Understanding the determinants that limit the population's access to surgical care in health services is highly relevant in order to provide data to support political interventions.

This study aimed to evaluate the time between diagnosis and elective surgery in adult patients with the longest waiting lists in Brazil; identify the determinants that interfere with access to the health service to perform surgery; and analyze the quality of life after the indicative diagnosis of surgical intervention.

A cross-sectional study was conducted with adult patients treated at three hospitals in the Southeast, North and South regions of Brazil, from October 2020 to October 2022. Data collection included socio-demographic data and assessment of quality of life using the WHOQOL-Bref instrument in the immediate postoperative period and one month after surgery.

A total of 250 patients participated in the study, 55.6% patients from the Southeast, 20.4% patients from the North and 24% patients from the South, with a mean age of 51.86 (SD = 14.27) years and clinical history such as arterial hypertension (p < 0.001). The longest mean waiting time for surgery identified was 26.23 (SD = 17.62) months in the South region, with a significant difference between the evaluated institutions (p = 0.02). Differences were observed between the first place of care of the evaluated patients (p < 0.001). There was a difference in the perception of quality of life between the immediate and late postoperative periods (p = 0.007) and in the physical domain, with an increase in scores among older patients (p = 0.004) and previous clinical history (p = 0.03).

Access to the health system varies by region and does not meet the standards proposed by the Brazilian health system. In addition, it seems that longer waiting times for surgery more perceptibly affect the quality of life of older adults and those with other associated diseases.

Pediatric surgical care is limited in Afghanistan. Few details are known about the state of pediatric surgery in Afghanistan. We explore the impact of a newly installed pediatric operating room by a children's charity on the provision of pediatric surgery in Afghanistan.

After the opening of the new Kids Operating Room at Ataturk Hospital in Kabul, Afghanistan, in March 2023, perioperative clinical data were prospectively collected until December 2023. All children (younger than 14 years of age) undergoing surgical procedures were included in a Research Electronic Data Capture database, and descriptive analyses were performed.

A total of 1,014 operations were performed during the study period. Seventy-three percent of the patients were from Kabul Province, and 80% were male. Thirty-four percent of the operations were emergencies. Mean age was 6.5 years. Patients who received elective surgery were, on average, younger (age 5.2 years) compared with those who received emergency surgery (age 7.6 years [p < 0.0001]). The most common emergent diagnoses were appendicitis (52%), intussusception (9%), genitourinary pathologies (8.7%), and neurosurgical trauma (6.1%). The most common elective cases were hernias 27%, undescended testes (18%), hypospadias/epispadias (9%), urinary tract stones (8%), hydrocele/spermatocele/varicocele (7%), gastrointestinal pathologies (7%), and neurosurgical disorders (6%). The most frequent procedures were appendectomy (18%), inguinal hernia repair (17%), and orchidopexy (13%). The rates of mortality and infectious complication were both 0.3%.

This is the largest study on the provision of pediatric surgical care in Afghanistan, demonstrating the successful implementation of infrastructure for surgical capacity in a low-resource setting with a complex political status. Future efforts to quantify the burden of untreated pediatric surgical disease in this setting should assist advocacy efforts toward resource allocation and public health initiatives.

Laparotomy is a common surgical procedure that entails incision of the abdomen and is associated with varying degrees of postoperative pain. Laparotomies can be performed in mice and result in facial grimacing, which can be quantified using PainFace, a software platform that automates facial grimace analyses.

We evaluated the extent to which incision of the ventral skin, peritoneum, and intestinal manipulation, all of which can occur as part of a laparotomy surgery, affects the magnitude and duration of facial grimacing in 2 strains of mice along with allodynia at the incision site in CD-1 mice.

White-coated CD-1 male and female mice and black-coated C57BL/6 male mice (8-12 weeks of age) were split into groups (n = 20 per group) that underwent laparotomies with varying manipulations.

Mouse grimace scale scores were higher in both strains after surgery when the small intestine was manipulated in 2 different ways compared to groups that received a cutaneous incision alone or cutaneous and peritoneal incision.

These studies show that mice exhibit more pronounced facial grimacing when both cutaneous and visceral tissues are injured during laparotomy surgery. Consistent with clinical findings, our experiments suggest that postoperative pain could be reduced by minimizing visceral tissue injury during surgical procedures.

In Ethiopia and other low-and middle-income countries, access to emergency and elective surgical care is still inadequate and inequitable. Ethiopia has initiated a nationwide strategic plan aimed at tackling obstacles within the surgical system. The aim of this study was to assess surgical and anesthesia care capacity and productivity in high volume Ethiopian hospitals.

An explanatory mixed-methods study was conducted in 24 high-volume public hospitals across Ethiopia's 10 regions and 2 city administrations. Data were collected through structured document reviews, site observations, and interviews using a validated WHO-aligned tool. Quantitative data were analyzed using SPSS, and qualitative responses were thematically analyzed using ATLAS.ti.

Addis Ababa hosts over 60% of the national surgical workforce, highlighting stark regional disparities. While 80% of hospitals reported adequate infrastructure, site observations revealed functional inconsistencies in PACU design, sterilization units, and equipment availability. Only 77% of hospitals consistently implemented patient monitoring and handover protocols. Surgical productivity was low, with an average of 2.5 surgeries per week per clinician and 52.39% annual workforce productivity. Best practices included the use of EMRs, backlog-reduction campaigns, and daily interdisciplinary briefings. However, persistent challenges included inadequate staffing, poor infrastructure, and uneven adoption of safety protocols.

Ethiopia's surgical system shows promising innovations in select hospitals, yet national scale-up is hindered by infrastructure gaps, uneven workforce distribution, and inconsistent safety practices. Addressing these challenges requires data-driven planning, targeted investment in underserved regions, and expanded use of digital systems and collaborative networks to promote best practice adoption across facilities.

Peripheral nerve blocks (PNB) have gained tremendous interest as a means of providing anesthesia and analgesia. Heterogeneity exists in the standards of practice (SoP) for PNB, especially in resource limited settings. Therefore, this study aimed to determine the SoP for administration of PNB at a tertiary care, University teaching hospital, in a low-middle income country (LMIC).

This was a prospective observational study conducted between September 2021 and March 2023. The SoP were collected through either direct or indirect observation, using a self-developed proforma. Data were collected for various domains and were mapped to structure, process and outcome. They were then benchmarked to identify best practices and deficiencies.

A total of 386 PNBs were recorded, of which 196 (50.8%) were directly observed. Majority were administered to low-risk individuals without comorbidities (61.9%). In the structure metrics resuscitation equipment was available in 76% while availability of resuscitation drugs (29%) was identified as needing improvement. Individual components of process metrics such as intravenous access, use of personal protective equipment, ultrasound guided block technique and use of short bevel needles exceeded the 95% benchmark, while components such as monitoring (54%), aseptic site preparation (76.5%), the Stop Before You Block procedure (61.9%) and use of block additives (70.2%) fell short of the benchmark. Postoperative multimodal analgesia prescription (4.7%) was identified as needing improvement. Of the outcome metrics, while immediate post-block complications (0%) and conversion rate to general anesthesia (8.3%) exceeded the benchmark (< 10%), cumulative toxic dose was exceeded (36.6%) when a mixture of local anesthetics was used.

