Progress towards universal access to safe, affordable surgical care is alarmingly off track, with over 160 million patients each year unable to receive surgery.
Low- and middle-income countries (LMICs) are bearing the brunt of the crisis, a new study reveals.
A global coalition of 60 health experts from 20 countries is calling for urgent action to address the crisis – warning that only 26% of LMICs are on course to meet a target for universal access to essential surgery within two hours.
No one has reached the recommended surgical volume of 5,000 procedures per 100,000 people annually.
The standard of surgical care remains a major concern, with 3.5 million adults worldwide dying within 30 days of surgery – a figure considerably higher than the two million adult deaths caused by HIV/AIDS, tuberculosis and malaria combined.
Overall, 50 million patients worldwide experience postoperative complications each year, with wound infection being the most common complication. Surgery significantly contributes to antimicrobial resistance, with up to 96% of infected wounds in LMICs being associated with antimicrobial resistance.
‘Surgical Health Policy 2025–2035: Strengthening Essential Services for Tomorrow’s Needs’ was published in July in The Lancet by the NIHR Global Health Research Unit on Global Surgery, led by the University of Birmingham.
Senior author Professor Aneel Bhangu, from the University of Birmingham, commented: ‘Surgery is not a luxury. It is a lifesaving, cost-effective intervention that underpins resilient health systems. Without urgent investment, millions will continue to suffer and die from treatable conditions.’
Researchers in the group, which is backed by funding from the UK’s National Institute for Health and Care Research (NIHR), have made several key recommendations, including:
• Reframing surgery as a foundational component of well-integrated health systems, rather than a siloed intervention, investing in surgery can boost patient care across numerous diseases by increasing access to diagnostics, intensive care, and critical drugs.
• Unlocking a ‘surgical prosperity dividend’ by increasing access to essential surgery; for example, scaling up breast, stomach, colon, and rectal cancer surgery in LMICs could enable 884,000 people to return to work and boost the global economy by over $80 billion each year.
• Developing innovative funding models for surgery; currently half of patients undergoing cancer surgery in LMICs make out-of-pocket payments which can result in catastrophic expenditure and poverty.
• Focusing efforts on making surgical services more resilient to future emergencies, including pandemics, climate change, natural disasters, and armed conflict.
• Adopting circular economy principles in surgical systems to reduce both waste and carbon emissions from operating theatres, which currently account for up to 25% of total hospital emissions.
• Addressing gender disparities in surgical leadership and improving access for marginalised populations to address health inequalities.
The report also emphasises the significance of surgery in achieving the Sustainable Development Goals (SDGs), highlighting its impact on health, economic productivity, and national security. It presents a new set of benchmarks for 2025–2035 to guide global efforts and enhance accountability.
Co-lead author Dr Dmitri Nepogodiev, from the University of Birmingham, said: ‘With widespread cuts to global health funding this year, we are at a pivotal moment for surgery. We must continue to secure funding to expand access to surgery while maintaining quality.
‘At the same time, we must prepare surgical systems for an increasingly unpredictable world. Pandemics, climate change, and armed conflict all threaten to disrupt care in the future, but most countries have made little progress in their preparedness since the COVID-19 pandemic.’
