Poor access to essential surgery is costing lives - study

Inadequate access to simple elective surgery in developing countries is storing up future health problems for patients and may create a spiral of future health complications putting more people’s lives at risk, a new study reveals.

Analysing the experience of more than 18,000 patients in 640 hospitals across 83 countries, researchers, experts used hernia repair to represent elective health care, concluding that such treatments are essential to prevent over-reliance on emergency systems.

The study reveals that inguinal hernias are treatable with simple day-case surgery, but, if neglected, the need for more complex emergency surgery increases substantially, leading to delayed recovery and far higher total health-care costs.

Led by experts at the University of Birmingham, the NIHR Global Health Research Unit in Surgery study notes that increasing reliance on emergency care has resulted in crisis management becoming routine across a wide range of conditions that respond well to early elective treatment.

Study co-author Dr Maria Picciochi, from the University of Birmingham, commented: “Boosting the use of elective surgery for conditions that can be fixed simple and early treatments will reduce the risk of complex, and potentially risky, emergency surgery.”

Study co-author Prof Aneel Bhangu, from the University of Birmingham, also added: “Health policy makers can use our findings as a proxy for other elective conditions, creating a system strengthening approach to integrate surgery into the wider system of health care. This would relieve pressure on emergency pathways and reduce the health burden on society and healthcare services.”

The study shows that inguinal hernias are mostly a disease of working-age patients around the world, and, if neglected, may require bowel resection. This more complex surgical treatment leads to slow recovery and far higher total health-care costs.

Researchers also found a clear global imbalance in access to mesh repair - reflecting poor access to simple medical devices in lower-income countries. Mesh is well proven to reduce long-term hernia recurrence, is simple to place, low-cost and scaleable.

The researchers identified actionable targets for system strengthening, which include:

• Educating communities and community health workers around hernia symptoms;
• Improving referral systems and increasing mesh repair for hernias;
• Establishing a global quality improvement programme in mesh placement for hernias - strengthening supply chains, making mesh affordable and increasing training; and
• Improving capacity for simple, cost-effective surgery.

“Our study showed multiple weaknesses in access and quality in current health-care systems, with a particular disadvantage in lower-income settings,” commented Dr. Picciochi. “As a result, there was higher emergency demand, which further reduced elective capacity and might create downward spirals.

“If weak access and quality persist over several electively treatable conditions, both surgical and non-surgical, multimorbidity can also become established, which makes future elective care harder and emergency care even more complicated.”

Findings of the study and its wider implications will be discussed during the side event hosted by the NIHR Global Surgery Unit at the World Health Assembly, on 28th May.