countries (United States, United Kingdom, Canada), while 13.9% (27/193) preferred mentors from their country. Ultimately, 48 applicants were matched with 13 mentors. ConclusionsDemand for the program surpassed capacity, highlighting a need for mentorship opportunities for women overall, particularly in LMICs.

Could Diaspora Surgeons be Key to Sustainable Impact in Global Surgery? The UK-Nigeria ENT corridor

.

Bridging the Surgical Divide: Addressing Access, Safety, Volume and Financial Burden in Mexico's Healthcare System through Global Surgery Research.

In 2008, Paul Farmer and Jim Yong Kim first referred to surgery as the "neglected stepchild of global health". Their powerful statement highlighted the critical neglect of surgical care within the global health agenda, emphasizing the urgent need for greater attention and resources. Today, this issue remains acutely relevant in Mexico, where inadequate investment, the risk of catastrophic expenditures, and limited surgical capacity continue to compromise the health and economic stability of millions. Surgical diseases remain a major cause of death and disability, particularly among the poor.

First reported human use of wireless laparoscopic system: is it ready for prime time?

ObjectiveDuring the advent of laparoscopy, surgeons directly explored the abdominal cavity with a telescope-like device through a small incision. Since then, numerous technological advances have transformed minimally invasive surgery (MIS). Yet, in our wireless world, various devices crowd the surgical field, with long wires and light sources posing fall and fire risks. The primary objective of this study was to analyze the first reported human use of a novel wireless laparoscopy system or WLS (ArthroFree™, Lazurite®, Cleveland, Ohio).MethodsThe utility and convenience of the WLS was assessed via two avenues: (1) by analyzing surgical outcomes from first human use and (2) by surveying healthcare professionals regarding its quality and utility.ResultsEighteen patients (mean age 44.2, 83.3% female, mean BMI 33.4) underwent operations with the WLS. Operations included gynecologic and general surgical procedures. There were no intraoperative or postoperative complications, and no conversions to traditional laparoscopy or laparotomy. Mean operating time was 71.94 ± 20.41 min, and estimated blood loss was minimal. Survey results revealed varied individual experiences. Strengths included adequate illumination, improved ergonomics, and simplicity of setup and ease of operation. One respondent criticized the image resolution. Feedback indicated an overall positive impact, and 67% of respondents supported inclusion of the device at their facility. Moreover, its deployment in resource-limited settings abroad has demonstrated its efficacy in global surgery, indicating its potential in various healthcare environments.ConclusionsThis is the first reported human use of a novel WLS. Clinical results supported efficiency and safety of the technology. The successful deployment of the WLS in diverse surgical environments, including resource-limited settings, highlights its potential as a universally adaptable tool in global surgery. This report represents a strong first step toward a wireless operating room with the promise of redefining surgical standards as well as bridging gaps in surgical care worldwide.Graphical abstract

Ethics in global surgery: Lived perspectives and current standards.

Ethics in global surgery: Lived perspectives and current standards.

WP6.9 - Essential Surgery Skills Course: A One Week Training Program to Prepare Surgeons for Humanitarian Deployment

Abstract Background Medical students, surgical trainees, and surgical faculty are increasingly interested in incorporating global surgery into their clinical practices and professional careers. However, many concerns remain about the preparation of surgeons for operating in resource-limited settings and their exposure to critical procedures such as cesarean sections, hysterectomies, or fracture reductions. In an attempt to address these concerns, academic institutions have developed advanced professional training programs for the global surgeon. Methods A six-day essential surgery skills conference was created at a large academic institution that provides trainees and surgeons with an overview of common surgical scenarios across orthopedics, urology, obstetrics, gynecology, general surgery, anesthesia and ultrasound in the form of didactics, simulations, and wet labs. Results 11 surgical trainees from four large academic institutions attended the essential surgery skills conference. Trainees attended sessions on point of care ultrasound, regional anesthesia, general anesthesia, hysterectomies, cesarean sections, post-partum hemorrhage, fracture reduction and fixation, ureteral injuries, and humanitarian deployment. A pre and post-test was administered. Improvement was noted in the trainees scores on the post-test in their knowledge of surgical subspecialty care. Trainees also reported feeling better prepared for humanitarian deployment. Conclusion Global surgery conferences can be designed to provide a networking and collaboration forum for improving access to surgical services worldwide. One-week predeparture conferences that discuss essential technical skills and relevant global surgery knowledge may better prepare surgeons to operate in resource-limited settings.

ThP7.8 - What is the gap in operative trauma surgical skills needed for humanitarian and military deployment? A systematic narrative review of surgeons in high-income countries

Abstract Aims The incidence of armed conflict, terrorist attacks and environmental disaster is increasing and death from traumatic injury remains a leading cause of mortality globally, posing complex challenges in surgical care. Despite advancements in trauma systems development, practice in high-income countries (HICs) is characterised by low trauma volumes, evolving non-operative strategies and increasing sub-specialisation, raising concerns about surgical preparedness for managing diverse injuries. This systematic review aims to assess the operative trauma skills of surgeons in HICs mapped against core military and humanitarian procedures. Examination of the breadth of skills acquired and identification of areas where further experience is required will inform the development of more comprehensive and adaptable surgical training programs. Methods A systematic literature review was conducted under the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines using MEDLINE and EMBASE. Inclusion criteria targeted general and trauma surgery consultants or trainees in HICs, analysing quantitative and qualitative data on operative workload and skills acquisition. Results Twelve studies from the USA, UK, Netherlands, Ireland, Australia, and New Zealand were included. Trainees demonstrated experience in general surgical trauma but lack exposure to critical skills in orthopaedic, vascular and obstetric and gynaecological surgery. Conclusion This review highlights a gap in the operative trauma surgical skills of surgeons in HICs and the need for re-evaluation of surgical training curricula to address the dynamic challenges posed by contemporary trauma care. Emphasising a versatile skillset and exploring avenues for enhanced exposure through didactic courses and global surgery partnerships might prove crucial for better preparing surgeons for the diverse and demanding scenarios in the field of trauma care

Global surgery and public health in aesthetics

Leveraging international collaboration and innovation to improve patient safety.

Global Surgery Speaker Series: An Education and Advocacy Resource for the Advancement of Global Plastic Surgery.

Global Surgery Speaker Series: An Education and Advocacy Resource for the Advancement of Global Plastic Surgery.

Global Neurosurgery: An Overview.

In the following article, we define the practice of global neurosurgery and review the major historical events defining this movement within the larger context of global surgery. The current state of the neurosurgical workforce, disease burden, and ongoing collaborative efforts are highlighted. Ethical practice leading the sustainability is discussed, as well as future targets for the global community as we look beyond the next decade of opportunities to affect the neurosurgical burden of disease.

Geospatial determinants of health: A global surgery lens

Geospatial determinants of health: A global surgery lens