Browse

You are looking at 1 - 10 of 18 items for

  • Refine by Access: user x
  • By Author: Park, Kee B. x
Clear All
Open access

Mapping the global neurosurgery workforce. Part 1: Consultant neurosurgeon density

Saksham Gupta, Zsombor T. Gal, Tejas S. Athni, Chrystal Calderon, William É Callison, Olaoluwa E. Dada, Winston Lie, Carolyn Qian, Ramya Reddy, Myron Rolle, Ronnie E. Baticulon, Bipin Chaurasia, Ellianne J. Dos Santos Rubio, Yoshua Esquenazi, Alexandra J. Golby, Ahmad F. Pirzad, and Kee B. Park

OBJECTIVE

It is unknown whether efforts to expand access to neurosurgery worldwide have translated to an increase in the global neurosurgery workforce, particularly in low- and middle-income countries. The main objective of this study was to quantify the number and distribution of consultant neurosurgeons worldwide, while also identifying temporal and geographic trends in the neurosurgery workforce in different income levels and WHO regions, and analyzing what factors might contribute to the growth of a national workforce.

METHODS

This study was a subanalysis of an electronic cross-sectional survey administered to participants identified through neurosurgery societies, personal contacts, and online searches of all 193 countries and 26 territories, independent states, and disputed regions as defined by the World Bank (WB) and United Nations between October 2022 and March 2023. Population-weighted statistics for the consultant neurosurgery workforce and resource availability were estimated, and linear regression analysis was conducted to identify correlations with growth in the workforce.

RESULTS

Data were obtained for 192 countries (99.5%) and 25 additional territories, states, and disputed regions (96.2%). One hundred seventy-seven respondents participated in the survey. There were an estimated 72,967 neurosurgeons worldwide, representing a global pooled density of 0.93 neurosurgeons per 100,000 people and a median country density of 0.44 neurosurgeons per 100,000 people. The authors found an increasing density of consultant neurosurgeons, from low-income countries (0.12 per 100,000 people), to lower-middle-income countries (LoMICs; 0.37), to upper-middle-income countries (UpMICs; 1.13), and to high-income countries (2.44). The WHO African and Southeast Asia regions had the lowest pooled neurosurgeon density, while the Western Pacific region (WPR) had the highest density. There were 29 countries, 14 territories, and 1 independent state with no neurosurgeons. Neurosurgeons in countries with higher income–level designations had more frequent access to resources and equipment. The annual growth rates in workforce density were highest in LoMICs (26.0%) and UpMICs (21.3%), and the most rapid annual growth was in the Southeast Asia region (33.0%). Regression analysis revealed that an increasing population quartile, the Eastern Mediterranean region (relative to the WPR), the presence of a national neurosurgery society, increasing global development aid, and national gross domestic product were associated with relative growth in national neurosurgeon density.

CONCLUSIONS

The authors estimate a global consultant neurosurgeon workforce of nearly 73,000 neurosurgeons, with stark disparities in the density and growth of the workforce in different WB income-level groups and WHO regions. The presence of a neurosurgery society was correlated with the growth of the workforce, and this study identified several regional targets for further intervention to expand access to neurosurgery.

Free access

Mapping the global neurosurgery workforce. Part 2: Trainee density

Saksham Gupta, Zsombor T. Gal, Tejas S. Athni, Chrystal Calderon, William É Callison, Olaoluwa E. Dada, Winston Lie, Carolyn Qian, Ramya Reddy, Myron Rolle, Ronnie E. Baticulon, Bipin Chaurasia, Ellianne J. Dos Santos Rubio, Yoshua Esquenazi, Alexandra J. Golby, Ahmad F. Pirzad, and Kee B. Park

OBJECTIVE

A sustainable neurosurgery workforce depends on robust training pipelines, but the size and distribution of the global neurosurgery trainee workforce has not been described. The objective of this study was to identify the types of training programs that exist in the global neurosurgery workforce, the support that trainees receive, the diversity of trainee experiences, and the accreditation processes that exist to regulate training programs.

METHODS

This study was a subanalysis of a cross-sectional survey administered online in all 193 countries and 26 territories, independent states, and disputed regions as defined by the World Bank and United Nations. Participants were identified through neurosurgery society leadership, the personal contacts of the coauthors, and bibliometric and search engine searches. Population-weighted statistics were constructed and segregated by country income level and WHO regions.

