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Article: Gastric cancer in Sub-Saharan Africa - a systematic review of primary data.

Ramadhar, Anishka / Miller, Phoebe N / Muchengeti, Mazvita / Kagura, Juliana / Chu, Kathryn / Gaskill, Cameron

Ecancermedicalscience

2024 Volume 18, Page(s) 1680

Abstract: Introduction: Gastric cancer (GC) is the third leading cause of global cancer-related mortality. Despite the shifting burden of GC to low-and middle-income countries, the data regarding incidence, treatment, and outcomes in these settings are sparse. ... ...

Abstract	Introduction: Gastric cancer (GC) is the third leading cause of global cancer-related mortality. Despite the shifting burden of GC to low-and middle-income countries, the data regarding incidence, treatment, and outcomes in these settings are sparse. The primary aim of this systematic review was to aggregate all available data on GC in sub-Saharan Africa (SSA) to describe the variability in incidence across the region. Methods: Studies reporting population-based primary data on GC in SSA were considered. The inclusion was limited to primary studies published between January 1995 and March 2022 which comprised of adult patients in SSA with GC. Studies without accessible full text in either French or English language were excluded. Unadjusted GC incidence rates with their standard errors for each study were recalculated from the crude numerators and denominators provided in individual studies. Results: A total of 5,626 articles were identified in the initial search, of which, 69 studies were retained. Reported incidence rates ranged from a high of 5.56 GC cases per 100,000 in Greater Meru Kenya to a low of 0.04 GC cases per 100,000 people in Benin City Nigeria. The overall crude pooled incidence was 1.20 GC cases per 100, 000 (95%CI 1.15-1.26) with a variability of 99.83% ( Conclusion: This systemic review demonstrates that GC incidence is highly variable across SSA. The limited data on GC treatment, mortality, and survival presents a significant challenge to providing a complete epidemiologic description of the burden of GC in SSA. There is a need for further robust data collection, exploration, and research studies on cancer care in SSA, with continued assessment of primary data availability.
Language	English
Publishing date	2024-03-07
Publishing country	England
Document type	Journal Article ; Review
ISSN	1754-6605
ISSN	1754-6605
DOI	10.3332/ecancer.2024.1680
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Article: A high-yield isolation and enrichment strategy for human lung microvascular endothelial cells.

Gaskill, Christa / Majka, Susan M

Pulmonary circulation

2017 Volume 7, Issue 1, Page(s) 108–116

Abstract: Vasculopathies, characterized by the formation of fragile and abnormal microvessels, are associated with the severity of many chronic lung diseases, including pulmonary fibrosis, emphysema/chronic obstructive pulmonary disease, systemic sclerosis, and ... ...

Abstract	Vasculopathies, characterized by the formation of fragile and abnormal microvessels, are associated with the severity of many chronic lung diseases, including pulmonary fibrosis, emphysema/chronic obstructive pulmonary disease, systemic sclerosis, and hypertension. However, the study of human lung vasculature has been limited by the ability to isolate generous quantities of microvascular endothelial cells (MVEC) free from mesenchymal contamination. Expansion and passaging of primary human MVEC in vitro typically results in loss of a traditional phenotype in favor of an intermediate mesenchymal one, as early as passage five. Here we provide a detailed protocol for the selection of large quantities of enriched primary human lung MVEC based upon differential adherence from mesenchyme and simple magnetic separation, which decreases the need for excessive passaging, in order to obtain sufficient cell numbers to successfully freeze stock cultures. Additional protocols are provided for Ac-di-LDL selection, characterization, and a sandwich angiogenesis method of functional tube formation. The complete protocol including cell isolation and characterization takes approximately six weeks to complete.
Language	English
Publishing date	2017-03-27
Publishing country	United States
Document type	Journal Article
ZDB-ID	2638089-4
ISSN	2045-8940 ; 2045-8932
ISSN (online)	2045-8940
ISSN	2045-8932
DOI	10.1177/2045893217702346
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Article ; Online: Assessment of the Surgical Oncology Case Volume Within the Public Sector in Tanzania.

