小柯机器人

NIHR全球外科健康研究所制定、测量和验证了119个国家1632家医院的手术准备指数。2022年10月31日出版的《柳叶刀》杂志发表了这项成果。

2015年《柳叶刀》全球外科委员会认定手术和麻醉是整体医疗系统不可或缺的组成部分。然而，新冠疫情暴露了世界各地计划手术服务的脆弱性，在大流行恢复规划中也被忽视。该研究旨在开发和验证一种新型指数，以支持局部择期手术系统的加强和解决不断增长的积压问题。

首先，研究组通过四个阶段的协商共识过程进行了国际咨询，以制定医院级评估的多领域指数（手术准备指数；SPI）。其次，测量了高收入国家（HIC）、中等收入国家（MIC）和低收入国家（LIC）的全球医院网络的手术准备情况，以探索SPI在国家、亚国家和医院层面的分布情况。最后，以新冠疫情作为外部系统冲击的例子，研究组将医院的SPI与其计划手术量之比（SVR；即在入院前作出手术决定的手术）进行比较，计算2021年6月6日至8月5日期间1个月评估期内观察到的手术量，与基于2019年同期医院管理数据（即疫情前基线）的预期手术量作比较。使用线性混合效应回归模型来确定增加SPI评分的效果。

在第一阶段，来自32个国家的69名临床医生（23[33%]名女性；46[67%]名男性；41名HIC患者，22名MIC患者，6名LIC患者）从103个候选指标的长名单中，选择23个作为择期手术系统准备的核心指标。多领域SPI包括11项设施和消耗品指标、2项人员配备指标、2个优先事项指标和8项系统指标。医院的得分从23分（准备最少）到115分（准备最充分）不等。

在第二阶段，来自119个国家的4714名临床医生在1632家医院评估了手术准备情况。1632家医院中有745家（45.6%）位于MIC或LIC。平均SPI评分为84.5分，在HIC（88.5）、MIC（81.8）和LIC（66.8）之间有所不同。在第三阶段，1217家（74.6%）医院在新冠疫情期间没有维持预期的SVR，其中625家（51.4%）来自HIC，538家（44.2%）来自MIC，54家（4.4%）从LIC。在混合效应模型中，SPI增加10点对应于SVR增加3.6%。这在HIC（4.8%）、MIC（2.8）和LIC（3.8）中是一致的。

研究结果表明，SPI包含23个指标，这些指标适用于全球，与不同的系统压力源相关，在国家以下各级有所不同，可由一线团队收集。在新冠肺炎的案例研究中，SPI较高与计划手术量比增加相关，与国家收入状况、新冠肺炎负担和医院类型无关。医院应每年对其手术准备情况进行自我评估，以确定可改进的领域，在本地手术系统中创造恢复力，并提高处理选择性手术积压的能力。

附：英文原文

Title: Elective surgery system strengthening: development, measurement, and validation of the surgical preparedness index across 1632 hospitals in 119 countries

Author: James C Glasbey, Tom EF Abbott, Adesoji Ademuyiwa, Adewale Adisa, Ehab AlAmeer, Sattar Alshryda, Alexis P Arnaud, Brittany Bankhead-Kendall, M K Abou Chaar, Daoud Chaudhry, Ainhoa Costas-Chavarri, Miguel F Cunha, Justine I Davies, Anant Desai, Muhammed Elhadi, Marco Fiore, James Edward Fitzgerald, Maria Fourtounas, Alex James Fowler, Kay Futaba, Gaetano Gallo, Dhruva Ghosh, Rohan R Gujjuri, Rebecca Hamilton, Parvez Haque, Ewen M Harrison, Peter Hutchinson, Gabriella Hyman, Arda Isik, Umesh Jayarajah, Haytham MA Kaafarani, Bryar Kadir, Ismail Lawani, Hans Lederhuber, Elizabeth Li, Markus W Lffler, Maria Aguilera Lorena, Harvinder Mann, Janet Martin, Dennis Mazingi, Craig D McClain, Kenneth A McLean, John G Meara, Antonio Ramos-De La Medina, Mengistu Mengesha, Ana Minaya, Maria Marta Modolo, Rachel Moore, Dion Morton, Dmitri Nepogodiev, Faustin Ntirenganya, Francesco Pata, Rupert Pearse, Maria Picciochi, Thomas Pinkney, Peter Pockney, Gabrielle H van Ramshorst, Toby Richards, April Camilla Roslani, Sohei Satoi, Raza Sayyed, Richard Shaw, Joana FF Simes, Neil Smart, Richard Sullivan, Malin Sund, Sudha Sundar, Stephen Tabiri, Elliott H Taylor, Mary L Venn, Dakshitha Wickramasinghe, Naomi Wright, Sebastian Bernardo Shu Yip, Aneel Bhangu, Omar Omar, Ewen Harrison, Aneel A Bhangu, Kwabena Siaw-Acheampong, Ruth A Benson, Edward Bywater, Brett E Dawson, Jonathan P Evans, Emily Heritage, Conor S Jones, Sivesh K Kamarajah, Chetan Khatri, Rachel A Khaw, James M Keatley, Andrew Knight, Samuel Lawday, Harvinder S Mann, Ella J Marson, Siobhan C Mckay, Emily C Mills, Gianluca Pellino, Abhinav Tiwari, Isobel M Trout, Richard JW Wilkin, Sadi Abukhalaf, Michel Adamina, Adesoji O Ademuyiwa, Arnav Agarwal, Murat Akkulak, Ehab Alameer, Derek Alderson, Felix Alakaloko, Markus Albertsmeier, Osaid Alser, Muhammad Alshaar, Knut Magne Augestad, Faris Ayasra, José Azevedo, Brittany K Bankhead-Kendall, Emma Barlow, David Beard, Ruth Blanco-Colino, Amanpreet Brar, Ana Minaya-Bravo, Kerry A Breen, Chris Bretherton, Igor Lima Buarque, Joshua Burke, Edward J Caruana, Mohammad Chaar, Sohini Chakrabortee, Peter Christensen, Daniel Cox, Moises Cukier, Giana H Davidson, Salomone Di Saverio, Thomas M Drake, John G Edwards, Sameh Emile, Shebani Farik, Samuel Ford, Tatiana Garmanova, Gustavo Mendona Ataíde Gomes, Gustavo Grecinos, Ewen A Griffiths, Magdalena Gruendl, Constantine Halkias, Intisar Hisham, Peter J Hutchinson, Shelley Hwang, Michael D Jenkinson, Pascal Jonker, Debby Keller, Angelos Kolias, Schelto Kruijff

