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56th Annual Meeting Abstracts

Global Operating Room Distribution and Pulse Oximetry Supply: an Estimation of Essential Infrastructural Components for Surgical care
Luke Funk, MD, MPH, Thomas G. Weiser, MD, MPH, William R. Berry, MD, MPH, Stuart R. Lipsitz, ScD, Alan F. Merry, MD, ChB, FRANZCA, FRCA, Atul A. Gwande, MD, MPH
Brigham and Women’s Hospital, Boston, MA

PURPOSE OF STUDY

Surgery is an essential component of health service delivery, but resources to ensure safe surgery are often inadequate.  We estimated the global distribution of operating rooms and quantified the availability of pulse oximetry, a possible indicator of operating room resources and an essential intraoperative monitoring device.

 

METHODS USED

We calculated operating room to hospital bed ratios in 7 regions based on profiles from 769 hospitals (92 countries) participating in WHO’s Safe Surgery initiative.  We used hospital bed information from all 192 WHO nations to estimate the number of operating rooms per 100,000 people in each of the 21 Global Burden of Disease sub-regions.  To estimate the availability of pulse oximetry, we sent surveys to anesthesia providers in 72 countries.  A predictive regression model was used to determine the pulse oximetry need for countries that did not have oximetry data available.

 

SUMMARY OF RESULTS

The number of operating rooms varies from 1.0 (95% CI 0.9-1.2) per 100,000 people in West Sub-Saharan Africa to 25.1 (95% CI 20.9-30.1) per 100,000 in Eastern Europe.  High income sub-regions all average more than 10 ORs per 100,000 people, while all low income sub-regions have less than 2 per 100,000.  Pulse oximetry data from 54 countries suggest that 19.2% (95% CI 15.2%-23.9%) of ORs worldwide are without pulse oximetry. 

 

CONCLUSIONS

At least 2 billion people worldwide have inadequate access to an operating room.  Even when an operating room is available, pulse oximetry is lacking in nearly one in five operating rooms.  Closing these resource gaps should be part of global health planning.

TABLES AND CHARTS

                       Estimated global number of operating rooms and their regional distribution

Sub-region

# of countries

Population

(millions)

Economic wealth

(GNI per capita)

Estimated Number of ORs

(95% CI)

Estimated number of ORs per 100,000 people

(95% CI)

Europe, Eastern

7

210.4

Upper middle

52,777 (43,951-63,373)

25.1 (20.9-30.1)

Asia Pacific, High Income

4

180.8

High

43,958 (38,995-49,554)

24.3 (21.6-27.4)

Europe, Central

12

119.1

Upper middle

18,747 (16,342-21,505)

15.7 (13.7-18.1)

Europe, Western

23

409.0

High

60,196 (53,478-67,757)

14.7 (13.1-16.6)

North America, High Income

2

335.4

High

48,037 (41,024-56,250)

14.3 (12.2-16.8)

Australasia

2

24.7

High

3,532 (2,095-5,954)

14.3 (8.4-24.1)

Latin America, Southern

3

58.9

Upper middle

8,058 (5,980-10,859)

13.7 (10.1-18.4)

Asia, Central

9

77.5

Lower middle

9,036 (7,938-10,286)

11.7 (10.2-13.3)

Caribbean

16

37.0

Lower middle

3,870 (3,129-4,785)

10.4 (8.4-12.9)

Latin America, Tropical

2

195.3

Upper middle

19,675 (14,306-27,058)

10.1 (7.3-13.9)

Asia, East

2

1,352.2

Lower middle

63,339 (55,758-71,551)

4.7 (4.1-5.3)

Latin America, Andean

3

50.1

Lower middle

2,263 (1,662-3,080)

4.5 (3.3-6.1)

Middle East / North Africa

18

413.6

Upper middle

17,592 (15,702-19,708)

4.3 (3.8-4.8)

Latin America, Central

9

218.1

Upper middle

8,729 (7,105-10,725)

4.0 (3.3-4.9)

Sub-Saharan Africa, Southern

6

68.5

Upper middle

2,104 (1,566-2,827)

3.1 (2.3-4.1)

Asia, Southeast

13

581.2

Lower middle

15,122 (13,578-16,842)

2.6 (2.3-2.9)

Oceania

14

8.3

Lower middle

162 (119-221)

1.9 (1.4-2.7)

Asia, South

6

1,523.1

Low

20,540 (17,944-23,512)

1.3 (1.1-1.5)

Sub-Saharan Africa, Central

6

87.0

Low

1,008 (743-1,368)

1.2 (0.9-1.6)

Sub-Saharan Africa, East

14

314.0

Low

3,472 (2,930-4,115)

1.1 (0.9-1.2)

Sub-Saharan Africa, West

19

308.1

Low

3,172 (2,662-3,780)

1.0 (0.9-1.2)

Totals

190

6,572.3

 

405,389 (385,405-426,408)

6.2 (5.9-6.5)

 

 
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