SOSAS Study in Rural India: Using Accredited Social Health Activists as Enumerators

Background: Global estimates show five billion people lack access to safe, quality, and timely surgical care. The wealthiest third of the world’s population receives approximately 73.6% of the world’s total surgical procedures while the poorest third receives only 3.5%. This pilot study aimed to assess the local burden of surgical disease in a rural region of India through the Surgeons OverSeas Assessment of Surgical Need (SOSAS) survey and the feasibility of using Accredited Social Health Activists (ASHAs) as enumerators. Material and Methods: Data were collected in June and July 2015 in Nanakpur, Haryana from 50 households with the support of Indian community health workers, known as ASHAs. The head of household provided demographic data; two household members provided personal surgical histories. Current surgical need was defined as a self-reported surgical problem present at the time of the interview, and unmet surgical need as a surgical problem in which the respondent did not access care. Results: One hundred percent of selected households participated, totaling 93 individuals. Twenty-eight people (30.1%; 95% CI 21.0–40.5) indicated they had a current surgical need in the following body regions: 2 face, 1 chest/breast, 1 back, 3 abdomen, 4 groin/genitalia, and 17 extremities. Six individuals had an unmet surgical need (6.5%; 95% CI 2.45%–13.5%). Conclusions: This pilot study in Nanakpur is the first implementation of the SOSAS survey in India and suggests a significant burden of surgical disease. The feasibility of employing ASHAs to administer the survey is demonstrated, providing a potential use of the ASHA program for a future countrywide survey. These data are useful preliminary evidence that emphasize the need to further evaluate interventions for strengthening surgical systems in rural India

Halo effect in trauma centers: Does it extend to emergent colectomy?

Background: Trauma centers (TCs) have been demonstrated to improve outcomes for some nontrauma surgical conditions, such as appendicitis, but it remains unclear if this extends to all emergency general surgery procedures. Using emergent colectomy in patients with diverticulitis as index condition, this study compared outcomes between TCs and nontrauma centers (NTCs).Materials and methods: The Nationwide Emergency Department Sample (2006-2011) was queried for patients ≥16 y with diverticulitis who underwent emergency surgical intervention. Outcomes included mortality, total charges, and length of stay (LOS). Mortality in TC and NTC was compared using logistic regression, controlling for patient, procedure, and hospital-level characteristics. Adjusted total charges and LOS were analyzed using generalized linear models with gamma and Poisson distributions, respectively.Results: A total of 25,396 patients were included, 5189 (20.4%) were treated at TC and 20,207 (79.6%) at NTC. Median age and sex distribution were similar. Unadjusted proportional in-hospital mortality did not differ between TC and NTC; median charges and LOS were greater in TC. After adjusting, the odds of mortality were significantly higher in TC (odds ratio [OR], 1.23; 95% confidence interval [CI], 1.02-1.51; P = 0.003) as were mean charges and LOS (P \u3c 0.001).Conclusions: The improved outcomes reported for other nontrauma conditions in TC were not observed for patients undergoing an emergent colectomy for diverticulitis after accounting for patient, procedure, and hospital-level characteristics. Future research is needed to assess differences in case mix between TC versus NTC and possible case-mix effects on outcomes to elucidate potential benefit of surgical care in a TC across the breadth of emergency general surgery conditions

Awareness of racial/ethnic disparities in surgical outcomes and care: Factors affecting acknowledgment and action

Background: Studies have demonstrated racial/ethnic disparities in surgical outcomes and care. Surgeon awareness and its association with institutional action remain unclear. The study sought to assess surgeons\u27 awareness of racial/ethnic disparities, ascertain whether demographic and practice factors influence acknowledgement of disparities, and determine whether surgeons are seeking to mitigate disparities. Methods: Anonymous online survey was administered to a random sample of American College of Surgeons (ACS) general surgeons (July 2013 to March 2014). Responses were weighted for nonresponse and risk-adjusted using logistic regression. Results: 172 surgeons completed the survey. Levels of acknowledged disparities were low. Less than one half reported institutional efforts to address disparities, and less than one fourth had taken efforts to investigate disparities in their personal practice. Several respondent factors including Academic Medical Center affiliation, awareness of the ACS statement on optimal access, and year of medical school graduation significantly associated with expressed acknowledgment of disparities. Conclusions: Such associations speak to the need for continued efforts to promote enhanced provider awareness and participation. As the field of surgical disparities moves from understanding to action, we must acknowledge the contributing role that providers pla

Epidemiology of pediatric surgical needs in low-income countries - Fig 1

<p><b>(A) Anatomic region and (B) type of surgical conditions in Nepal, Rwanda, Sierra Leone, and Uganda.</b> *Unmet need: There were 755 conditions among 738 children. Met need: There were 575 conditions among 443 children. NOTE: Met need was defined as any surgically-treatable condition that was reported as having had surgical care, minor or major, in the past. Unmet need was defined as any condition that is surgically treatable, and the respondent did not seek healthcare, sought healthcare but could not receive surgical care, or had persistent, untreated complications/sequela from receiving surgical care. Percentages are based on number of conditions in each category divided by the total number of unmet/met conditions in the respective country.</p

Demographic and healthcare facility characteristics and healthcare seeking behaviors among pediatric SOSAS survey respondents, by country.

<p>Demographic and healthcare facility characteristics and healthcare seeking behaviors among pediatric SOSAS survey respondents, by country.</p

Child health indicators and surgery providers in 4 low- and middle-income countries compared to US.

<p>Child health indicators and surgery providers in 4 low- and middle-income countries compared to US.</p