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c onnecting surgery to the social (justice) network

c onnecting surgery to the social (justice) network. ben bryner the sujal parikh memorial symposium on global health university of michigan March 26, 2011. w hy talk about surgery?. it’s “the neglected stepchild of global health” personal experience

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c onnecting surgery to the social (justice) network

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  1. connecting surgery to the social (justice) network ben bryner the sujalparikh memorial symposium on global health university of michigan March 26, 2011

  2. why talk about surgery? it’s “the neglected stepchild of global health” personal experience 234 million operations performed yearly (compare w/ ~137 million births annually)

  3. Things surgeons talk about • Things global health experts talk about International health Surgery

  4. this talk • Surgical diseases and disparities • What’s different about surgery • What’s being tried • Traps and possible ways to avoid them

  5. burden of surgical disease • Trauma accounts for 9% of mortality (WHO) • ~50% between 15-44 years

  6. An estimation of the global volume of surgery: a modelling strategy based on available data. Weiser, Regenbogen, Thompson, Haynes, Lipsitz, Gawande. The Lancet, 3723:9633, 139-144, July 2008

  7. ~1100 units worldwide

  8. 77,000 operating rooms worldwide have no pulse oximeter

  9. case studies • TD: 81yo with diverticulitis, complicated by multiple intraabdominal infections, pneumonia • 39 separate operations and procedures • 376 days in the surgical ICU • 1126 notes

  10. how is surgery different? • less (directly) reliant on licensing • heavy reliance on supply streams, • prolonged training • facilities / referral networks • prehospital care

  11. university initiatives • HMS – Program in Global Surgery and Social Change • OHSU – International Surgery Program • International Surgery Research Fellowship • UCSF - Global Partners in Anesthesia and Surgery • Projects in IT, prehospital responder training • Children’s Hospital Boston – Global Surgery Fellowship

  12. survey of US surgery residencies • Perceived barriers to international rotations: Global Health in General Surgery Residency: A National Survey Sudha P. Jayaraman, Alexander L. Ayzengart, Laura H. Goetz, DorukOzgediz, and Diana L. Farmer Journal of the American College of SurgeonsVolume 208, Issue 3, March 2009, Pages 426-433

  13. survey of US surgery residencies • Reciprocal benefits to non-US sites: Global Health in General Surgery Residency: A National Survey Sudha P. Jayaraman, Alexander L. Ayzengart, Laura H. Goetz, DorukOzgediz, and Diana L. Farmer Journal of the American College of SurgeonsVolume 208, Issue 3, March 2009, Pages 426-433

  14. other organizations • Canadian Network for International Surgery • Bethune Round Table • Workshops • GHDonline/surgery

  15. WHO approach • Improving safety regardless of resource availability • Safe Surgery Saves Lives / checklist initiative: • estimated 500,000 lives per year could be saved

  16. traps

  17. sticking around FIGURE 1. Mortality, complication, and failure to rescue rates for medicare patients undergoing six major abdominal operations. Complications, Failure to Rescue, and Mortality With Major Inpatient Surgery in Medicare Patients. Ghaferi, Amir; Birkmeyer, John; Dimick, Justin Annals of Surgery. 250(6):1029-1034, December 2009.

  18. Sujal’s example

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