Optimising resources for surgical procedures in Low resource settings: an Ontological Analysis

Background: Surgical care has been neglected in the global health agenda despite representing 30% of the global disease burden. Lack of timely and affordable access to surgical care, particularly to those in the poorest regions in low and middle income countries, result in high morbidity and high mortality from easy treatable conditions. In this study, we stratified and critically analyzed the most commonly performed surgeries with their costs in-order to ascertain the resources essential for the same using an ontological framework. Methodology: The total number of patients included in the study was 1374, of which 862 were males and 512 females. They underwent 1917 surgeries. The three most frequent procedures, with the frequencies in parentheses, were: Laparotomy (200), Inguinal Mesh Repair (180), and Major Debridement (170); the three least frequent were Liver Hydatid Cyst Drainage (8), Pilonidal/Gluteal Abscess Incision &Drainage (8), and Ray Amputation (8). The 1917 surgeries included 55 procedures. The 55 procedures were then coded onto an ontological framework. Results: Around 76% of the procedures cost within INR 25,000/- (approximately $375) and 56% of them were of Levels 1and 2 as per the standard surgical classification. Conclusions: A large group of procedures can be packaged and made available at low resource centers at an affordable cost to communities. It is possible to perform Level 1 and Level 2 surgeries in peripheral centers. This study serves as a starting point for policy makers and funders to incorporate surgical care as a necessary part of national health and development programs.