connecting surgery to

the social (justice) networkben bryner

the sujal parikh memorial symposium on global health

university of michigan

March 26, 2011

why talk about surgery?

it’s “the neglected stepchild of global health”

personal experience

234 million operations performed yearly

(compare w/ ~137 million births annually)

SurgeryInternational

health

Things surgeons talk about

Things global health experts talk about

this talk

Surgical diseases and disparities

What’s different about surgery

What’s being tried

Traps and possible ways to avoid them

burden of surgical disease

Trauma accounts for 9% of mortality (WHO)~50% between 15-44 years

An estimation of the global volume of surgery: a modelling strategy based on available data. Weiser, Regenbogen, Thompson, Haynes, Lipsitz, Gawande. The Lancet, 3723:9633, 139-144, July 2008

~1100 units worldwide

77,000 operating rooms worldwide have no pulse oximeter

case studies

TD: 81yo with diverticulitis, complicated by multiple intraabdominal infections, pneumonia

39 separate operations and procedures

376 days in the surgical ICU

1126 notes

how is surgery different?

less (directly) reliant on licensing

heavy reliance on supply streams,

prolonged training

facilities / referral networks

prehospital care

university initiatives

HMS – Program in Global Surgery and Social Change

OHSU – International Surgery Program International Surgery Research Fellowship

UCSF - Global Partners in Anesthesia and Surgery Projects in IT, prehospital responder training

Children’s Hospital Boston – Global Surgery Fellowship

survey of US surgery residencies

Perceived barriers to international rotations:

Global Health in General Surgery Residency: A National Survey Sudha P. Jayaraman, Alexander L. Ayzengart, Laura H. Goetz, Doruk Ozgediz, and Diana L. Farmer

Journal of the American College of SurgeonsVolume 208, Issue 3, March 2009, Pages 426-433

survey of US surgery residencies

Reciprocal benefits to non-US sites:

Global Health in General Surgery Residency: A National Survey Sudha P. Jayaraman, Alexander L. Ayzengart, Laura H. Goetz, Doruk Ozgediz, and Diana L. Farmer

Journal of the American College of SurgeonsVolume 208, Issue 3, March 2009, Pages 426-433

other organizations

Canadian Network for International SurgeryBethune Round TableWorkshops

GHDonline/surgery

WHO approach

Improving safety regardless of resource availabilitySafe Surgery Saves Lives / checklist initiative:

estimated 500,000 lives per year could be saved

traps

sticking around

Complications, Failure to Rescue, and Mortality With Major Inpatient Surgery in Medicare Patients.Ghaferi, Amir; Birkmeyer, John; Dimick, Justin

Annals of Surgery. 250(6):1029-1034, December 2009.

FIGURE 1. Mortality, complication, and failure to rescue rates for medicare patients undergoing six major abdominal operations.

Sujal’s example