Standards of practice for structure, process and outcome were partly achieved for PNB at this tertiary care center in a low-middle income country. Strategies to improve SoP have been proposed and will need to be evaluated in future quality improvement initiatives.

Provision of anesthesia care must go hand in hand with surgical care to equitably widen surgical coverage of underserved populations, especially the rural segments of low- and middle-income countries. The aim of this study was to assess the availability of key items and infrastructure needed for anesthesia care.

We conducted a cross-sectional survey at ten subdistrict or taluqa headquarter (THQ) hospitals and five district headquarter (DHQ) hospitals in six rural districts of the Sindh province of Pakistan using the Anesthesia Facility Assessment Tool. We assessed the domains of infrastructure, workforce, service delivery, conduct of anesthesia, equipment, and medications. We also scored these components and then compared the difference in mean scores.

Three hospitals did not meet the minimum bed number required for a secondary hospital. Four hospitals had nonfunctioning operating rooms and conducted procedures elsewhere. Ten had full-time, certified anesthesiologists, while 11 had a postanesthesia care unit. There were only two hospitals with critical care units providing mechanical ventilation, and only one hospital conducting telemetry. Six hospitals did not have a dedicated anesthesia provider present at all times. Thirteen hospitals did not use the World Health Organization preoperative checklist before performing procedures. There were deficiencies in drugs such as hypnotics, opioids, and vasopressors.

There are many shortcomings in anesthesia care provision among these rural hospitals. Greater attention and investment are needed to safely conduct anesthesia in this setting.

Background: Vitamin D is vital for musculoskeletal health, with emerging evidence highlighting its role in muscle function. While its preoperative and postoperative benefits for bone health are well documented, the effect of vitamin D supplementation on post-surgical muscle recovery remains underexplored. This systematic review consolidates current evidence on the impact of vitamin D supplementation in enhancing muscle strength following surgery. Methods: This review adhered to PRISMA guidelines and was registered on PROSPERO. A systematic search of PubMed, EMBASE, and Cochrane databases was conducted, covering articles from inception to 15 January 2025. Studies evaluating the effect of vitamin D supplementation on muscle strength in surgical contexts were included. Data extraction focused on study design, population demographics, vitamin D dosage, timing, and measured outcomes. A narrative synthesis was performed due to heterogeneity in study designs and outcomes. Results: From 701 initial records, 10 studies met the inclusion criteria. The findings indicate that vitamin D supplementation, particularly high-dose regimens administered preoperatively or early postoperatively, significantly improves muscle strength and functional outcomes in orthopaedic surgeries, such as hip and knee replacements, and bariatric surgeries. The benefits varied by surgical type, baseline vitamin D levels, and supplementation strategy. However, inconsistent dosing regimens and limited long-term follow-up studies hinder conclusive evidence. Conclusions: Vitamin D supplementation demonstrates potential in enhancing post-surgical muscle recovery and functional outcomes. Tailored supplementation strategies, based on patient-specific needs and surgical context, are essential. Future research should address optimal dosing regimens and evaluate long-term impacts on recovery and quality of life.

Obstetric fistulas are common in low-resourced settings, but the factors associated with successful repair remain unclear in Zambia. We assessed the socio-demographics, fistula characteristics, and healthcare factors associated with successful obstetric fistula repair outcomes in Zambia.

Our retrospective cohort study was based on the Zambia Fistula Foundation Treatment Network's clinical database, including 1439 women who underwent obstetric fistula surgical repairs at hospitals in Zambia between 2017 and 2023. Tanahashi's Health Services Coverage framework guided the selection of potential factors associated with successful obstetric fistula repair outcomes. We employed Multivariate Imputation by Chained Equations (MICE) before conducting logistic regression analyses. Univariable models, a multivariable model, and marginal probabilities were then fitted to examine the associations between successful obstetric fistula repair outcome, a fistula that is closed and dry, and relevant covariates.

Our results showed an overall fistula repair success rate of 88.1%. Patients from the Northern and Muchinga provinces showed 51% (AOR = 0.49, 95% CI = 0.27, 0.90) lower odds of surgical repair success compared to those from Central and Lusaka provinces. Patients with a previous fistula repair had 47% lower odds of success (AOR = 0.53, 95% CI = 0.32, 0.87) than those without. Finally, surgeries rated intermediate in difficulty had 64% (AOR = 0.36, 95% CI = 0.18, 0.70), and those rated difficult had 90% (AOR = 0.10, 95% CI = 0.05, 0.21) lower odds of success than simple repairs.

We identified geographic location, previous repair history, and surgical complexity as the factors associated with successful obstetric fistula repair outcomes.

Living donor liver transplantation (LDLT) is crucial for addressing organ scarcity and improving survival and quality of life. Variations in practices and outcomes are influenced by geographic, economic, and cultural factors. This study examined the association between short-term LDLT outcomes and the Human Development Index (HDI), a composite metric ranking countries by life expectancy, education, and income. Data from September 2023 to June 2024 were prospectively collected through the International LDLT Registry, involving 70 institutions from 26 countries. This prospective global cohort included 1,575 pairs (3,150 cases). Donors from very high HDI regions had a higher prevalence of comorbidities (17.4%) than those from low HDI regions (1.2%, p<0.001). High HDI regions showed lower donor complication rates (9.8%) compared to lower HDI regions (21.4%, p<0.001). Multivariable analysis indicated significantly reduced short-term postoperative donor morbidity in very high HDI regions (OR 0.32, 95% CI 0.23-0.44, p<0.001). Failure-to-rescue rates were substantially higher in low HDI regions (83.3% vs. 2.3%, p<0.001). The study highlights the significant disparities in LDLT practices and short-term outcomes across HDI levels, emphasizing the need for global cooperation to standardize practices and enhance care quality to ensure equitable access to liver transplantation worldwide.

Access to surgery across sub-Saharan Africa faces persistent challenges with substantial disparity between disease burden and the surgical workforce. This updated situational analysis of specialist surgeons was undertaken to monitor progress toward global surgery development goals and address workforce deficits.

A cross-sectional analysis of the surgeon workforce across 12 of the 14 member countries of The College of Surgeons of East, Central and Southern Africa (COSECSA) was conducted between 2021 and 2022. The data was validated by at least two sources, including medical council registers and direct contact with surgeons via COSECSA Country representatives. Results were compared to data collection undertaken in 2015.

2555 surgeons were identified as practising within the region, a 42% increase since 2015. This represents a rise of only 0.06 surgeons per 100,000. Surgeon density varies widely, with an 18-fold difference between the lowest (Mozambique, 0.22/100,000) and the highest surgeon densities (Namibia, 3.97/100,000). Women surgeons constitute one-tenth of the surgical workforce, a figure stagnant since 2015. Most surgeons (58%) practice in highly populated areas, and 78% work in their country of primary qualification.