Issue&Volume: 2022-10-31

Abstract:

Background

The 2015 Lancet Commission on global surgery identified surgery and anaesthesia as indispensable parts of holistic health-care systems. However, COVID-19 exposed the fragility of planned surgical services around the world, which have also been neglected in pandemic recovery planning. This study aimed to develop and validate a novel index to support local elective surgical system strengthening and address growing backlogs.

Methods

First, we performed an international consultation through a four-stage consensus process to develop a multidomain index for hospital-level assessment (surgical preparedness index; SPI). Second, we measured surgical preparedness across a global network of hospitals in high-income countries (HICs), middle-income countries (MICs), and low-income countries (LICs) to explore the distribution of the SPI at national, subnational, and hospital levels. Finally, using COVID-19 as an example of an external system shock, we compared hospitals' SPI to their planned surgical volume ratio (SVR; ie, operations for which the decision for surgery was made before hospital admission), calculated as the ratio of the observed surgical volume over a 1-month assessment period between June 6 and Aug 5, 2021, against the expected surgical volume based on hospital administrative data from the same period in 2019 (ie, a pre-pandemic baseline). A linear mixed-effects regression model was used to determine the effect of increasing SPI score.

Findings

In the first phase, from a longlist of 103 candidate indicators, 23 were prioritised as core indicators of elective surgical system preparedness by 69 clinicians (23 [33%] women; 46 [67%] men; 41 from HICs, 22 from MICs, and six from LICs) from 32 countries. The multidomain SPI included 11 indicators on facilities and consumables, two on staffing, two on prioritisation, and eight on systems. Hospitals were scored from 23 (least prepared) to 115 points (most prepared). In the second phase, surgical preparedness was measured in 1632 hospitals by 4714 clinicians from 119 countries. 745 (45·6%) of 1632 hospitals were in MICs or LICs. The mean SPI score was 84·5 (95% CI 84·1–84·9), which varied between HIC (88·5 [89·0–88·0]), MIC (81·8 [82·5–81·1]), and LIC (66·8 [64·9–68·7]) settings. In the third phase, 1217 (74·6%) hospitals did not maintain their expected SVR during the COVID-19 pandemic, of which 625 (51·4%) were from HIC, 538 (44·2%) from MIC, and 54 (4·4%) from LIC settings. In the mixed-effects model, a 10-point increase in SPI corresponded to a 3·6% (95% CI 3·0–4·1; p<0·0001) increase in SVR. This was consistent in HIC (4·8% [4·1–5·5]; p<0·0001), MIC (2·8 [2·0–3·7]; p<0·0001), and LIC (3·8 [1·3–6·7%]; p<0·0001) settings.

Interpretation

The SPI contains 23 indicators that are globally applicable, relevant across different system stressors, vary at a subnational level, and are collectable by front-line teams. In the case study of COVID-19, a higher SPI was associated with an increased planned surgical volume ratio independent of country income status, COVID-19 burden, and hospital type. Hospitals should perform annual self-assessment of their surgical preparedness to identify areas that can be improved, create resilience in local surgical systems, and upscale capacity to address elective surgery backlogs.

DOI: 10.1016/S0140-6736(22)01846-3

Source: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(22)01846-3/fulltext

LANCET：《柳叶刀》，创刊于1823年。隶属于爱思唯尔出版社，最新IF：202.731
官方网址：http://www.thelancet.com/
投稿链接：http://ees.elsevier.com/thelancet