• Paul Truche, Robert S Semco, Nathaniel F Hansen, Tarsicio Uribe-Leitz, Lina Roa, Benjamin G Allar, Ilan B Layman, Regan W Bergmark, Wendy Williams, Robert Riviello, Craig D McClain, Molly P Jarman, Zara Cooper, John G Meara, and Gezzer Ortega.
• Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA.
• Ann. Surg. 2023 Jun 1; 277 (6): 952957952-957.

ObjectiveTo determine the association between SAO workforce and mortality from emergent surgical and obstetric conditions within US HR Rs.BackgroundSAO workforce per capita has been identified as a core metric of surgical capacity by the Lancet Commission on Global Surgery, but its utility has not been assessed at the subnational level for a high-income country.MethodsThe number of practicing surgeons, anesthesiologists, and obstetricians per capita was estimated for all HRRs using the US Health Resources & Services Administration Area Health Resource File Database. Deaths due to emergent general surgical and obstetric conditions were determined from the Center for Disease Control and Prevention WONDER database. We utilized B-spline quantile regression to model the relationship between SAO workforce and emergent surgical mortality at different quantiles of mortality and calculated the expected change in mortality associated with increases in SAO workforce.ResultsThe median SAO workforce across all HRRs was 74.2 per 100,000 population (interquartile range 33.3-241.0). All HRRs met the Lancet Commission on Global Surgery lower target of 20 SAO per 100,000, and 97.7% met the upper target of 40 per 100,000. Nearly 2.8 million Americans lived in HRRs with fewer than 40 SAO per 100,000. Increases in SAO workforce were associated with decreases in surgical mortality in HRRs with high mortality, with minimal additional decreases in mortality above 60 to 80 SAO per 100,000.ConclusionsIncreasing SAO workforce capacity may reduce emergent surgical and obstetric mortality in regions with high surgical mortality but diminishing returns may be seen above 60 to 80 SAO per 100,000. Trial Registration: N/A.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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