Everyone in the world should have access to 44 surgical procedures. So says “Essential Surgery,” a reference book released today by the Disease Control Priorities Network (DCP3) in the University of Washington's Department of Global Health.

Making these 44 procedures available worldwide could avert 1.5 million deaths per year, said Charles Mock, UW professor of surgery and book editor.  “Essential surgical procedures are among the most cost-effective of all health interventions, with a cost-effectiveness similar to immunizations, bed nets, antiretroviral therapy for HIV and other interventions that have received wide attention and investment globally,” Mock said.

Essential-Jamison

The book cover and its lead editor, Dean Jamison, UW professor emeritus of global health.

pictures of the Essential Surgeries book cover and Dean Jamison of UW

Haile Debas, director of the Global Health Institute at the University of California, San Francisco, announced the book at the opening of the Consortium of Universities for Global Health meeting in Boston. Debas credited Dean Jamison, UW professor of global health and chief editor of the book, for putting surgery on the global health map.

“We’ve come a long way in global health to start the meeting with surgery,” Debas said.

Most of the procedures can be performed in first-level hospitals, the authors said in conveying the critical value of investment in those facilities.

For a long time, surgery was seen as a luxury and not essential to global health, said Atul Gawande, executive director of Ariadne Labs, while speaking to a packed conference session. This book is significant because it shows how cost-effective surgery is, he said, and the huge impact of such simple interventions as a surgical checklist and first-responder training. 

DCP3 found that by providing surgery for traffic injuries, obstetric emergencies and common ailments such as cataracts, poor countries could gain $10 worth of health benefits for every $1 invested.

The book has 80 authors from 20 countries. Andreas Stergachis, UW professor of epidemiology and global health; Carol Levin, UW senior research scientist in global health; and Joseph Babigumira, UW assistant professor of global health, were co-authors on chapters covering family planning, post-abortion care and the costs and cost-effectiveness of surgical procedures and platforms.

DCP3 was Jamison said DCP3 will be defining 12-15 essential packages to improve improving global health. The full series will compose nine individual volumes that will be published in 2015-2016. The Lancet published key messages from Essential Surgery and will be publishing key messages from all the volumes preceding their release, Jamison said.

LIST OF 44 PROCEDURES (sans authors' notations)

Dental

• Extraction
• Drainage of dental abscess
• Treatment for caries

Obstetric, gynecological and family planning

• Normal delivery
• Caesarean birth
• Vacuum extraction or forceps delivery
• Ectopic pregnancy
• Manual vacuum aspiration and dilation and curettage
• Tubal ligation
• Vasectomy
• Hysterectomy for uterine rupture or intractable post-partum hemorrhage
• Visual inspection with acetic acid and cryotherapy for precancerous cervical lesions
• Repair obstetric fistula

General surgical

• Drainage of superficial abscess
• Male circumcision
• Repair of perforations (perforated peptic ulcer, typhoid ileal perforation, etc)
• Appendectomy
• Bowel obstruction
• Colostomy
• Gallbladder disease (including emergency surgery for acute cholecystitis)
• Hernia (including incarceration)
• Hydrocelectomy
• Relief of urinary obstruction; catheterisation or suprapubic cystostomy (tube into bladder through skin)

Injury

• Resuscitation with basic life support measures
• Suturing laceration
• Management of non-displaced fractures
• Resuscitation with advanced life support measures, including surgical airway†
• Tube thoracostomy (chest drain)
• Trauma laparotomy
• Fracture reduction
• Irrigation and debridement of open fractures
• Placement of external fixator; use of traction
• Escharotomy or fasciotomy (cutting of constricting tissue to relieve pressure from swelling)
• Trauma-related amputations
• Skin grafting
• Burr hole

Congenital

• Cleft lip and palate repair
• Club foot repair
• Shunt for hydrocephalus
• Repair of anorectal malformations and Hirschsprung's disease

Visual impairment

• Cataract extraction and insertion of intraocular lens
• Eyelid surgery for trachoma

Non-trauma orthopedic

• Drainage of septic arthritis
• Debridement of osteomyelitis