Access to and quality of elective care: a prospective cohort study using hernia surgery as a tracer condition in 83 countries

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dc.authoridCamuera, Maite/0000-0001-6623-5513
dc.authoridLi, Crystal/0000-0001-9091-1681
dc.authoridTolani, Musliu Adetola/0000-0003-4296-9744
dc.authoridElghrieb, Ahmed/0000-0002-9138-3806
dc.authoridYeshitila, Addis/0000-0001-7965-5242
dc.authoridSharma, Kruti/0000-0002-1461-2978
dc.authoridGonzalez Ponce, Fanny Yesenia/0000-0001-7645-3290
dc.contributor.authorPicciochi, Maria
dc.contributor.authorBhangu, Aneel
dc.contributor.authorDajti, I.
dc.contributor.authorDjama, Z.
dc.contributor.authorLucchini, M.
dc.contributor.authorHuatuco, R. M. Palacios
dc.contributor.authorAtherton, K.
dc.date.accessioned2025-03-20T09:51:04Z
dc.date.available2025-03-20T09:51:04Z
dc.date.issued2024
dc.departmentİzmir Bakırçay Üniversitesi
dc.description.abstractBackground Timely and safe elective health care facilitates return to normal activities for patients and prevents emergency admissions. Surgery is a cornerstone of elective care and relies on complex pathways. This study aimed to take a whole-system approach to evaluating access to and quality of elective health care globally, using inguinal hernia as a tracer condition. Methods This was a prospective, international, cohort study conducted between Jan 30 and May 21, 2023, in which any hospital performing inguinal hernia repairs was eligible to take part. Consecutive patients of any age undergoing primary inguinal hernia repair were included. A measurement set mapped to the attributes of WHO's Health System Building Blocks was defined to evaluate access (emergency surgery rates, bowel resection rates, and waiting times) and quality (mesh use, day-case rates, and postoperative complications). These were compared across World Bank income groups (high-income, upper-middle-income, lower-middle-income, and low-income countries), adjusted for hospital and country. Factors associated with postoperative complications were explored with a three-level multilevel logistic regression model. Findings 18 058 patients from 640 hospitals in 83 countries were included, of whom 1287 (7 center dot 1%) underwent emergency surgery. Emergency surgery rates increased from high-income to low-income countries (6 center dot 8%, 9 center dot 7%, 11 center dot 4%, 14 center dot 2%), accompanied by an increase in bowel resection rates (1 center dot 2%, 1 center dot 4%, 2 center dot 3%, 4 center dot 2%). Overall waiting times for elective surgery were similar around the world (median 8 center dot 0 months from symptoms to surgery), largely because of delays between symptom onset and diagnosis rather than waiting for treatment. In 14 768 elective operations in adults, mesh use decreased from high-income to low-income countries (97 center dot 6%, 94 center dot 3%, 80 center dot 6%, 61 center dot 0%). In patients eligible for day-case surgery (n=12 658), day-case rates were low and variable (50 center dot 0%, 38 center dot 0%, 42 center dot 1%, 44 center dot 5%). Complications occurred in 2415 (13 center dot 4%) of 18 018 patients and were more common after emergency surgery (adjusted odds ratio 2 center dot 06, 95% CI 1 center dot 72-2 center dot 46) and bowel resection (1 center dot 85, 1 center dot 31-2 center dot 63), and less common after day-case surgery (0 center dot 39, 0 center dot 34-0 center dot 44). Interpretation This study demonstrates that elective health care is essential to preventing over-reliance on emergency systems. We identified actionable targets for system strengthening: clear referral pathways and increasing mesh repair in lower-income settings, and boosting day-case surgery in all income settings. These measures might strengthen non-surgical pathways too, reducing the burden on society and health services. Copyright (c) 2024 The Author(s). Published by Elsevier Ltd. This is an Open Access article under the CC BY 4.0 license.
dc.description.sponsorshipNIHR Global Health Research Unit on Global Surgery and Portuguese Hernia and Abdominal Wall Society
dc.description.sponsorshipNIHR Global Health Research Unit on Global Surgery and Portuguese Hernia and Abdominal Wall Society (Sociedade Portuguesa de Hernia e Parede Abdominal).
dc.identifier.doi10.1016/S2214-109X(24)00142-6
dc.identifier.endpageE1103
dc.identifier.issn2214-109X
dc.identifier.issue7
dc.identifier.pmid38797188
dc.identifier.scopusqualityQ1
dc.identifier.startpageE1094
dc.identifier.urihttps://doi.org/10.1016/S2214-109X(24)00142-6
dc.identifier.urihttps://hdl.handle.net/20.500.14034/2398
dc.identifier.volume12
dc.identifier.wosWOS:001270761400001
dc.identifier.wosqualityQ1
dc.indekslendigikaynakWeb of Science
dc.indekslendigikaynakPubMed
dc.language.isoen
dc.publisherElsevier Sci Ltd
dc.relation.ispartofLancet Global Health
dc.relation.publicationcategoryMakale - Uluslararası Hakemli Dergi - Kurum Öğretim Elemanı
dc.rightsinfo:eu-repo/semantics/openAccess
dc.snmzKA_WOS_20250319
dc.titleAccess to and quality of elective care: a prospective cohort study using hernia surgery as a tracer condition in 83 countries
dc.typeArticle

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