RESULTS

Data were obtained for 187 countries (96.9%) and 25 additional territories, states, and disputed regions (96.2%). There were an estimated 1261 training programs and 10,546 trainees within the regions sampled, representing a global pooled density of 0.14 neurosurgery trainees per 100,000 people and a median national density of 0.06 trainees per 100,000 people. There was a higher density in high-income countries (HICs; 0.48 trainees per 100,000 people) compared with upper-middle-income countries (0.09 per 100,000), lower-middle-income countries (0.06 per 100,000), and low-income countries (LICs; 0.07 per 100,000). The WHO European (0.36 per 100,000) and Americas (0.27 per 100,000) regions had the highest trainee densities, while the Southeast Asia (0.04 per 100,000) and African (0.05 per 100,000) regions had the lowest densities. Among countries with training programs, LICs had the poorest availability of subspecialty training and resources such as cadaver laboratories and conference stipends for trainees. Training program accreditation processes were more common in HICs (81.8%) than in low- and middle-income countries (LMICs; 69.2%) with training programs.

CONCLUSIONS

The authors estimate that there are at least 1261 neurosurgery training programs with 10,546 total trainees worldwide. The density of neurosurgery trainees was disproportionately higher in HICs than LMICs, and the WHO European and Americas regions had the highest trainee densities. The trainee workforce in LICs had the poorest access to subspecialty training and advanced resources.

Free access

Letter to the Editor. The molecular mechanisms of folic acid fortification to prevent spina bifida

Juan Armando Mejía and Luis Garcia Rairan

Free access

The role of neurosurgeons in global public health: the case of folic acid fortification of staple foods to prevent spina bifida

Nathan A. Shlobin, Jordan T. Roach, Vijaya Kancherla, Adrian Caceres, Eylem Ocal, Kemel A. Ghotme, Sandi Lam, Kee B. Park, Gail Rosseau, Jeffrey P. Blount, Frederick A. Boop, and the Global Alliance for the Prevention of Spina Bifida-F (GAPSBiF)

OBJECTIVE

The global neurosurgery movement arose at the crossroads of unmet neurosurgical needs and public health to address the global burden of neurosurgical disease. The case of folic acid fortification (FAF) of staple foods for the prevention of spina bifida and anencephaly (SBA) represents an example of a new neurosurgical paradigm focused on public health intervention in addition to the treatment of individual cases. The Global Alliance for the Prevention of Spina Bifida-F (GAPSBiF), a multidisciplinary coalition of neurosurgeons, pediatricians, geneticists, epidemiologists, food scientists, and fortification policy experts, was formed to advocate for FAF of staple foods worldwide. This paper serves as a review of the work of GAPSBiF thus far in advocating for universal FAF of commonly consumed staple foods to equitably prevent SBA caused by folic acid insufficiency.

METHODS

A narrative review was performed using the PubMed and Google Scholar databases.

RESULTS

In this review, the authors describe the impact of SBA on patients, caregivers, and health systems, as well as characterize the multifaceted requirements for proper spina bifida care, including multidisciplinary clinics and the transition of care, while highlighting the role of neurosurgeons. Then they discuss prevention policy approaches, including supplementation, fortification, and hybrid efforts with folic acid. Next, they use the example of FAF of staple foods as a model for neurosurgeons’ involvement in global public health through clinical practice, research, education and training, and advocacy. Last, they describe mechanisms for involvement in the above initiatives as a potential academic tenure track, including institutional partnerships, organized neurosurgery, neurosurgical expert groups, nongovernmental organizations, national or international governments, and multidisciplinary coalitions.

CONCLUSIONS

The role of neurosurgeons in caring for children with spina bifida extends beyond treating patients in clinical practice and includes research, education and training, and advocacy initiatives to promote context-specific, evidence-based initiatives to public health problems. Promoting and championing FAF serves as an example of the far-reaching, impactful role that neurosurgeons worldwide may play at the intersection of neurosurgery and public health.

Free access

Barriers to neurotrauma care in low- to middle-income countries: an international survey of neurotrauma providers

Saniya Mediratta, Jacob R. Lepard, Ernest J. Barthélemy, Jacquelyn Corley, and Kee B. Park

OBJECTIVE

Delays along the neurosurgical care continuum are associated with poor outcomes and are significantly greater in low- to middle-income countries (LMICs), with timely access to neurotrauma care remaining one of the most significant unmet neurosurgical needs worldwide. Using Lancet Global Surgery metrics and the Three Delays framework, the authors of this study aimed to identify and characterize the most significant barriers to the delivery of neurotrauma care in LMICs from the perspective of local neurotrauma providers.

METHODS

The authors conducted a cross-sectional study through the dissemination of a web-based survey to neurotrauma providers across all World Health Organization geographic regions. Responses were analyzed with descriptive statistics and Kruskal-Wallis testing, using World Bank data to provide estimates of populations at risk.

