Study: Millions worldwide still lack access to essential surgical care

Progress towards universal access to safe, affordable surgical care is dangerously off track as at least 160 million patients each year are unable to receive surgery - with Low- and Middle-income Countries (LMICs) bearing the brunt of the crisis, a new study reveals. 

A global coalition of 60 health experts representing 20 countries is calling for urgent action to resolve the crisis – warning that only 26% of LMICs are on track to meet a target for everyone to be able to access essential surgery within 2 hours, and none have achieved the recommended surgical volume of 5,000 procedures per 100,000 people per year. 

Quality of surgical care remains a key concern, with 3.5 million adults worldwide dying within 30 days of surgery, considerably more than the combined 2 million adult deaths attributable to HIV/AIDS, tuberculosis, and malaria. Overall, 50 million patients worldwide suffer postoperative complications every year, with wound infection the most frequent complication. Surgery is a key contributor to antimicrobial resistance, with up to 96% of infected wounds in LMICs being linked to antimicrobial resistance. 

'Surgical Health Policy 2025–2035: Strengthening Essential Services for Tomorrow's Needs' is published today (14 July) in The Lancet by the University of Birmingham-led NIHR Global Health Research Unit on Global Surgery. 

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. 

• Focussing 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 inequalities in health outcomes. 

The report also emphasizes the role of surgery in achieving the Sustainable Development Goals (SDGs), citing its impact on health, economic productivity, and national security. It proposes a new set of benchmarks for 2025–2035 to guide global efforts and ensure accountability. 

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." 

Dr. Dmitri Nepogodiev, Co-lead author, University of Birmingham