Brand, Nathan R / Akoko, Larry / Kotecha, Vihar / Mwakyembe, Theresia / Mwashambwa, Masumbuko / Hamid, Rukia / Hando, Deo / Komba, Charles / Mwanga, Ally / Mbele, Peter / Itule, Paul / Jackson, Joshua / Misidai, Mungeni / Gaskill, Cameron / Ozgediz, Doruk

JCO global oncology

2024 Volume 10, Page(s) e2300316

Abstract: Purpose: Surgery provides vital services to diagnose, treat, and palliate patients suffering from malignancies. However, despite its importance, there is little information on the delivery of surgical oncology services in Tanzania.: Methods: ... ...

Abstract	Purpose: Surgery provides vital services to diagnose, treat, and palliate patients suffering from malignancies. However, despite its importance, there is little information on the delivery of surgical oncology services in Tanzania. Methods: Operative logbooks were reviewed at all national referral hospitals that offer surgery, all zonal referral hospitals in Mainland Tanganyika and Zanzibar, and a convenience sampling of regional referral hospitals in 2022. Cancer cases were identified by postoperative diagnosis and deidentified data were abstracted for each cancer surgery. The proportion of the procedures conducted for patients with cancer and the total number of cancer surgeries done within the public sector were calculated and compared with a previously published estimate of the surgical oncology need for the country. Results: In total, 69,195 operations were reviewed at 10 hospitals, including two national referral hospitals, five zonal referral hospitals, and three regional referral hospitals. Of the cases reviewed, 4,248 (6.1%) were for the treatment of cancer. We estimate that 4,938 cancer surgeries occurred in the public sector in Tanzania accounting for operations conducted at hospitals not included in our study. Prostate, breast, head and neck, esophageal, and bladder cancers were the five most common diagnoses. Although 387 (83%) of all breast cancer procedures were done with curative intent, 506 (87%) of patients with prostate and 273 (81%) of patients with esophageal cancer underwent palliative surgery. Conclusion: In this comprehensive assessment of surgical oncology service delivery in Tanzania, we identified 4,248 cancer surgeries and estimate that 4,938 likely occurred in 2022. This represents only 25% of the estimated 19,726 cancer surgeries that are annually needed in Tanzania. These results highlight the need to identify strategies for increasing surgical oncology capacity in the country.
MeSH term(s)	Male ; Humans ; Tanzania/epidemiology ; Public Sector ; Surgical Oncology ; Hospitals ; Neoplasms/diagnosis ; Neoplasms/epidemiology ; Neoplasms/surgery
Language	English
Publishing date	2024-03-06
Publishing country	United States
Document type	Journal Article
ISSN	2687-8941
ISSN (online)	2687-8941
DOI	10.1200/GO.23.00316
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Article ; Online: Cost-Effectiveness of a Locally Organized Surgical Outreach Mission: Making a Case for Strengthening Local Non-Governmental Organizations.

Gyedu, Adam / Gaskill, Cameron / Boakye, Godfred / Abantanga, Francis

World journal of surgery

2017 Volume 41, Issue 12, Page(s) 3074–3082

Abstract: Introduction: Many low- and middle-income countries (LMICs) have a high prevalence of unmet surgical need. Provision of operations through surgical outreach missions, mostly led by foreign organizations, offers a way to address the problem. We sought to ...

