Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change
Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change
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DOI：
10.3171/2017.11.jns171500
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发表时间：
2019-04-01
影响因子：
4.1
通讯作者：
Park, Kee B.
中科院分区：
文献类型：
--
作者：
Dewan, Michael C.;Rattani, Abbas;Park, Kee B.
目标 世界各地在提供外科护理方面的差异导致原本可以预防的残疾和死亡。人们越来越需要具体量化神经外科疾病的全球负担，以及满足这一需求所需的劳动力。方法对描述全球神经外科负担的多国合作努力的结果进行汇总和总结。首先，将国家登记处、第三方建模数据和已发表的荟萃分析数据相结合，生成 10 种常见神经外科疾病的发病率和数量数据。接下来，进行了全球测绘调查，以确定每个国家神经外科医生的数量和位置。最后，进行了一项从业者调查，以量化需要手术的疾病比例以及每年神经外科病例的中位数。神经外科病例短缺的计算方法是基本神经外科病例数量与现有神经外科劳动力容量之间的差值。 结果 每年，估计有 2260 万名患者患有神经系统疾病或损伤，需要神经外科医生的专业知识，其中 1380 万人需要手术。创伤性脑损伤、中风相关疾病、肿瘤、脑积水和癫痫构成了全世界基本神经外科护理的大部分。每年需要增加大约 23,300 名神经外科医生来解决超过 500 万例基本神经外科病例（全部发生在低收入和中等收入国家），但这些病例尚未得到满足。外科手术人员的分配存在巨大差异，造成巨大的地理治疗差距，特别是在非洲和东南亚。 结论 每年，超过 500 万名患有可治疗的神经外科疾病的患者永远不会接受治疗性外科手术。非洲和东南亚的人群尤其面临风险，因为这些地区的神经外科医生患神经外科疾病的比例极低。作为加强外科系统的一部分，通过扩大神经外科劳动力来增加低收入和中等收入国家获得基本神经外科护理的机会，对于预防数百万神经系统疾病患者的严重残疾和死亡是必要的。
OBJECTIVE Worldwide disparities in the provision of surgical care result in otherwise preventable disability and death. There is a growing need to quantify the global burden of neurosurgical disease specifically, and the workforce necessary to meet this demand.METHODS Results from a multinational collaborative effort to describe the global neurosurgical burden were aggregated and summarized. First, country registries, third-party modeled data, and meta-analyzed published data were combined to generate incidence and volume figures for 10 common neurosurgical conditions. Next, a global mapping survey was performed to identify the number and location of neurosurgeons in each country. Finally, a practitioner survey was conducted to quantify the proportion of disease requiring surgery, as well as the median number of neurosurgical cases per annum. The neurosurgical case deficit was calculated as the difference between the volume of essential neurosurgical cases and the existing neurosurgical workforce capacity.RESULTS Every year, an estimated 22.6 million patients suffer from neurological disorders or injuries that warrant the expertise of a neurosurgeon, of whom 13.8 million require surgery. Traumatic brain injury, stroke-related conditions, tumors, hydrocephalus, and epilepsy constitute the majority of essential neurosurgical care worldwide. Approximately 23,300 additional neurosurgeons are needed to address more than 5 million essential neurosurgical cases-all in low- and middle-income countries-that go unmet each year. There exists a gross disparity in the allocation of the surgical workforce, leaving large geographic treatment gaps, particularly in Africa and Southeast Asia.CONCLUSIONS Each year, more than 5 million individuals suffering from treatable neurosurgical conditions will never undergo therapeutic surgical intervention. Populations in Africa and Southeast Asia, where the proportion of neurosurgeons to neurosurgical disease is critically low, are especially at risk. Increasing access to essential neurosurgical care in low-and middle-income countries via neurosurgical workforce expansion as part of surgical system strengthening is necessary to prevent severe disability and death for millions with neurological disease.