Poor Nations Face Severe Shortage of Operating Rooms and Equipment

More than 2 billion people in the poorer regions of the world lack adequate access to surgical care, mostly as a result of shortages of operating theaters and equipment such as pulse oximeters, according to a new study.

Researchers at the Harvard School of Public Health (Boston, MA, USA) conducted an analysis of 21 global sub- regions, and calculated more than a 20-fold disparity in the availability of operating theaters between rich and poor areas, despite the fact that the poorest regions have the world's highest burden of surgically treated conditions such as injuries and obstetric complications. Local analyses in sub-Saharan Africa and southeastern Asia also indicate shortages of anesthesia and surgical equipment, including the availability of surgical theaters themselves.

Conversely, the wealthiest third of the world's population undergoes 75% of the 234 million surgeries performed each year, whereas those in the poorest third undergo only 4% of surgical procedures. To observe differences in resource distribution, the researchers examined the profiles of operating theaters in 769 hospitals in 92 countries, and information about functioning pulse oximeters was obtained from 172 anesthesiologists in hospitals around the world. The researchers also queried the national secretaries of all 122 members of the World Federation of Societies of Anaesthesiologists (WFSA; London, United Kingdom) regarding whether their national minimum standards of anesthesia care included pulse oximetry use during surgery.

Using economic data, the researchers then divided each country into high-income, high middle-income, low middle-income and low-income categories and calculated the number of operating theaters per 100,000 population, as well as the number of hospitals with and without pulse oximetry. The results showed that Eastern Europe--which is classified as high-middle income--and the high-income regions of Asia-Pacific led in numbers of operating theaters, whereas central, eastern, and western sub-Saharan Africa were at the bottom of the list. A relatively high percentage of hospitals in Eastern Europe lacked pulse oximeters, but again sub-Saharan Africa fared worst. Overall, high-income sub-regions had at least 14 operating theaters per 100,000 people, compared with less than 2 in the low-income areas, despite their higher burden of surgically treated diseases. The study was published online on July 1, 2010, in the Lancet.

"Conservative estimates suggest that 11% of the world's disability-adjusted life years are attributable to diseases that are often treated with surgery, such as heart and cerebrovascular disease, cancer, and injuries resulting from road traffic accidents,” concluded lead author Luke Funk, M.D., and colleagues. "The absence of pulse oximeters in more than half of the operating theaters in those sub-regions is not only a safety concern for patients, but also increases doubt about availability of other essential equipment such as sutures, surgical instruments, drugs, and autoclaves.”

Related Links:
Harvard School of Public Health
World Federation of Societies of Anaesthesiologists