Abstract	Introduction: Many low- and middle-income countries (LMICs) have a high prevalence of unmet surgical need. Provision of operations through surgical outreach missions, mostly led by foreign organizations, offers a way to address the problem. We sought to assess the cost-effectiveness of surgical outreach missions provided by a wholly local organization in Ghana to highlight the role local groups might play in reducing the unmet surgical need of their communities. Methods: We calculated the disability-adjusted life years (DALY) averted by surgical outreach mission activities of ApriDec Medical Outreach Group (AMOG), a Ghanaian non-governmental organization. The total cost of their activities was also calculated. Conclusions about cost-effectiveness were made according to World Health Organization (WHO)-suggested parameters. Results: We analyzed 2008 patients who had been operated upon by AMOG since December 2011. Operations performed included hernia repairs (824 patients, 41%) and excision biopsy of soft tissue masses (364 patients, 18%). More specialized operations included thyroidectomy (103 patients, 5.1%), urological procedures (including prostatectomy) (71 patients, 3.5%), and plastic surgery (26 patients, 1.3%). Total cost of the outreach trips was $283,762, and 2079 DALY were averted; cost per DALY averted was 136.49 USD. The mission trips were "very cost-effective" per WHO parameters. There was a trend toward a lower cost per DALY averted with subsequent outreach trips organized by AMOG. Conclusion: Our findings suggest that providing surgical services through wholly local surgical mission trips to underserved LMIC communities might represent a cost-effective and viable option for countries seeking to reduce the growing unmet surgical needs of their populations.
Language	English
Publishing date	2017-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-017-4131-3
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Article ; Online: Benchmarking Global Trauma Care: Defining the Unmet Need for Trauma Surgery in Ghana.

Gyedu, Adam / Stewart, Barclay / Gaskill, Cameron / Donkor, Peter / Quansah, Robert / Mock, Charles

The Journal of surgical research

2019 Volume 247, Page(s) 280–286

Abstract: Background: The Lancet Commission on Global Surgery recommended 5000 operations/100,000 persons annually, but did not define condition-specific guidelines. New Zealand, Lancet Commission on Global Surgery's benchmark country, documented 1158 trauma ... ...

Abstract	Background: The Lancet Commission on Global Surgery recommended 5000 operations/100,000 persons annually, but did not define condition-specific guidelines. New Zealand, Lancet Commission on Global Surgery's benchmark country, documented 1158 trauma operations/100,000 persons, providing a benchmark for trauma surgery needs. We sought to determine Ghana's annual trauma operation rate compared with this benchmark. Methods: Data on all operations performed in Ghana from June 2014 to May 2015 were obtained from representative sample of 48/124 district (first level), 8/11 regional, and 3/5 tertiary hospitals and scaled up for nationwide estimates. Trauma operations were grouped by hospital level and categorized into "essential" (most cost-effective, highest population impact) versus "other" (specialized) as per the World Bank's Disease Control Priorities Project. Ghana's annual trauma operation rate was compared with the New Zealand benchmark to quantify current met needs for trauma surgery. Results: About 232,776 operations were performed in Ghana; 35,797 were for trauma. Annual trauma operation rate was 134/100,000 (95% UI: 98-169), only 12% of the New Zealand benchmark. District hospitals performed 62% of all operations in the country, but performed only 38% of trauma operations. Eighty seven percentage of trauma operations were deemed "essential". Among specialized trauma operations, only open reduction and internal fixations had even modest numbers (3483 operations). Most other specialized trauma operations were rare. Conclusions: Ghana has a large unmet need for operative trauma care. The low percentage of trauma operations in district hospitals indicates an even greater unmet need in rural areas. Future global surgery benchmarking should consider benchmarks for trauma and other specialties, as well as for different hospital levels.
MeSH term(s)	Benchmarking/statistics & numerical data ; Developing Countries/statistics & numerical data ; Ghana ; Global Health/standards ; Health Services Needs and Demand/statistics & numerical data ; Hospitals, District/statistics & numerical data ; Humans ; New Zealand ; Surgical Procedures, Operative/statistics & numerical data ; Tertiary Care Centers/statistics & numerical data ; Wounds and Injuries/surgery
Language	English
Publishing date	2019-11-02
Publishing country	United States
Document type	Comparative Study ; Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	80170-7
ISSN	1095-8673 ; 0022-4804
ISSN (online)	1095-8673
ISSN	0022-4804
DOI	10.1016/j.jss.2019.10.013
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Article ; Online: Suppression of TCF4 promotes a ZC3H12A-mediated self-sustaining inflammatory feedback cycle involving IL-17RA/IL-17RE epidermal signaling.

