Evaluating the collection, comparability and findings of six global surgery indicators: Collection, comparability and findings of six global surgery indicators

Research output: Contribution to journalArticlepeer-review


  • H. Holmer
  • A. Bekele
  • L. Hagander
  • E. M. Harrison
  • P. Kamali
  • J. S. Ng-kamstra
  • M. A. Khan
  • L. Knowlton
  • A. J. M. Leather
  • I. H. Marks
  • J. G. Meara
  • M. G. Shrime
  • M. Smith
  • K. Søreide
  • T. G. Weiser

Colleges, School and Institutes

External organisations

  • Karolinska University Hospital; Solna, Stockholm Sweden
  • University of Global Health Equity; Kigali Rwanda
  • Department of Paediatric Surgery, Skåne University Hospital Children's Hospital; Lund Sweden
  • Department of Clinical Surgery, Royal Infirmary of Edinburgh and Surgical Informatics, Centre for Medical Informatics, Usher Institute, University of Edinburgh; Edinburgh UK
  • InciSioN, International Student Surgical Network; Leuven Belgium
  • Department of Critical Care Medicine, University of Calgary, Calgary; Alberta Canada
  • CMH Lahore Medical College and Institute of Dentistry; Lahore Pakistan
  • Department of Surgery, Stanford University, Palo Alto, California, USA.
  • King's Centre for Global Health and Health Partnerships, School of Population Health and Environmental Sciences, Faculty of Life Sciences and Medicine, King's College London; London UK
  • Department of Plastic and Oral Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts, USA.
  • Center for Global Surgery Evaluation, Massachusetts Eye and Ear Infirmary; Boston USA
  • Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand; Johannesburg South Africa
  • Department of General Surgery, Chris Hani Baragwaneth Academic Hospital; Johannesburg South Africa
  • Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway. Electronic address: ksoreide@mac.com.


In 2015, six indicators were proposed to evaluate global progress towards access to safe, affordable and timely surgical and anaesthesia care. Although some have been adopted as core global health indicators, none has been evaluated systematically. The aims of this study were to assess the availability, comparability and utility of the indicators, and to present available data and updated estimates.

Nationally representative data were compiled for all WHO member states from 2010 to 2016 through contacts with official bodies and review of the published and grey literature, and available databases. Availability, comparability and utility were assessed for each indicator: access to timely essential surgery, specialist surgical workforce density, surgical volume, perioperative mortality, and protection against impoverishing and catastrophic expenditure. Where feasible, imputation models were developed to generate global estimates.

Of all WHO member states, 19 had data on the proportion of the population within 2h of a surgical facility, 154 had data on workforce density, 72 reported number of procedures, and nine had perioperative mortality data, but none could report data on catastrophic or impoverishing expenditure. Comparability and utility were variable, and largely dependent on different definitions used. There were sufficient data to estimate that worldwide, in 2015, there were 2 038 947 (i.q.r. 1 884 916–2 281 776) surgeons, obstetricians and anaesthetists, and 266·1 (95 per cent c.i. 220·1 to 344·4) million operations performed.

Surgical and anaesthesia indicators are increasingly being adopted by the global health community, but data availability remains low. Comparability and utility for all indicators require further resolution.


Original languageEnglish
JournalBritish Journal of Surgery
Early online date20 Dec 2018
Publication statusE-pub ahead of print - 20 Dec 2018