Currently there is a higher rate of population growth relative to surgical workforce expansion. Innovative approaches in surgical training are crucial to meet 2030 workforce targets. The non-progression in the ratio of female to male surgeons demands attention. Future workforce planning should recognize the growing impact of female doctors on the healthcare workforce and prioritize strategies to support women in surgical careers.

The Komfo Anokye Teaching Hospital (KATH) in Ghana serves a population of over 5.4 million people. The number of operating rooms creates a bottleneck to accessing surgical care. In a previously published paper, the plastic surgery department at KATH sought to utilize a wide-awake local anesthesia no tourniquet (WALANT) technique to perform hand surgery as a solution to improving surgical capacity. This technique, popularized by Donald H. Lalonde, was first utilized in February 2017 at KATH. We aim to provide an update on the utilization of this procedure room created almost a decade ago.

Surgeries from January 1, 2023, to December 31, 2023, were included in this study. Procedures were categorized into elective versus emergent, and information regarding the cost of procedures for the patient was analyzed.

In 2023, a total of 500 surgeries were performed in the WALANT procedure room, with an average of 42 surgeries performed monthly. This represents a 40% increase in surgical volume compared to 2017. The plastic surgery team performed a total of 188 hand surgeries and 249 nonhand reconstructive surgeries. The procedure room has also garnered increased utilization from general surgery and orthopedic surgery, with an 86.4% increase in utilization from 2017. Prices remain comparable to prices in 2017 and remain more cost-effective compared to the same procedure done under general anesthesia in the main operating room. A total cost savings for patients of ₵578,816.30 was achieved for the 2023 year.

This local anesthesia technique and subsequent procedure room were born out of a necessity to increase surgical capacity at a major tertiary center in Ghana. Over the past 7 years, it has proven to be increasingly productive while remaining cost-effective for both patients and the hospital system alike. The transformation of a storage room into this procedure room shows how easily replicable this setup can be throughout other hospital systems. Finally, WALANT is an accepted practice in many parts of the world, and is easily learned. This model is thus a sustainable and practical solution to the surgical capacity problems facing overburdened medical systems in developing countries.

ObjectiveTo evaluate learners' acceptance of multiuser virtual reality (VR) simulation platform while practicing the Furlow repair technique for cleft palate reconstruction.DesignNonrandomized with pre- and postsurveys.SettingTertiary care institution's Department of Surgery September 2023 through August 2024.ParticipantsTwenty plastic surgery residents from level PGY1 to PGY6 from a single institution.InterventionsMultiuser Meta Quest 2 VR simulation-based workshop with an expert surgeon demonstrating a Furlow cleft palate repair. Feedback included audio and visual.Main outcome measuresLearner confidence in using VR as a tool for surgical education, understanding of the Furlow technique, and opinion regarding the incorporation of VR into surgical and medical education. Satisfaction as measured by the Student Evaluation of Educational Quality questionnaire survey with a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree).Results20 residents participated in this study, of which 65% had previously participated in a cleft palate repair and 40% had used VR. After the simulation, trainees' confidence in using VR as a tool for surgical education, understanding of the Furlow technique, and opinion regarding the incorporation of VR into surgical and medical education significantly increased (P < .05). Trainees found the simulation stimulating (4.85 ± 0.67), interesting (4.45 ± 0.83), clear (4.60 ± 0.82), an effective teaching tool (4.75 ± 0.44) and would recommend it to others (4.90 ± 0.31). Participants reported that they would feel somewhat comfortable repeating the simulation alone (3.95 ± 1.05).ConclusionMultiuser VR-based simulation workshops can significantly increase learners' confidence and skills in the Furlow technique and promote positive opinions regarding VR as an educational tool. Learners considered this platform effective and stimulating and would recommend it as an educational tool.

To show the feasibility of performing human telesurgery robotic-assisted radical prostatectomy (RARP) between two countries using low-latency ultra-long-distance connectivity. This study described the outcomes of performing RARP on a man in his 60's with localized intermediate-risk prostatic adenocarcinoma located in Kuwait City while the surgeon (SA) was approximately 7000 kilometers (Km) away at Toumai robotic surgical system (TRSS) headquarters in Shanghai. Operative and connectivity details were reported. RARP was performed in December 2024. There were no major clinical or technical problems encountered during the procedure. The average round-trip latency (RTL) was 181.4 milliseconds (ms) using fiber optic broadband network with 5G network as back-up. On the Shanghai end two wired broadband networks were employed as back-up to ensure patient safety. There was an experienced fellowship-trained robotic surgeon (AA) in the operating room in Kuwait capable of taking over in case of clinical or connectivity issues. There were no reported complications. The patient was discharged on postoperative day (POD) 2. Final pathology described Gleason score 7(3 + 4), ISUP 2, and negative surgical margins (pT2Nx). The catheter was removed on POD 9, and the patient was continent a week later. His serum prostate specific antigen (PSA) was undetectable seven weeks post-operatively. This study described the feasibility of human RARP telesurgery between two countries using low-latency, long-distance fiber optic broadband network with 5G network as back-up with successful clinical outcomes. There is a need to establish robust legal and regulatory framework to allow wider international expansion of telesurgery.

Background: This study aimed to assess the impact of Enhanced Recovery After Surgery (ERAS) compliance and to identify which components of this protocol are most likely to affect postoperative outcomes in patients undergoing colorectal cancer surgery. Methods: This is a retrospective cohort evaluating patients who underwent elective colon resection. ERAS compliance was assessed based on adherence to the protocol components. The study examined the following outcomes: postoperative complications, readmission rates, mortality, conversion to open surgery, stoma creation, and length of hospital stay. Results: Of the 410 patients studied, 59% achieved ≥75% compliance. Comparison between compliance groups (<75% versus ≥75%) showed significant differences in overall complications (P = .002), severe complications (P = .001), and length of hospital stay (P < .001). The area under the receiver operating characteristic curve for predicting the absence of severe complications based on ERAS compliance was 0.677 (95% confidence interval: 0.602-0.752). Logistic regression analyses demonstrated that ERAS compliance was significantly associated with a reduced risk of severe complications (P < .001), as well as that the following items: avoiding prophylactic drains (P < .001), minimal use of postoperative opioids (P = .045), avoidance of postoperative salt and water overload (P < .001), postoperative nutritional support (P = .048), and early mobilization (P = .025). Conclusion: High ERAS compliance is associated with improved postoperative outcomes in colorectal cancer surgery. Key protocol components for preventing severe complications include avoiding prophylactic drains, minimal postoperative opioid use, avoiding salt and water overload, nutritional support, and early mobilization.

With life expectancies increasing worldwide, there is a concomitant rise in the incidence of fragility fractures. As such, low-income and lower-middle-income countries (LICs and LMICs) will be faced with increased incidences of hip fractures. The care of these fractures is adversely affected by various factors that include under-resourced healthcare systems and large socioeconomic disparities, which disproportionately affect patient care in these regions relative to high-income countries. The purpose of this study was to determine treatment trends and outcomes of hip fracture care in lesser resourced regions as reported in primary literature sources through a systematic review.