JCI insight

2024 Volume 9, Issue 8

Abstract: IL-17C is an epithelial cell-derived proinflammatory cytokine whose transcriptional regulation remains unclear. Analysis of the IL17C promoter region identified TCF4 as putative regulator, and siRNA knockdown of TCF4 in human keratinocytes (KCs) ... ...

Abstract	IL-17C is an epithelial cell-derived proinflammatory cytokine whose transcriptional regulation remains unclear. Analysis of the IL17C promoter region identified TCF4 as putative regulator, and siRNA knockdown of TCF4 in human keratinocytes (KCs) increased IL17C. IL-17C stimulation of KCs (along with IL-17A and TNF-α stimulation) decreased TCF4 and increased NFKBIZ and ZC3H12A expression in an IL-17RA/RE-dependent manner, thus creating a feedback loop. ZC3H12A (MCPIP1/Regnase-1), a transcriptional immune-response regulator, also increased following TCF4 siRNA knockdown, and siRNA knockdown of ZC3H12A decreased NFKBIZ, IL1B, IL36G, CCL20, and CXCL1, revealing a proinflammatory role for ZC3H12A. Examination of lesional skin from the KC-Tie2 inflammatory dermatitis mouse model identified decreases in TCF4 protein concomitant with increases in IL-17C and Zc3h12a that reversed following the genetic elimination of Il17c, Il17ra, and Il17re and improvement in the skin phenotype. Conversely, interference with Tcf4 in KC-Tie2 mouse skin increased Il17c and exacerbated the inflammatory skin phenotype. Together, these findings identify a role for TCF4 in the negative regulation of IL-17C, which, alone and with TNF-α and IL-17A, feed back to decrease TCF4 in an IL-17RA/RE-dependent manner. This loop is further amplified by IL-17C-TCF4 autocrine regulation of ZC3H12A and IL-17C regulation of NFKBIZ to promote self-sustaining skin inflammation.
MeSH term(s)	Animals ; Transcription Factor 4/metabolism ; Transcription Factor 4/genetics ; Humans ; Interleukin-17/metabolism ; Interleukin-17/genetics ; Mice ; Keratinocytes/metabolism ; Ribonucleases/metabolism ; Ribonucleases/genetics ; Signal Transduction ; Receptors, Interleukin-17/metabolism ; Receptors, Interleukin-17/genetics ; Inflammation/metabolism ; Inflammation/genetics ; Disease Models, Animal ; Epidermis/metabolism ; Dermatitis/metabolism ; Dermatitis/genetics ; Dermatitis/immunology ; Dermatitis/pathology ; Feedback, Physiological ; Gene Expression Regulation ; Adaptor Proteins, Signal Transducing
Chemical Substances	Transcription Factor 4 ; Interleukin-17 ; TCF4 protein, human ; Ribonucleases (EC 3.1.-) ; Receptors, Interleukin-17 ; IL17RA protein, human ; Zc3h12a protein, mouse (EC 3.1.-) ; IL17C protein, human ; Nfkbiz protein, mouse ; Tcf4 protein, mouse ; Adaptor Proteins, Signal Transducing
Language	English
Publishing date	2024-03-12
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural ; Research Support, Non-U.S. Gov't
ISSN	2379-3708
ISSN (online)	2379-3708
DOI	10.1172/jci.insight.172764
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Article ; Online: A Nationwide Enumeration of Operations Performed for Pediatric Patients in Ghana.

