O. Yerokun3, L. M. Baumann1,2, P. Jani5, P. Frykman12, I. Ibanga9, K. Asuman8, S. Krishnaswami10, K. Nguyen18, E. O’Flynn16, B. Onajin-Obembe13, M. Ratel15, S. Bruce6, E. Stieber7, M. Swaroop2, N. Wetzig17, J. Wood11, A. Zeidan14, M. Meheš19, B. Allen19, F. Abdullah1,2, A. Latif4 1Ann & Robert H. Lurie Children’s Hospital,Division Of Pediatric Surgery,Chicago, IL, USA 2Northwestern University,Department Of Surgery,Chicago, IL, USA 3Johns Hopkins Bloomberg School Of Public Health,General Preventative Medicine,Baltimore, MD, USA 4Johns Hopkins University School Of Medicine,Anesthesiology And Critical Care Medicine,Baltimore, MD, USA 5The College Of Surgeons Of East, Central And Southern Africa,Arusha, ARUSHA, Tanzania 6Pan African Academy Of Christian Surgeons,Linden, NC, USA 7Smile Train,New York, NY, USA 8African Agency For Integrated Development,Kampala, KAMPALA, Uganda 9Pro-Health International,Edwardsville, IL, USA 10Oregon Health And Science University,Pediatric Surgery,Portland, OR, USA 11IVUMed,Salt Lake City, UT, USA 12Global Pediatric Surgical Technology And Education Project,Irvine, CA, USA 13Nigerian Society Of Anesthetists,Lagos, LAGOS, Nigeria 142nd Chance Association Reconstructive Surgery For Life Reconstruction,Meyrin, GENEVA, Switzerland 15Korle-Bu Neuroscience Foundation,Langley, BC, Canada 16Royal College Of Surgeons Of Ireland,Dublin, LEINSTER, Ireland 17HEAL Africa,Gisenyi, RUBAVU, Rwanda 18Mending Kids,Burbank, CA, USA 19G4 Alliance,New York, NY, USA
Introduction:
With increased awareness of the global burden of surgical disease and severe disparity in access to care, emergency and essential surgical care and anesthesia are recognized as a core component of universal health coverage. Achieving global improvement requires a universal language for accurate analysis and exchange of information. While examples of large-scale data systems exist, many registries in low- and middle-income countries (LMICs) are limited in scope. The Global Alliance for Surgical, Obstetric, Trauma and Anesthesia Care (G4 Alliance) is a coalition of organizations advocating for improved access to safe surgical and anesthesia care. The development of a universal, global operative data platform can allow for improved quality, structure, and process in areas with the most need.
Methods:
A comprehensive review of existing regional and international perioperative databases and surgical registries was performed. Information commonly collected in the perioperative period was identified. A list of surgical procedures considered to be essential procedures in any global setting was created based on existing standards (Bellwether procedures, Disease Control Priorities 3 for Essential Surgery) and expert consensus. These measures were compiled into a collection tool that was disseminated broadly to a multinational group of surgical, anesthesia, trauma, and obstetric experts as part of a working group for the G4 Alliance. Feedback was collected both electronically and in-person during semi-annual board meetings using a modified Delphi approach and used as the basis for developing a final draft tool for the minimum operative case log.
Results:
A total of 14 experts provided critique via email or during in-person review of data parameters and procedures. Following completion of three Delphi rounds, a consensus was reached for 38 data parameters and 74 operative procedures to include in the final draft tool. The parameters were categorized by general, demographic, preoperative, intraoperative, and postoperative information (Table 1). Highly specialized procedures were excluded from the procedure set. All critical demographic and operative parameters were included independent of perceived collection practice in LMICs.
Conclusion:
In order to properly address the gap in delivery of safe surgical care, data-driven quality improvement is necessary. This requires a robust data system that communicates standardized information from disparate settings across the globe. The development of a minimum operative dataset will further efforts to understand the resources currently utilized for surgical care, and help take a systematic approach to eliminate the unnecessary morbidity and mortality related to surgically treatable disease.