The article search was conducted on December 16, 2020, and April 14, 2022, in 3 databases: PubMed, Web of Science, and Embase. A search strategy unique to each database was developed with a research librarian using English search terms.

Studies were selected using DistillerSR systematic review software. Two rounds of screening were performed for inclusion: 1) title and abstract screening and 2) full-text screening. Two researchers independently reviewed all articles. No articles were excluded based on language.

The extracted information included country, study demographics and design, hip fracture location, treatment, and outcomes.

Of the 2533 initially identified abstracts, a total of 24 articles met the criteria for inclusion and were selected for final data extraction after full-text screening.

This systematic review demonstrates a paucity of research evaluating geriatric hip fractures in LICs and LMICs. Additional research is needed to better characterize the preferred treatment by fracture type and associated complications in resource-limited environments.

There is an urgent need to mitigate the environmental impact of surgery, with surgery representing a major contributor to carbon emissions. This study explores literature detailing current sustainability practices and initiatives in plastic surgery and evaluates methods used to facilitate the attainment of net zero targets.

Following the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidelines, a systematic search was performed using MEDLINE, EMBASE and Cochrane Library databases (PROSPERO registration number CRD42023446104). Studies pertaining to sustainability practices in plastic surgery were included.

An initial search yielded 1083 studies, of which 15 met inclusion criteria. The studies were analysed for data on waste, carbon footprint and cost reduction. Hand surgery was the leading subspecialty with initiatives to tackle waste, such as using procedure-specific surgical packs of the Wide-Awake Local Anaesthesia No Tourniquet technique, while also considering surgeons' preferences. Other initiatives were implemented in craniofacial, skin cancer and breast surgery. Successful recycling initiatives were reported with a monthly average of 39.6 tonnes of waste redirected to be recycled per month. Five studies, from skin and hand surgery, demonstrated a simultaneous benefit through reduction in cost by individualising sustainability practices for specific procedures. The average carbon footprint per procedure, of the included studies reporting emissions, was 22.7 kgCO2-eq.

This systematic review demonstrated the necessity of an agile approach towards implementing sustainability practices, tailoring sustainability strategies to the requirements of each surgical procedure. The development of standardised outcome sets to evaluate the best practices in sustainability was emphasised.

Every year, around 300 million surgeries are conducted worldwide, with an estimated 4.2 million deaths occurring within 30 days after surgery. Adequate patient education is crucial, but often falls short due to the stress patients experience before surgery. Large language models (LLMs) can significantly enhance this process by delivering thorough information and addressing patient concerns that might otherwise go unnoticed.

This cross-sectional study evaluated Chat Generative Pretrained Transformer-4o's audio-based responses to frequently asked questions (FAQs) regarding six general surgical procedures. Three experienced surgeons and two senior residents formulated seven general and three procedure-specific FAQs for both preoperative and postoperative situations, covering six surgical scenarios (major: pancreatic head resection, rectal resection, total gastrectomy; minor: cholecystectomy, Lichtenstein procedure, hemithyroidectomy). In total, 120 audio responses were generated, transcribed, and assessed by 11 surgeons from 6 different German university hospitals.

ChatGPT-4o demonstrated strong performance, achieving an average score of 4.12/5 for accuracy, 4.46/5 for relevance, and 0.22/5 for potential harm across 120 questions. Postoperative responses surpassed preoperative ones in both accuracy and relevance, while also exhibiting lower potential for harm. Additionally, responses related to minor surgeries were minimal, but significantly more accurate compared to those for major surgeries.

This study underscores GPT-4o's potential to enhance patient education both before and after surgery by delivering accurate and relevant responses to FAQs about various surgical procedures. Responses regarding the postoperative course proved to be more accurate and less harmful than those addressing preoperative ones. Although a few responses carried moderate risks, the overall performance was robust, indicating GPT-4o's value in patient education. The study suggests the development of hospital-specific applications or the integration of GPT-4o into interactive robotic systems to provide patients with reliable, immediate answers, thereby improving patient satisfaction and informed decision-making.

Neurosurgical nursing involves the provision of pre- and post-operative care to neurologic patients. Specialized nurses in the field of neurosurgery are vital for patient outcomes and wellbeing. Nevertheless, there is underestimation and limited access to neurosurgical nursing in low- and middle-income countries (LMICs). This review primarily aims to shed light on the significance of nursing in the neurosurgical department of LMICs. It provides insight into the healthcare systems, the collaborative approaches that emerged in this concern, and the issues pertaining to integrating neurosurgical nursing in these countries.

Literature search was conducted from March 2024, where the articles were retrieved from PubMed/Medline, EBSCOhost, Google Scholar, and Embase. The terms "neurosurgical nursing," "neurosurgery," "neurosurgical care," "neurosurgical nurses," and "low- and middle-income countries OR LMICs" were used to search relevant studies. Previous articles discussing neurosurgical care in LMICs were considered in this review.

Nurses participate in 90% of interactions between healthcare providers and patients. They provide holistic care by considering the physical, cultural, and psychosociological needs pertaining to their patients. Furthermore, they possess ability to establish rapport via communication with patients which improves the standard of care delivered. To achieve results satisfactory to the wellbeing of affected populations, neurosurgical disciplines necessitate the aid of skilled nursing colleagues. However, there is a lack of relevant technology, innovations, and funding alongside human resources in LMICs.

Education, training, and dynamic collaboration are crucial factors for neurosurgical nurses to provide the best quality of care to patients. It is also pivotal to focus on research concerning the present issue, implement further policies which encourage dynamic cooperation between the neurosurgical multidisciplinary team, and collaborate on a global level to enhance neurosurgical nursing in LMICs.

Climate change is an emerging global health crisis, disproportionately affecting low- and middle-income countries (LMICs) where health outcomes are increasingly compromised by environmental stressors such as pollution, natural disasters, and human migration. With a focus on promoting health equity, Global Surgery advocates for expanding access to surgical care and enhancing health outcomes, particularly in resource-limited and disaster-affected areas like LMICs. The healthcare industry-and more specifically, surgical care-significantly contributes to the global carbon footprint, primarily through resource-intensive settings, i.e. operating rooms that generate greenhouse gases and substantial medical waste. Therefore, Global Surgery efforts aimed at improving surgical access through an increase in surgical volumes may inadvertently exacerbate health challenges for vulnerable populations by further contributing to environmental degradation. This predicament is particularly pronounced in LMICs, who already suffer from a disproportionate share of the global burden of disease, and where the demand for surgery is rising without corresponding resilient infrastructure. LMICs face a double jeopardy of health inequity coupled with climate vulnerability. As a movement positioned to improve health around the world, Global Surgery has an increasingly significant role in envisioning and ensuring a sustainable future. Global Surgery initiatives must prioritise sustainable infrastructure in both high-income countries (HICs) and LMICs, all while accounting for the unequal polluting contributions between HICs and LMICs and, consequently, moral responsibilities moving forward. Moreover, through targeting upstream causes of poor health at urban and perioperative levels, Global Surgery's interventions may help to reduce the global burden of disease-avoiding preventable surgeries and their carbon footprints from the outset. Altogether, Global Surgery and climate change are two matters of social justice whose solutions must synergistically centralise the health of both the planet and its most vulnerable people.