Gyedu, Adam / Stewart, Barclay / Gaskill, Cameron / Salia, Emmanuella / Wadie, Raymond / Abantanga, Francis / Donkor, Peter / Mock, Charles

European journal of pediatric surgery : official journal of Austrian Association of Pediatric Surgery ... [et al] = Zeitschrift fur Kinderchirurgie

2020 Volume 31, Issue 2, Page(s) 199–205

Abstract: Introduction: Currently, there are no existing benchmarks for evaluating a nation's pediatric surgical capacity in terms of met and unmet needs.: Materials and methods: Data on pediatric operations performed from 2014 to 2015 were obtained from a ... ...

Abstract	Introduction: Currently, there are no existing benchmarks for evaluating a nation's pediatric surgical capacity in terms of met and unmet needs. Materials and methods: Data on pediatric operations performed from 2014 to 2015 were obtained from a representative sample of hospitals in Ghana, then scaled up for national estimates. Operations were categorized as "essential" (most cost-effective, highest population impact) as designated by the World Bank's Disease Control Priorities versus "other." Estimates were then compared with pediatric operation rates in New Zealand to determine unmet pediatric surgery need in Ghana. Results: A total of 29,884 operations were performed for children <15 years, representing an annual operation rate of 284/100,000 (95% uncertainty interval: 205-364). Essential procedures constituted 66% of all pediatric operations; 12,397 (63%) were performed at district hospitals. General surgery (8,808; 29%) and trauma (6,302; 21%) operations were most common. Operations for congenital conditions were few (826; 2.8%). Tertiary hospitals performed majority (55%) of operations outside of the essential category. Compared with the New Zealand benchmark (3,806 operations/100,000 children <15 years), Ghana is meeting only 7% of its pediatric surgical needs. Conclusion: Ghana has a large unmet need for pediatric surgical care. Pediatric-specific benchmarking is needed to guide surgical capacity efforts in low- and middle-income country healthcare systems.
MeSH term(s)	Benchmarking ; Child ; Developing Countries ; Female ; Ghana/epidemiology ; Hospitals, District/statistics & numerical data ; Humans ; Male ; Needs Assessment/statistics & numerical data ; Surgical Procedures, Operative/statistics & numerical data ; Tertiary Care Centers/statistics & numerical data
Language	English
Publishing date	2020-04-02
Publishing country	United States
Document type	Journal Article ; Multicenter Study
ZDB-ID	1065043-x
ISSN	1439-359X ; 0939-7248 ; 0939-6764 ; 0930-7249
ISSN (online)	1439-359X
ISSN	0939-7248 ; 0939-6764 ; 0930-7249
DOI	10.1055/s-0040-1705130
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Zs.A 3140: Show issues

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Article ; Online: Interlaboratory comparison of heavy metal testing in animal diagnostic specimens and feed using inductively coupled plasma-mass spectrometry.

McGeehan, Steven / Baszler, Timothy / Gaskill, Cynthia / Johnson, Joseph / Smith, Lori / Raisbeck, Merl / Schrier, Nick / Harris, Heather / Talcott, Patricia

Journal of veterinary diagnostic investigation : official publication of the American Association of Veterinary Laboratory Diagnosticians, Inc

2020 Volume 32, Issue 2, Page(s) 291–300

Abstract: We compared inductively coupled plasma-mass spectrometry (ICP-MS) test results for the analysis of heavy metals (As, Ba, Cd, Hg, Pb, and Se) in pet foods and routine veterinary diagnostic specimens using intralaboratory and interlaboratory comparisons. ... ...

