Epidemiology of surgeries

Surgery is defined as “any condition for which the most potentially effective treatment is an
intervention that requires suture, incision, excision, manipulation, or other invasive procedure
that usually, but not always, requires anaesthesia”(1).
(http://www.who.int/bulletin/volumes/90/3/11-093732/en/).

The application of surgical knowledge is gaining momentum to solve many health issues.
Surgery can be used for prophylactic or curative management and hence is required in all
ages such as neonates to elderly population.

Looking at the burden of disease requiring surgical interventions, it was observed that 234
million operations are performed each year (2).
(http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0089693)

As per WHO reports, an estimated 266.2 to 359.5 million operations were performed in 2012.
For the year 2012, an estimated 312.9 million operations were performed– an increase of
38.2% from an estimated 226.4 million operations in 2004. The estimated mean global
surgical rate was 4469 operations per 100 000 people per year (3) .
(http://www.who.int/bulletin/volumes/94/3/15-159293/en/).

The increase in the incidence of injuries, non communicable diseases, complicated infections
have contributed to increasing rate of surgeries across globe. Despite the increasing
requirement of efficient surgical and anaesthesia care, the data available on this is very
limited. Approximately 73.6% of these procedures were performed in high-income countries
and 3.5% of surgical procedures were performed in low-income countries. It is observed that
38% of total surgical burden is due to trauma (4) (http://bioethics.wfu.edu/wp-
content/uploads/2015/09/Topic-6-Global-Surgery-and-Global-Health-Metrics.pdf).

In 2010, 10 million major inpatient operations were performed in the United States,
associated with 28.6% of all admissions. The highest frequencies of operation were in the
subcategories of musculoskeletal (84.0%), neoplasm (61.4%), and transport Injuries (43.2%).
In the United States during the same period, the DALYs associated with HIV/AIDS and Road
Injury declined 61% and 16%, respectively, and the greatest increase was in Alzheimer’s
Disease (159%) (2)
.(http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0089693)

As per the data from North American sub-region, the frequency of operation across the three
broad categories of disease were; 23.9% for communicable/maternal/neonatal/nutritional
diseases, 33.9% for non-communicable diseases, and 34.6% for injury. At the sub-category
level, this frequency varied from 0.2% for Mental and Behavioural Disorders to a high of
84.0% for Musculoskeletal Disorders.

In the elderly patients increasing age, co-morbities such as diabetes mellitus, hypertension,
hypothyroidism, respiratory diseases like COPD, obesity, habits such as smoking, alcohol,
physical inactivity etc contribute to increasing need for surgeries. The baseline health,
mental, and social status of elderly patients who present with acute surgical emergencies is
often unknown and comorbidities under recognized. Elective surgical care involves
comprehensive geriatric assessment and the pre-operative optimization of comorbid states,
but in emergency surgery there is limitation in the information collected along with goals of
care (5) ( https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4105124/)

Table 1 Elderly with five chronic comorbities (6)

Hypertension 57%

Diabetes 20%

CAD 15%

Cancer 9%

CVD 9%

Chang et al investigated the impact of comorbities on the treatment outcomes when rectal
cancer surgeries were performed in older patients. This presented them a situation of ethical
dilemma whether to perform surgeries or not. They concluded that though it presented a
higher risk of nosocominal complications, significant adverse effect on 1-year mortality were
not observed in their study and suggested further research to establish effective therapeutic
strategies (7).

References

1. Amardeep Thind CM, Richard A Gosselin, & Kelly McQueen. Surgical epidemiology: a call for
action 03 February 2012. Available from: http://www.who.int/bulletin/volumes/90/3/11-
093732/en/.
2. Rose J CD, Weiser TG, Kassebaum NJ, Bickler SW (2014) The Role of Surgery in Global Health:
Analysis of United States Inpatient Procedure Frequency by Condition Using the Global Burden of
Disease 2010 Framework. PLoS ONE 9(2): e89693. https://doi.org/10.1371/journal.pone.0089693.
3. Thomas G Weiser ABH, George Molina, Stuart R Lipsitz , Micaela M Esquivel, Tarsicio Uribe-
Leitz, Rui Fu, Tej Azad, Tiffany E Chao, William R Berry & Atul A Gawande. Size and distribution of the
global volume of surgery in 2012: Bulletin of the World Health Organization 2016;94:201-209F. doi:
http://dx.doi.org/10.2471/BLT.15.159293. Available from:
http://www.who.int/bulletin/volumes/94/3/15-159293/en/.
4. Palilonis MA. An Introduction to Global Health and Global Health Ethics: Global Surgery and
Global Health Metrics. Available from: http://bioethics.wfu.edu/wp-
content/uploads/2015/09/Topic-6-Global-Surgery-and-Global-Health-Metrics.pdf.
5. Merani S, Payne J, Padwal RS, Hudson D, Widder SL, Khadaroo RG. Predictors of in-hospital
mortality and complications in very elderly patients undergoing emergency surgery. World Journal of
Emergency Surgery : WJES. 2014;9:43-.
6. Fillenbaum GG, Pieper CF, Cohen HJ, Cornoni-Huntley JC, Guralnik JM. Comorbidity of five
chronic health conditions in elderly community residents: determinants and impact on mortality.
The journals of gerontology Series A, Biological sciences and medical sciences. 2000;55(2):M84-9.
7. Chang H-R, Shih S-C, Lin F-M. Impact of Comorbidities on the Outcomes of Older Patients
Receiving Rectal Cancer Surgery. International Journal of Gerontology. 2012;6(4):285-9.