Abortion-related complications significantly contribute to maternal morbidity and mortality globally. Post-abortion care (PAC) services are essential to safeguarding women's rights by substantially mitigating the health risks associated with abortions - a step which is fundamental to achieving reproductive and maternal health-related Sustainable Development Goals.

We conducted a secondary analysis of data from the nationally representative Service Provision Assessment (SPA) surveys conducted between 2015 and 2024 across three regions in seven low- and middle-income countries: Afghanistan, Bangladesh, Nepal, the Democratic Republic of Congo (DRC), Ethiopia, Senegal, and Haiti. We included 2951 primary facilities and 473 referral facilities offering normal delivery services. We used PAC signal functions to report capacity to provide basic and comprehensive PAC services in primary and referral facilities, respectively.

Of all primary facilities offering normal delivery services, 50% in Afghanistan, 1% in Bangladesh, 8% in Nepal, 5% in DRC, 34% in Ethiopia, 38% in Senegal, and 19% in Haiti had the capacity to provide basic PAC services. Of the referral facilities, 47% in Afghanistan, 16% in Bangladesh, 50% in Nepal, 52% in DRC, 75% in Ethiopia, 46% in Senegal, and 32% in Haiti had the capacity to provide comprehensive PAC services. Primary facilities in Bangladesh, DRC, and Nepal had critical gaps in referral, ie, effective communication with referral centres and availability of a functional vehicle for emergency transportation. In referral facilities, 74% in Bangladesh and 59% in Nepal had the provision of blood transfusion. In terms of basic PAC services in primary facilities, the capacity of Senegal (from 16% in 2015 to 38% in 2019; P = 0.001) and Haiti (from 12% in 2013 to 19% in 2018; P = 0.007) increased, but the capacity of Bangladesh decreased (from 4% in 2014 to 1% in 2017; P = 0.016) over time.

There are substantial gaps in the capacity to provide basic and comprehensive PAC services in the selected countries. Investing in primary healthcare and improving communication and transportation should be the priority for enhancing basic PAC services, while strengthening referral hospitals to effectively handle emergencies and conduct major surgeries could significantly bolster their capacity to provide comprehensive PAC services.

Around five billion people globally lack access to safe, timely, and affordable surgical facilities and care in low-income and middle-income countries (LMICs). Global initiatives have been launched, including efforts led by organizations. Also, regional efforts have shed light on the unique challenges faced by different areas within LMICs. Despite these efforts, many countries still face significant challenges, including inadequate infrastructure, limited availability of trained surgical personnel, lack of essential medical equipment, and insufficient financial resources allocated to healthcare and their related possible factors. Here is that we aim to identify the progress made in areas such as capacity building, training programs, infrastructure development, and policy reforms, as well as highlight the gaps that persist, providing a foundation for future research. Such a comprehensive scoping review will be crucial to enhance surgical care services and ultimately improve health outcomes in LMICs.

A comprehensive literature search up to November 2024 will be conducted across six major databases. PubMed, Scopus, Ovoid, Web of Science, Cochrane Central, CNKI (China National Knowledge Infrastructure) database. The methodology will follow the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist. The first version of this project will not include a quality appraisal.

A comparative analysis of the effectiveness of anesthesia methods used in general medicine and dentistry has been carried out. The study highlights various methods of anesthesia, including general, regional and local anesthesia, as well as innovative methods such as computer-based monitoring of the depth of anesthesia and the use of ultrasound to accurately administer the anesthetic. In dentistry, local anesthesia is more often used, which minimizes pain and has fewer side effects. One of the key issues in anesthesiology is the effectiveness of anesthesia, which depends on many factors, including the type of surgery, the physiological characteristics of the patient, and economic components. The main sources of information for this work were scientific articles published in peer-reviewed medical journals. The main platforms for finding relevant literature were: PubMed, ScienceDirect and Google Scholar.

Intra-operative cardiac arrest is a rare but life-threatening event. Over the past two decades, various initiatives have improved the care of patients undergoing surgery at our quaternary teaching hospital in Brazil. We aimed to evaluate the epidemiology of intra-operative cardiac arrest and associated 30-day mortality over an 18-year period. A secondary aim was to identify associated risk factors.

We conducted a retrospective observational study using data collected from 1 January 2005 to 31 December 2022. Factors associated with cardiac arrest and mortality were identified using multivariable logistic regression analysis.

Among the 154,178 cases, the overall rates of intra-operative cardiac arrest (n = 297) and associated 30-day mortality (n = 248) were 19.3 (95%CI (16.6-21.9)) and 16.1 (95% CI 13.9-18.3) per 10,000 anaesthetics, respectively. These decreased over time (2005-2010 vs. 2017-2022) from 26.3 (95%CI 21.0-31.6) to 15.4 (95%CI 12.0-18.7) per 10,000 anaesthetics, and from 23.4 (95%CI 18.8-28.1) to 13.7 (95%CI 10.8-16.7) per 10,000 anaesthetics, respectively. Factors associated with intra-operative cardiac arrest included children aged < 1 year (adjusted OR (95%CI) 3.51 (1.87-6.57)); ASA physical status 3-5 (adjusted OR (95%CI) 13.85 (8.86-21.65)); emergency surgery (adjusted OR (95%CI) 10.06 (7.85-12.89)); general anaesthesia (adjusted OR (95%CI) 8.79 (4.60-19.64)); surgical procedure involving multiple specialities (adjusted OR (95%CI) 9.13 (4.24-19.64)); cardiac surgery (adjusted OR (95%CI) 7.69 (5.05-11.71)); vascular surgery (adjusted OR (95%CI) 6.21 (4.05-9.51)); and gastrointestinal surgery (adjusted OR (95%CI) 2.98 (1.91-4.65)).

We have shown an important reduction in intra-operative cardiac arrest and associated 30-day mortality over an 18-year period. Identification of relative risk factors associated with intra-operative cardiac arrest can be used to improve the safety and quality of patient care, especially in a resource-limited setting.

Although the number of female physicians in the United States has been increasing, most practicing surgeons in the United States are men. By contrast, Indonesia has achieved notable gender parity among surgeons, with the number of women practicing as plastic surgeons projected to soon surpass that of men. Achieving greater female representation in plastic surgery is important for delivering high-quality care, especially in the face of physician shortages and high burnout rates.

This survey study was conducted at the 26th annual scientific meeting of the Indonesian Association of Plastic Reconstructive and Aesthetic Surgeons, in Manado, Indonesia, in August 2023. Respondents were asked about their perceptions of plastic surgery, mentorship, career motivations, and caregiving responsibilities. Responses were scored using a 3-point Likert scale of agreement with statements (disagree, neutral, or agree); χ 2 and Fisher exact tests were performed to assess differences in responses by sex.