Abstract	We compared inductively coupled plasma-mass spectrometry (ICP-MS) test results for the analysis of heavy metals (As, Ba, Cd, Hg, Pb, and Se) in pet foods and routine veterinary diagnostic specimens using intralaboratory and interlaboratory comparisons. Four laboratories, 1 principal laboratory and 3 collaborating laboratories, conducted instrument comparison (limit of detection [LOD], limit of quantification [LOQ], and linear dynamic range [LDR] on 24 data sets), in-house method comparison (accuracy and precision on 120 data sets), and interlaboratory comparison (reproducibility on 528 data sets using Horwitz equation analysis). Matrices tested included 2 types of pet food jerky treats (chicken and sweet potato), bovine blood, and bovine liver and kidney. The instrument comparison study confirmed that ICP-MS provided the sensitivity necessary for the analysis of all heavy metals tested at concentrations below the level of concern for routine diagnostic testing. The "in-house" method comparison samples, spiked at low (0.04 µg/g), medium (0.4 µg/g), and high (8.0 µg/g; note: the high validation level spike for mercury was 2 µg/g) concentration levels, indicated that ICP-MS can meet U.S. FDA acceptance criteria for both accuracy (90-105% recovery) and precision (< 6% coefficient of variation). The interlaboratory comparison studies showed that ICP-MS is a reproducible method for the analysis of heavy metals (HorRat value of 0.5-2.0) except for mercury in one laboratory, which used a different sample preparation method (open block rather than microwave digestion). Overall, our study showed that ICP-MS is a reproducible method for the analysis of heavy metals in spite of minor differences in methodology.
MeSH term(s)	Animal Feed/analysis ; Animals ; Cattle/blood ; Cattle/metabolism ; Kidney/chemistry ; Liver/chemistry ; Mass Spectrometry/veterinary ; Metals, Heavy/analysis
Chemical Substances	Metals, Heavy
Language	English
Publishing date	2020-02-13
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	287603-6
ISSN	1943-4936 ; 1040-6387
ISSN (online)	1943-4936
ISSN	1040-6387
DOI	10.1177/1040638720903115
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Zs.A 3645: Show issues

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Article ; Online: Risk-stratified posthepatectomy pathways based upon the Kawaguchi-Gayet complexity classification and impact on length of stay.

Kim, Bradford J / Arvide, Elsa M / Gaskill, Cameron / Martin, Allison N / Kawaguchi, Yoshikuni / Chiang, Yi-Ju / Dewhurst, Whitney L / Phan, Teresa L / Tran Cao, Hop S / Chun, Yun Shin / Katz, Matthew H G / Vauthey, Jean Nicolas / Tzeng, Ching-Wei D / Newhook, Timothy E

Surgery open science

2022 Volume 9, Page(s) 109–116

Abstract: Background: The Kawaguchi-Gayet classification is a validated system to stratify open liver resections by complexity and postoperative complications. We hypothesized that Kawaguchi-Gayet classification could be used to create and implement risk- ... ...

Abstract	Background: The Kawaguchi-Gayet classification is a validated system to stratify open liver resections by complexity and postoperative complications. We hypothesized that Kawaguchi-Gayet classification could be used to create and implement risk-stratified posthepatectomy pathways to reduce length of stay and variation in care. Methods: Clinicopathologic data from hepatectomy patients (1/2017-6/2020) were abstracted from a prospective database. All open hepatectomies were assigned to groups based on 2 levels of Kawaguchi-Gayet classification, and corresponding risk-stratified posthepatectomy pathways were created to decrease length of stay by 1 day compared to patients who were historically treated without a pathway: low-intermediate risk (open Kawaguchi-Gayet I/II) and high risk (open Kawaguchi-Gayet III). Outcomes were compared between periods before ("PRE"; 1/1/2017-9/30/2019) and after ("POST"; 10/1/2019-6/30/2020) implementation. Results: Among 487 open hepatectomies (PRE: 374, POST: 113), 55.0% (n = 268) were low-intermediate risk and 45.0% (n = 219) were high risk. Major complications were similar PRE/POST: low-intermediate risk (PRE: 7.8%, POST: 9.4%, P = .681) and high risk (PRE: 18.9%, POST 10.0%, P = 0.139). Risk-stratified posthepatectomy pathway implementation reduced median length of stay for both low-intermediate risk (4 to 3.5 days, P = .009) and high risk (5 to 4 days, P = 0.022) patients. Risk-stratified posthepatectomy pathways decreased length of stay variation, reflected in mean and standard deviation for all patients (PRE 5.5 ± 7.5 vs POST 4.4 ± 2.8 days). There was no difference in 90-day readmission rates between PRE (12.6%) and POST (8.8%) periods (P = .278). Conclusion: The creation and implementation of risk-stratified posthepatectomy pathways reduced length of stay without increasing readmissions after hepatectomy. These generalizable risk-stratified posthepatectomy pathways preoperatively stratify patients a priori into pathways for individualized preoperative discussions on realistic postoperative complications and length of stay expectations.
Language	English
Publishing date	2022-05-08
Publishing country	United States
Document type	Journal Article
ISSN	2589-8450
ISSN (online)	2589-8450
DOI	10.1016/j.sopen.2022.04.006
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Article ; Online: Enumeration of Operations Performed for Elderly Patients in Ghana: An Opportunity to Improve Global Surgery Benchmarking.

