• Tarsicio Uribe-Leitz, Micaela M Esquivel, George Molina, Stuart R Lipsitz, Stéphane Verguet, John Rose, Stephen W Bickler, Atul A Gawande, Alex B Haynes, and Thomas G Weiser.
• Department of Surgery, Stanford University, School of Medicine, 300 Pasteur Drive, Stanford, CA, 94305, USA, pturibe@stanford.edu.
• World J Surg. 2015 Sep 1; 39 (9): 2168-72.

BackgroundWe previously identified a range of 4344-5028 annual operations per 100,000 people to be related to desirable health outcomes. From this and other evidence, the Lancet Commission on Global Surgery recommends a minimum rate of 5000 operations per 100,000 people. We evaluate rates of growth and estimate the time it will take to reach this minimum surgical rate threshold.MethodsWe aggregated country-level surgical rate estimates from 2004 to 2012 into the twenty-one Global Burden of Disease (GBD) regions. We calculated mean rates of surgery proportional to population size for each year and assessed the rate of growth over time. We then extrapolated the time it will take each region to reach a surgical rate of 5000 operations per 100,000 population based on linear rates of change.ResultsAll but two regions experienced growth in their surgical rates during the past 8 years. Fourteen regions did not meet the recommended threshold in 2012. If surgical capacity continues to grow at current rates, seven regions will not meet the threshold by 2035. Eastern Sub-Saharan Africa will not reach the recommended threshold until 2124.ConclusionThe rates of growth in surgical service delivery are exceedingly variable. At current rates of surgical and population growth, 6.2 billion people (73% of the world's population) will be living in countries below the minimum recommended rate of surgical care in 2035. A strategy for strengthening surgical capacity is essential if these targets are to be met in a timely fashion as part of the integrated health system development.

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