Bellwethers versus Baskets: Operative Capacity and the Metrics of Global Surgery

Excerpt

A core concept promoted by health services researchers interested in the impact of surgical and anesthesia care on global health programs is that of “bellwether” procedures: that is, a select set of well-defined operations that represents the capacity of a facility or health ecosystem to provide surgical care. The Lancet Commission on Global Surgery (LCoGS) developed and proposed this concept by using three conditions—the acute abdomen, obstetric complications, and open fracture—that, if appropriately treated, collectively represented the capacity of a facility to deliver over 90% of emergency and essential surgical care [1, 2]. Treatment of these conditions became known as “Bellwether procedures”, defined as cesarean delivery, laparotomy, and treatment of open fracture, and were proposed as archetype operations to evaluate surgical delivery and the capacity of a health system to deliver complex but critically essential operative care. …