RESULTS

Eighty-two (36.9%) of 222 neurosurgeons representing 47 countries participated in the survey. It was estimated that 3.9 billion people lack access to neurotrauma care within 2 hours. Nearly 3.4 billion were estimated to be at risk for impoverishing expenditure and 2.9 billion were at risk of catastrophic expenditure as a result of paying for care for neurotrauma injuries. Delays in seeking care were rated as slightly common (p < 0.001), those in reaching care were very common (p < 0.001), and those in receiving care were slightly common (p < 0.05). The most significant causes for delays were associated with reaching care, including geographic distance from a facility, lack of ambulance service, and lack of finances for travel. All three delays were correlated to income classification and geographic region.

CONCLUSIONS

While expanding the global neurosurgical workforce is of the utmost importance, the study data suggested that it may not be entirely sufficient in gaining access to care for the emergent neurosurgical patient. Significant income and region-specific variability exists with regard to barriers to accessing neurotrauma care. Highlighting these barriers and quantifying worldwide access to neurotrauma care using metrics from the Lancet Commission on Global Surgery provides essential insight for future initiatives aiming to strengthen global neurotrauma systems.

Free access

Global neurosurgery: continued momentum at the 72nd World Health Assembly

Gail Rosseau, Walter D. Johnson, Kee B. Park, Peter J. Hutchinson, Laura Lippa, Russell Andrews, Franco Servadei, and Roxanna M. Garcia

Global neurosurgery is the practice of neurosurgery with the primary purpose of delivering timely, safe, and affordable neurosurgical care to all who need it. This field is led by neurosurgeons, and global neurosurgery sessions are now part of every major international neurosurgical meeting. The World Federation of Neurosurgical Societies (WFNS) is working to coordinate activities and align all related activities for greater impact. This report updates the contributions made by the WFNS-WHO Liaison Committee at the most recent World Health Assembly (WHA) in 2019. The WHA is a decision-making body of the World Health Organization (WHO), attended by its 194 Member States. The WFNS has maintained official relations as a nongovernmental organization with the WHO for over 30 years, and this year 15 neurosurgical delegates attended events during the WHA. Participation by neurosurgeons continues to grow as many WHA events focused on global surgery have intrinsically involved neurosurgical leadership and participation. This year, resolution WHA72.31, entitled “Emergency and trauma care, Emergency care systems for universal health coverage: ensuring timely care for the acutely ill and injured,” was passed. This resolution provides further opportunities for neurosurgical advocacy as the landscape of global surgery gains recognition and momentum.

Free access

A comparison of publication to TBI burden ratio of low- and middle-income countries versus high-income countries: how can we improve worldwide care of TBI?

Maria Pia Tropeano, Riccardo Spaggiari, Hernán Ileyassoff, Kee B. Park, Angelos G. Kolias, Peter J. Hutchinson, and Franco Servadei

OBJECTIVE

Traumatic brain injury (TBI) is a global public health problem and more than 70% of trauma-related deaths are estimated to occur in low- and middle-income countries (LMICs). Nevertheless, there is a consistent lack of data from these countries. The aim of this work is to estimate the capacity of different and heterogeneous areas of the world to report and publish data on TBI. In addition, we wanted to estimate the countries with the highest and lowest number of publications when taking into account the relative TBI burden.

METHODS

First, a bibliometric analysis of all the publications about TBI available in the PubMed database from January 1, 2008, to December 31, 2018, was performed. These data were tabulated by country and grouped according to each geographical region as indicated by the WHO: African Region (AFR), Region of the Americas (PAH), South-East Asia Region (SEAR), European Region (EUR), Eastern Mediterranean Region (EMR), and Western Pacific Region (WPR). In this analysis, PAH was further subdivided into Latin America (AMR-L) and North America (AMR-US/Can). Then a “publication to TBI volume ratio” was derived to estimate the research interest in TBI with respect to the frequency of this pathology.

RESULTS

Between 2008 and 2018 a total of 8144 articles were published and indexed in the PubMed database about TBI. Leading WHO regions in terms of contributions were AMR-US/Can with 4183 articles (51.36%), followed by EUR with 2003 articles (24.60%), WPR with 1507 (18.50%), AMR-L with 141 articles (1.73%), EMR with 135 (1.66%), AFR with 91 articles (1.12%), and SEAR with 84 articles (1.03%). The highest publication to TBI volume ratios were found for AMR-US/Can (90.93) and EUR (21.54), followed by WPR (8.71) and AMR-L (2.43). Almost 90 times lower than the ratio of AMR-US/Can were the ratios for AFR (1.15) and SEAR (0.46).