In this validated survey of 175 plastic surgeon trainees and attendings, there were no significant differences between sexes in the perception and roles of mentorship in preparing for a career in plastic surgery. Respondents from both sexes espoused optimistic views on work-life balance items, including time for family and friends and flexibility of work schedules.

Indonesia can serve as a model for encouraging greater gender parity in plastic surgery. Community-level interventions, such as family leave policies, childcare provisions, and initiatives to promote an inclusive culture, will create a more supportive workplace to increase women's representation in plastic surgery in the United States and around the world.

The surgical glue is widely used in closing cutaneous surgical wounds. Corticosteroids are indicated for their anti-inflammatory and immunomodulatory properties. The present work evaluated the pharmacological effects of triamcinolone (AT) incorporated into surgical glue (C) on the initial phase of the wound healing process in Wistar rats.

Through in-vivo studies, the effects of the healing process, C or C+AT in the same rat were evaluated for seven and 14 days post-surgery.

The C+AT association did not change the physicochemical properties of the polymer. This association in wound healing confirmed the anti-inflammatory and immunomodulatory effects of the corticosteroid, with less neovascularization and fibrosis, in addition to the remodeling of the extracellular matrix carried out by the balance of myofibroblasts and less dense collagen fibers, culminating in tissue regeneration and possible reduction of side effects.

This association is a powerful and innovative pharmacological tool, promising in translational medicine.

The global burden of surgical conditions is becoming increasingly prevalent in the developing world. Hand surgery, in particular congenital hand surgery, presents with its own challenges, particularly the unique skill sets needed, multidisciplinary nature and heterogeneity of cases. The aim of this review article is to present our experience of practising congenital hand surgery in Cambodia, and to explore the feasibility of teaching this specialty in developing countries within a meaningful and sustainable framework. Since 2013, a group of hand surgeons and therapists have visited the Children Surgical Centre in Cambodia. A community-oriented curriculum was developed following the initial visits, with analysis of data and local surgeon's skill sets. These were further refined using the Pareto analysis and selected competency procedures to develop entrustable professional activities (EPAs). Common paediatric hand cases were identified and taught to the local surgeons. Essential elements of this model include the need for measurable outcomes, clear curriculum goals, long-term partnerships and information technology support.

To (1) estimate the prevalence and trajectory of functional disability exceeding patient-acceptable and clinically significant levels in older surgical patients preoperatively and at 30, 90, and 180 days postoperatively, (2) identify risk factors associated with postoperative functional disability, and (3) compare adverse clinical outcomes between participants with and without functional disability.

Multicenter prospective study.

Remote preoperative and postoperative assessments.

307 older patients aged ≥65 years undergoing non-cardiac surgery.

Functional disability was assessed using the 12-item World Health Organization Disability Assessment Schedule 2.0 on an online survey, with a score ≥ 16 % exceeding a patient-acceptable symptom state and ≥ 35 % indicating significant, or at least moderate, severity.

We found that 133 (43 %) patients exhibited preoperative functional disability exceeding a patient-acceptable level, with 42 (14 %) experiencing clinically significant, or at least moderate, functional disability. The Functional Disability group showed greater improvement in function than the No-disability group. Specifically, over 60 % of participants in the Functional Disability group showed significant improvement at 90 and 180 days postoperatively, with 40 % being disability-free. However, 12 % of the Functional Disability group and 9 % of the No-disability group experienced a clinically important worsening in functional disability at 180 days postoperatively. Preoperative functional disability and depression were associated with nearly 6- and 4-fold higher odds of functional disability at 180 days, respectively.

Patients with preoperative functional disability experienced greater postoperative improvement in functional disability than the No-disability group. Preoperative evaluation of functional disability informs perioperative care and recovery for patients and clinicians.

Telesurgery is as a promising solution to support and deliver advanced health care services to underserved areas. The primary endpoint of our study was to prove the concept of low-latency long-distance connectivity and to describe the feasibility of remote surgery.

A prospective study was conducted from February 29 to March 1, 2024, in live animal models (porcine) connecting surgeons from Orlando (USA) to the animal laboratory in Shanghai (China) using 5G and Wi-Fi connections, in combination with continental and transpacific fiber. We performed ten radical nephrectomies and two partial nephrectomies in five animals using the MicroPort MedBot robotic platform. Intraoperative and telesurgery connection variables were reported with a descriptive statistical analysis.

No complications or conversions were reported. The mean animal weight was 38.2 (35-40) kg, the mean operative time was 32.7 (21-45) min, and the mean blood loss was 23.3 (20-30) ml. The mean latency was 296 (±50) ms. Findings from animal studies may not always translate directly to human outcomes.

We described the feasibility of transpacific low-latency telesurgery in live porcine models with no intraoperative complications. Achieving optimal low-latency connectivity via telecommunication networks was essential for effectively performing the surgical procedures. However, we still need further investigation to achieve even lower latencies for human trials. We found that long-distance telesurgery is safe and feasible in animal models. However, it is a complex practice, and we still need further studies before translating these results to human trials.

Our research has demonstrated the feasibility of low-latency long-distance telesurgery in live animal models. However, this type of telesurgery is a complex procedure, and further work is needed to translate these results to human trials.

In resource-limited environments, it is critical to triage burn patients most likely to benefit from operative intervention. This study sought to identify patients with a more significant treatment effect after operative intervention following burn injury at a tertiary burn center in Lilongwe, Malawi.

This is a retrospective analysis of burn patients presenting to Kamuzu Central Hospital from 2011 to November 2022. We compared patients based on whether they had scald or flame burns. Using logistic regression, we estimated the adjusted treatment effect of operative intervention on in-hospital mortality. Operative intervention was defined as burn excision and debridement with or without skin grafting.

We included 3266 patients. 2099 (64.7 %) patients had a scald burn, and 1144 (35.3 %) had a flame burn. 630 patients (19.3 %) underwent surgery. Crude mortality among all patients was 18.1 %, and for patients who underwent surgery, it was 9.7 %. When adjusted for total body surface area burned (TBSA) and age, the average treatment effect of surgery on mortality was - 0.07 (95 % CI - 0.11, - 0.033) for patients with scald burns and - 0.17 (95 % CI - 0.22, - 0.11) for patients with flame burns (Fig. 1). For patients with flame burns, the adjusted odds ratio of death associated with surgery was 0.26 (95 % CI 0.17, 0.39).

Operative intervention confers a survival advantage for patients with flame burns, and the average treatment effect was more significant compared to patients with scald burns. In general, in resource-limited environments flame burns should be prioritized for surgery over scald burns to improve patient outcomes.