Gyedu, Adam / Stewart, Barclay / Gaskill, Cameron / Salia, Emmanuella Lebasaana / Wadie, Raymond / Donkor, Peter / Mock, Charles

World journal of surgery

2019 Volume 43, Issue 7, Page(s) 1644–1652

Abstract: Introduction: The Lancet Commission on Global Surgery proposed 5000 operations/100,000 people annually as a benchmark for developing countries but did not define benchmarks for different age groups. We evaluated the operation rate for elderly patients (≥ ...

Abstract	Introduction: The Lancet Commission on Global Surgery proposed 5000 operations/100,000 people annually as a benchmark for developing countries but did not define benchmarks for different age groups. We evaluated the operation rate for elderly patients (≥65 years) in Ghana and estimated the unmet surgical need for the elderly by comparison to a high-income country benchmark. Methods: Data on operations performed for elderly patients over a 1-year period in 2014-5 were obtained from representative samples of 48/124 small district hospitals and 12/16 larger referral hospitals and scaled-up for nationwide estimates. Operations were categorized as essential (most cost-effective, highest population impact) versus other according to The World Bank's Disease Control Priority project (DCP-3). Data from New Zealand's National Minimum Dataset were used to derive a benchmark operation rate for the elderly. Results: 16,007 operations were performed for patients ≥65 years. The annual operation rate was 1744/100,000 (95% UI 1440-2048), only 12% of the New Zealand benchmark of 14,103/100,000. 74% of operations for the elderly were in the essential category. The most common procedures (15%) were for urinary obstruction. 58% of operations were performed at district hospitals; 54% of these did not have fully-trained surgeons. Referral hospitals more commonly performed operations outside the essential category. Conclusion: The operation rate was well beneath the benchmark, indicating a potentially large unmet need for Ghana's elderly population. Most operations for the elderly were in the essential category and delivered at district hospitals. Future global surgery benchmarking should consider specific benchmarks for different age groups.
MeSH term(s)	Aged ; Aged, 80 and over ; Benchmarking/standards ; Developing Countries ; Female ; Ghana ; Health Services Accessibility/standards ; Health Services Accessibility/statistics & numerical data ; Health Services for the Aged/standards ; Health Services for the Aged/statistics & numerical data ; Hospitals/standards ; Hospitals/statistics & numerical data ; Humans ; Male ; Needs Assessment ; Quality Indicators, Health Care/statistics & numerical data ; Retrospective Studies ; Surgical Procedures, Operative/standards ; Surgical Procedures, Operative/statistics & numerical data
Language	English
Publishing date	2019-03-01
Publishing country	United States
Document type	Journal Article ; Research Support, N.I.H., Extramural
ZDB-ID	224043-9
ISSN	1432-2323 ; 0364-2313
ISSN (online)	1432-2323
ISSN	0364-2313
DOI	10.1007/s00268-019-04963-7
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