CONCLUSIONS

An important disparity currently exists between countries with a high burden of TBI and those in which most of the research is conducted. A call for improvement of data collection and research outputs along with an increase in international collaboration could quantitatively and qualitatively improve the ability of LMICs to ameliorate TBI care and develop clinical practice guidelines.

Free access

Editorial. Research in global neurosurgery: informing the path to achieving neurosurgical equity

Kee B. Park

Full access

Third delay in traumatic brain injury: time to management as a predictor of mortality

Saksham Gupta, Monty Khajanchi, Vineet Kumar, Nakul P. Raykar, Blake C. Alkire, Nobhojit Roy, and Kee B. Park

OBJECTIVE

Traumatic brain injury (TBI) is a global epidemic with an increasing incidence in low- and middle-income countries (LMICs). The time from arrival at the hospital to receiving appropriate treatment (“third delay”) can vary widely in LMICs, although its association with mortality in TBI remains unknown.

METHODS

A retrospective cohort analysis with multivariable logistic regression was conducted using the Toward Improved Trauma Care Outcomes in India database, which contains data from 4 urban trauma centers in India from 2013–2015.

RESULTS

There were 6278 TBIs included in the cohort. The patients’ median age was 39 years (interquartile range 27–52 years) and 80% of patients were male. The most frequent mechanisms of injury were road traffic accidents (52%) and falls (34%). A majority of cases were transfers from other facilities (79%). In-hospital 30-day mortality was 27%; of patients who died, 21% died within 24 hours of arrival. The median third delay was 10 minutes (interquartile range 0–60 minutes); 34% of cases had moderate third delay (10–60 minutes) and 22% had extended third delay (≥ 61 minutes). Overall 30-day mortality was associated with moderate third delay (OR 1.3, p = 0.001) and extended third delay (OR 1.3, p = 0.001) after adjustment by pertinent covariates. This effect was pronounced for 24-hour mortality: moderate and extended third delays were independently associated with ORs of 3.4 and 3.8, respectively, for 24-hour mortality (both p < 0.001).

CONCLUSIONS

Third delay is associated with early mortality in patients with TBI, and represents a target for process improvement in urban trauma centers.

Full access

The global neurosurgical workforce: a mixed-methods assessment of density and growth

Swagoto Mukhopadhyay, Maria Punchak, Abbas Rattani, Ya-Ching Hung, James Dahm, Serena Faruque, Michael C. Dewan, Sophie Peeters, Sonal Sachdev, and Kee B. Park

OBJECTIVE

In 2000, the global density of neurosurgeons was estimated at 1 per 230,000 population, which remains the most recent estimate of the global neurosurgeon workforce density. In 2004, the World Health Organization (WHO) estimated that there were 33,193 neurosurgeons worldwide, including trainees. There have been no updates to this estimate in the past decade. Moreover, only WHO region–level granularity regarding neurosurgeon distribution exists; country-level estimates are limited. The neurosurgery workforce is a crucial component to meeting the growing burden of neurosurgical diseases, which not only represent high absolute incidences and prevalences, but also represent correspondingly high disability-adjusted life years affecting hundreds of millions of people worldwide. Combining the lack of knowledge about the availability of the neurosurgical workforce and the increasing demand for neurosurgical services underscores the need for a system of neurosurgical workforce density surveillance.

METHODS

This study involved 3 key steps: 1) global survey/literature review to obtain the number of working neurosurgeons per WHO-recognized country, 2) regression to interpolate any missing data, and 3) calculation of workforce densities and comparison to available historical data by WHO region.

RESULTS

Data for 198 countries were collected (158) or interpolated (40). The global total number of neurosurgeons was estimated at 49,940. Overall, neurosurgeon density ranged from 0 to 58.95 (standardized to per 1,000,000 population) with a median of 3.56 (IQR 0.29–8.26). Thirty-three countries were found to have no neurosurgeons (zero). The highest density, 58.95, was in Japan, where 7495 neurosurgeons are taking care of a population of 127,131,800.

CONCLUSIONS

In 2015, the Lancet Commission on Global Surgery estimated that 143 million additional surgical procedures are needed in low- and middle-income countries each year, and a subsequent study revealed that approximately 15% of those surgical procedures are neurosurgical. Based on our results, we can conclude that there are approximately 49,940 neurosurgeons currently, worldwide. The availability of neurosurgeons appears to have increased in all geographic regions over the past decade, with Southeast Asia experiencing the greatest growth. Such remarkable expansion should be assessed to determine factors that could play a role in other regions where the acceleration of growth would be beneficial.