Identifying a Basket of Surgical Procedures to Standardize Global Surgical Metrics: An International Delphi Study.

OBJECTIVE We aimed to define a globally applicable list of surgical procedures, or "basket", which could represent a health system's capacity to provide surgical care and standardize global surgical measurement. SUMMARY OF BACKGROUND DATA Six indicators have been proposed to assess access to safe, affordable, timely surgical and anesthesia care, with a focus on laparotomy, caesarean section, and treatment of open fracture. However, comparability, particularly for these procedures, has been limited by a lack of definitional clarity and their overly broad scope. METHODS We conducted a three round international expert Delphi exercise between April and June 2019 using REDCap to identify a set of procedures representative of surgical capacity. To be included, procedures had to be important for treating common conditions, well-defined, and impactful (i.e. well-recognized clinical or functional benefit). Procedures were eliminated or prioritized in each round, and those noted as "extremely" or "very important" by ≥ 50% of respondents in round 3 were included in the final "basket". RESULTS Altogether 331 respondents from 78 countries participated in the Delphi process. A final basket of 32 procedures representing diseases categories in trauma, cancer, congenital anomalies, maternal/reproductive health, aging, and infection were identified as important for inclusion to assess surgical capacity. CONCLUSIONS This surgical basket could allow a more standardized assessment of a country's surgical system. Further testing and refinement will likely be needed, but this basket can be used immediately to guide ongoing monitoring and evaluation of global surgery capacities to improve and strengthen surgery and anesthesia care.