From definitions to implementation – A guide to collect and apply the Lancet Commission on Global Surgery indicators: An Utstein consensus report

Metrics for surgery, obstetrics, and anesthesia are crucial for implementing programs and monitoring progress toward safe and effective healthcare systems in pursuit of universal healthcare. A suite of metrics put forward by the Lancet Commission on Global Surgery has been adopted in principle by global health, anaesthesia, and surgical leadership in diverse settings. However, barriers to implementation limit their value. Barriers include inconsistencies in definitions and methodologies such as inadequate consideration given to sampling frames, representativeness, categorizations, missing data, and data collection infrastructure. Using the Utstein consensus methodology, we developed a uniform approach to collecting metrics in surgery, obstetrics, and anesthesia. We created a standard toolkit to facilitate the rapid implementation of the Lancet Commission indicators. The metadata and data dictionaries allow a standardized assessment of preparedness for, delivery of, and the effect of care at the population level.