Elsevier

Surgery

Volume 158, Issue 1, July 2015, Pages 44-54
Surgery

Lancet Commission
The role of facility-based surgical services in addressing the national burden of disease in New Zealand: An index of surgical incidence based on country-specific disease prevalence

https://doi.org/10.1016/j.surg.2015.04.005Get rights and content

Background

Surgery is a crucial component of health systems, yet its contribution has been difficult to define. We linked national hospital service utilization with national epidemiologic data to describe the use of surgical procedures in the management of a broad spectrum of conditions.

Methods

We compiled International Classification of Diseases-10-Australian Modification codes from the New Zealand National Minimum Dataset, 2008–2011. Using primary cause of admission, we aggregated hospitalizations into 119 disease states and 22 disease subcategories of the World Health Organization Global Health Estimate (GHE). We queried each hospitalization for any surgical procedure in a binary manner to determine the volume of surgery for each disease state. Surgical procedures were defined as requiring general or neuroaxial anesthesia. We then divided the volume of surgical cases by counts of disease prevalence from the Global Burden of Disease Study 2010 to determine annual surgical incidence.

Results

Between 2008 and 2011, there were 1,108,653 hospital admissions with 275,570 associated surgical procedures per year. Surgical procedures were associated with admissions for all 22 GHE disease subcategories and 116 of 119 GHE disease states. The sub-categories with the largest surgical case volumes were Unintentional Injuries (48,073), Musculoskeletal Diseases (38,030), and Digestive Diseases (27,640). Surgical incidence ranged widely by individual disease states with the highest in: Other Neurological Conditions, Abortion, Appendicitis, Obstructed Labor, and Maternal Sepsis.

Conclusion

This study confirms that surgical care is required across the entire spectrum of GHE disease subcategories, illustrating a critical role in health systems. Surgical incidence might be useful as an index to estimate the need for surgical procedures in other populations.

Section snippets

Methods

This study was approved by the University of Otago Human Ethics Committee (Health) (Reference Number HD14/42). Raw data were only handled by coauthors with direct affiliation with the New Zealand Ministry of Health.

Our primary data source of facility-based surgical service utilization was the New Zealand National Minimum Dataset (NMDS).8 The NMDS is a national repository of hospital discharge information from public sector hospitals of New Zealand's nationalized health care system. The database

Results

During the 4-year study period there were 1,108,653 annual hospital admissions in the NMDS with an associated 275,569 annual surgical volume (Table II). At least one surgical procedure was performed in 24.9% of hospital admissions. With a population census of 4,368,000, the overall national rate of publically financed surgical procedures was 7,840 per 100,000 inhabitants.25

Among patients who were hospitalized, the need for surgical procedures varied widely across WHO GHE subcategories (Fig 1).

Discussion

This analysis confirms previous research that the need for surgical care spans the entire spectrum of GHE disease sub-categories.7 In addition, we demonstrate that the need for surgery is dynamic across disease states, which is consistent with the heterogeneous nature of disease states and surgical services themselves. By linking an administrative hospital utilization dataset to disease prevalence data, this study illustrates the critical role operative intervention plays in treating

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