The timing of prophylactic antibiotic use has become a hospital's surgical quality indicator. This study aims to assess the association of hospital characteristics with rate of prophylactic antibiotic use over 1 day for clean surgery. The retrospective cohort study was conducted using open government data, and hospitals must legally disclose to Taiwan's National Health Insurance Administration (NHIA). We identified 278 hospitals that reported 9491 records of prophylactic antibiotic use over 1 day for clean surgery from the 2009 first quarter to the 2019 fourth quarter. Regression models with generalized estimating equations were estimated. Overall, the median rate of prophylactic antibiotic use over 1 day for clean surgery in hospitals was 11.1% (interquartile range: 1.9% to 30%). Multivariable analyses showed that regional (coefficient [B] = 9.45, 95% confidence interval [CI]: 6.02-12.87, P < .001) and local hospitals (B = 15.04, 95% CI: 9.61-20.47, P < .001) had higher rates of prophylactic antibiotic use more than 1 day for clean surgery than medical centers. Moreover, public (B = 4.94, 95% CI: 0.61-9.28, P = .025) and medical care corporation hospitals (B = 8.17, 95% CI: 0.85-15.49, P = .029) experienced significantly greater proportions of antibiotic use over 1 day for clean surgery than medical care foundation hospitals after adjustments. This study revealed that low-level, public, and medical care corporation hospitals had higher rates of prophylactic antibiotic use over 1 day for clean surgery. These findings may represent a quality improvement opportunity for postoperative antibiotic use.

Over the past three decades, advancements in our understanding of the pathophysiology of spinal cord injury (SCI) have underscored the critical importance of early treatment for both traumatic and non-traumatic cases. Early surgical intervention significantly improves outcomes by limiting the extent of secondary damage. Despite numerous studies highlighting the superior outcomes associated with early decompression surgery for patients with SCIs, hospital reviews reveal that less than 60% of patients undergo surgical decompression within 24 h of injury. This occurs despite consensus among physicians regarding the benefits of early surgery. Therefore, it is important to highlight the multifactorial causes of this knowledge to action discordance. This review aims to elucidate the administrative, logistical, and technical challenges that hinder timely access to surgery for SCIs.

Patient age is assumed to be an important risk factor for the occurrence of burst suppression, yet this has still to be confirmed by large datasets.

In this single-center retrospective analysis at a university hospital, the electronic patient records of 38,628 patients (≥18 years) receiving general anesthesia between January 2016 and December 2018 were analyzed. Risk factors for burst suppression were evaluated using univariate and multivariable analysis. We measured the incidence of burst suppression as indicated by the burst suppression ratio (BSR) of the Entropy Module, the maximum and mean BSR values, relative burst suppression duration, mean volatile anesthetic concentrations, and mean age-adjusted minimum alveolar concentrations (aaMAC) at burst suppression, and cases of potentially misclassified burst suppression episodes. Analyses were done separately for the total anesthesia period, as well as for the Induction and Maintenance phase. The association with age was evaluated using linear and polynomial fits and by calculating correlation coefficients.

Of the 54,266 patients analyzed, 38,628 were included, and 19,079 patients exhibited episodes with BSR >0. Patients with BSR >0 were significantly older, and age had the highest predictive power for BSR >0 (area under the receiving operating characteristic [AUROC] = 0.646 [0.638-0.654]) compared to other patient or procedural factors. The probability of BSR >0 increased linearly with patient age (ρ = 0.96-0.99) between 1.9% and 9.8% per year. While maximal and mean BSR showed a nonlinear relationship with age, relative burst suppression duration also increased linearly during maintenance (ρ = 0.83). Further, episodes potentially indicating burst suppression that were not detected by the Entropy BSR algorithm also became more frequent with age. Volatile anesthetic concentrations sufficient to induce BSR >0 were negatively correlated with age (sevoflurane: ρ = -0.71), but remained close to an aaMAC of 1.0.

The probability of burst suppression during general anesthesia increases linearly with age in adult patients, while lower anesthetic concentrations induce burst suppression with increasing patient age. Simultaneously, algorithm-based burst suppression detection appears to perform worse in older patients. These findings highlight the necessity to further enhance EEG application and surveillance strategies in anesthesia.

Early diagnosis and treatment of surgical wound infection can be challenging. This is especially relevant in the management of periprosthetic joint infection: early detection is key to success and reducing morbidity, mortality and resource use. 'Smart' dressings have been developed to detect parameters suggestive of infection. This scoping review investigates the current status of the field, limited to devices tested in animal models and/or humans, with a focus on their application to arthroplasty. The literature was searched using MEDLINE/PubMed and Embase databases from 2000 to 2023. Original articles assessing external sensing methods for the detection of wound infection in animal models or human participants were included. Sixteen articles were eligible. The results were broadly divided by sensing method: colorimetric, electrochemical and fluorescence/photothermal responses. Six of the devices detected more than one parameter (multimodal), while the rest were unimodal. The most common parameters examined were temperature and pH. Most 'smart' dressings focused on diagnosing infection in chronic wounds, and none were tested in humans with wound infections. There is limited late-stage research into using dressing sensors to diagnose wound infection in post-surgical patients. Future research should explore this to enable inpatient and remote outpatient monitoring of post-operative wounds to detect wound infection.

Improved perioperative care has enhanced survival in children with congenital gastrointestinal conditions and abdominal wall defects (AWD). However, epidemiological and surgical outcomes in developing nations are still scarce. Our aim was to assess the burden and mortality of common congenital gastrointestinal anomalies and AWD in Malaysia, and their influencing factors.

Using the Global PaedSurg study protocol with permission, we performed a prospective cohort study on children presenting for the first time between October 2021 and April 2022 with these conditions: Esophageal atresia (EA), congenital diaphragmatic hernia (CDH), intestinal atresia, gastroschisis, exomphalos, anorectal malformation (ARM) and Hirschsprung's disease. We compared mortality and 30-day outcome data across different geographical regions in Malaysia.

There were 228 patients with 242 study conditions (EA n = 28, CDH n = 36, intestinal atresia n = 49, gastroschisis n = 12, exomphalos n = 8, ARM n = 77, Hirschsprung's disease n = 32). Our mortality rate was 8.8%; 60% of these were CDH patients. Factors significantly associated with mortality were CDH diagnosis, central venous access requirement, higher American Society of Anesthesiologists (ASA) score, blood transfusion and ventilation requirement.

Diagnosis of CDH is the most important predictor for sepsis on arrival and mortality, therefore measures should be taken for early recognition and aggressive management.

Iran's healthcare system has a significant discrepancy between the national tariff and the cost of global surgical procedures (GSPs). This study aimed to compare the actual costs of GSPs with national tariffs in Iran's public hospitals.

This retrospective cross-sectional study was conducted in 2017. Using the census method, 6126 GSPs performed in three public hospitals were investigated in this study. Additionally, national tariffs from the Supreme Council of Health Insurance were obtained. The tariff-cost gap was the discrepancy between a GSP's actual costs and tariff. Multiple linear regression analysis determined factors affecting the tariff-cost gap.

