Identifying a basket of surgical procedures standardize global surgical metrics: A delphi study

Objective:
We aimed to define a globally applicable list of surgical proce dures, or ‘‘basket,’’ which could represent a health system’s capacity toprovide surgical care and standardize global surgical measurement

Summary of Background Data:
Six indicators have been proposed to assessaccess to safe, affordable, timely surgical and anesthesia care, with a focus onlaparotomy, cesarean section, and treatment of open fracture. However,comparability, particularly for these procedures, has been limited by a lack of definitional clarity and their overly broad scope.

Methods:
We conducted a 3 round international expert Delphi exercise between April and June 2019 using REDCap to identify a set of procedures representative of surgical capacity. To be included, procedures had to be important for treating common conditions, well-defined, and impactful (ie, well-recognized clinical or functional benefit). Procedures were elimi nated or prioritized in each round, and those noted as ‘‘extremely’’ or ‘‘very important’’ by 50% of respondents in round 3 were included in the final ‘‘basket.’’

Results:
Altogether 331 respondents from 78 countries participated in the Delphi process. A final basket of 32 procedures representing disease catego ries in trauma, cancer, congenital anomalies, maternal/reproductive health, aging, and infection were identified for inclusion to assess surgical capacity.

Conclusions:
This surgical basket facilitates a more standardized assessment of a country’s surgical system. Further testing and refinement will likely be needed, but this basket can be used immediately to guide ongoing monitoring and evaluation of global surgery capacities to improve and strengthen surgery and anesthesia care.