The average actual cost of GSPs was 637 USD, while the average tariff was 495 USD. The reimbursement covered only 78% of the costs. The gap was higher in older (B=1.05, 95% CI: 0.76-1.35, P<0.001), females (B=26.7, 95% CI: 15.5-37.9, P<0.001), patients with a longer stay (B=81.2, 95% CI: 77.5-84.8, P<0.001), and procedures performed by full-time surgeons (B=67.3, 95% CI: 56.9-77.5, P<0.001). Furthermore, neurosurgery had the highest effect on forecasting the gap between actual costs and tariffs among surgical specialties (B=346.9, 95% CI: 214.3-479.5, P<0.001).

Public hospitals suffer from large financial losses due to the national tariff for many GSPs not covering their actual costs. It is suggested that tariffs be increased for certain customer segments that can bear higher costs and global tariffs be adjusted to match actual service delivery costs.

Treatable surgical diseases account for a significant proportion of the global burden of disease, particularly in low- and middle-income communities. The number of deaths owing to poor surgical care or its non-availability has been reported to exceed those from HIV/AIDS, tuberculosis and malaria combined. The Ugandan government and its development partners aim to put in place measures to achieve universal health coverage for all communities. These include construction and equipping health facilities, training of health workers, opening up road networks, and poverty alleviation programmes. However, these efforts have, as yet, fallen short as evidenced by external hernias remaining the leading cause of intestinal obstruction for more than 40 years. We recommend establishment of global surgery collaborations with rural-based medical training schools and other health facilities, essential surgical skills training for medical students, task shifting in surgical care and integration of regular surgical camps in the Uganda's healthcare delivery model.

Despite the globalization of health information, collaborations between high-income countries (HICs) and low/middle-income countries (LMICs), while present, could still increase. This study builds on previous research highlighting LMIC underrepresentation in neurosurgery literature. We conducted a comprehensive bibliometric analysis using the Scopus database to investigate collaborative neurosurgical research between HIC institutions and those in low-income country (LIC)/LMICs. Articles published between 2018 and 2020 were examined. Articles were categorized into 3 groups: guidelines, conferences, and consensus statements; articles related to training and collaborations; and other articles. We categorized articles and authors by country, role, and specific subtopic. We included 238 reports from 34 neurosurgical journals for analysis. Geographic distribution indicated that India led LIC/LMIC contributions (25.21%). Among HICs, the United States had the highest contribution (47.76%). In collaborative studies, Uganda, Cameroon, Tanzania, Indonesia, and Nigeria made significant contributions. LICs and LMICs accounted for 446 authors, while HICs contributed with 592. India has presented the highest number of authors in significant positions. In HICs, significant positions are recognized in USA articles. When scoring authors' position in collaborative papers, still HICs had a clear prevalence. The highest number of collaborations between HICs and LICs/LMICs has been observed in articles related to training and collaborations. Kenya matched India's contributions in training and collaborations. Global guidelines and consensus papers can enhance patient care, but LMICs' involvement remains limited. Further attention to training and collaboration initiatives is needed. This study emphasizes the importance of promoting collaboration and training between countries with varying resources to advance neurosurgical care globally.

Same-day surgical case cancellation consumes resources, disrupts patient care, and has a global prevalence of 18%. A retrospective analysis found that 44% of scheduled elective surgeries were canceled at a public tertiary hospital in Lilongwe, Malawi. To better characterize these cancellations, this study defines a process map for surgical case completion and investigates hospital staff and patient perspectives on contributing factors and burdens of cancellation.

We conducted participatory process mapping and in-depth interviews with hospital staff (n = 23) and patients (n = 10) to detail perioperative processes and perspectives on cancellations. We used purposive sampling to recruit staff by hospital role and patients whose surgery had been canceled. Interviews were audio-recorded, translated, and transcribed for process mapping accuracy and thematic analysis using the constant comparative method and NVivo software.

Staff delineated specific steps of the perioperative process, generating a process map that identifies inefficiencies and opportunities for intervention. Hospital staff described unavoidable causes of case cancellation, such as unreliable water supply and material shortages. Modifiable causes linked to wasted time and resources were also evident, such as chronic tardiness, communication barriers, and inadequate preoperative assessment. Thematic analysis of perceived impacts of cancellation revealed compromised provider-patient relationships, communication breakdown, and emotional distress. Staff and patients expressed frustration, embarrassment, fear, and demoralization when planned surgeries were canceled.

We demonstrate the use of process mapping as a tool to identify implementation targets for reducing case cancellation rates. Hospital systems can adapt this approach to address surgical case cancellation in their specific setting.

Surgical site infections (SSIs) are a major health challenge in Africa, leading to poor patient outcomes. This study aims to systematically review and summarize existing research on the rate and patterns of SSIs in orthopedic surgery across Africa. A thorough search was conducted using databases such as Embase (via Ovid), PubMed, Scopus, African Journals Online (AJOL), and Google Scholar for literature published between January 2000 and July 2024. The search used terms such as "surgical site infection," "SSI," "surgical wound infection," "orthopedic surgery," and "Africa." After screening, studies that did not meet the criteria were excluded, leaving seven studies (five retrospective and two prospective) with 989 patients who had undergone orthopedic procedures in both elective and emergency settings. The overall incidence of SSIs was 10.5%, affecting 104 patients, with rates ranging from 4.2% in Ethiopia to 39% in Togo. Of the infections reported, 43% were superficial, 26% were deep, 11% affected organ space, and 20% were chronic. This review sheds light on the high rates of SSIs in orthopedic surgeries in Africa, emphasizing the need for better infection control and improved surgical practices. More research is necessary to fill the gaps and develop strategies that can be applied in different healthcare settings.

Cerebral arteriovenous malformations (AVMs) can lead to significant morbidity and are particularly challenging to manage in resource-limited settings where endovascular treatment modalities are unaffordable for most patients.

To describe the first case series of AVM from Iraq with an analysis of the related clinicoradiologic characteristics, operative features, and outcomes.

A single-center database from October 2018 to December 2022 was reviewed to analyze the characteristics of cerebral AVMs who underwent surgical treatment in Baghdad, Iraq. We collected patient demographics, clinical, radiologic, operative, and the follow-up combined outcome results (modified Rankin Scale score and the presence of AVM remnants).

Of the 54 AVM patients treated with microsurgery, the majority of lesions have Spetzler-Martin grade of 3 (31.5%), followed by grade 1 (29.6%). The parietal lobe was the most common location of AVM in 25.9% of the cases, and the temporal location had better outcomes. The mean duration of surgery was 8.5 hours, ranging from 3 to 14 hours, with 20.3% of cases having undergone preoperative stereotactic radiosurgery, and just one patient received preoperative embolization. Good combined outcome (modified Rankin Scale 0-2 and no AVM remnant) was associated with lower SM grades (P=0.003); location in the nondominant hemisphere (P=0.036), and noneloquent regions (P=0.006); absence of deep venous drainage (P=0.042) and no intraoperative brain swelling (P=0.004). The mortality rate in our series was 5.5%.

Good clinicoradiologic outcomes can be achieved through microsurgery in a setting where endovascular treatment is inaccessible to patients due to limited resources.