Operative and consultative proportions of neurosurgical disease worldwide: estimation from the surgeon perspective

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OBJECTIVE

The global magnitude of neurosurgical disease is unknown. The authors sought to estimate the surgical and consultative proportion of diseases commonly encountered by neurosurgeons, as well as surgeon case volume and perceived workload.

METHODS

An electronic survey was sent to 193 neurosurgeons previously identified via a global surgeon mapping initiative. The survey consisted of three sections aimed at quantifying surgical incidence of neurological disease, consultation incidence, and surgeon demographic data. Surgeons were asked to estimate the proportion of 11 neurological disorders that, in an ideal world, would indicate either neurosurgical operation or neurosurgical consultation. Respondent surgeons indicated their confidence level in each estimate. Demographic and surgical practice characteristics—including case volume and perceived workload—were also captured.

RESULTS

Eighty-five neurosurgeons from 57 countries, representing all WHO regions and World Bank income levels, completed the survey. Neurological conditions estimated to warrant neurosurgical consultation with the highest frequency were brain tumors (96%), spinal tumors (95%), hydrocephalus (94%), and neural tube defects (92%), whereas stroke (54%), central nervous system infection (58%), and epilepsy (40%) carried the lowest frequency. Similarly, surgery was deemed necessary for an average of 88% cases of hydrocephalus, 82% of spinal tumors and neural tube defects, and 78% of brain tumors. Degenerative spine disease (42%), stroke (31%), and epilepsy (24%) were found to warrant surgical intervention less frequently. Confidence levels were consistently high among respondents (lower quartile > 70/100 for 90% of questions), and estimates did not vary significantly across WHO regions or among income levels. Surgeons reported performing a mean of 245 cases annually (median 190). On a 100-point scale indicating a surgeon’s perceived workload (0—not busy, 100—overworked), respondents selected a mean workload of 75 (median 79).

CONCLUSIONS

With a high level of confidence and strong concordance, neurosurgeons estimated that the vast majority of patients with central nervous system tumors, hydrocephalus, or neural tube defects mandate neurosurgical involvement. A significant proportion of other common neurological diseases, such as traumatic brain and spinal injury, vascular anomalies, and degenerative spine disease, demand the attention of a neurosurgeon—whether via operative intervention or expert counsel. These estimates facilitate measurement of the expected annual volume of neurosurgical disease globally.

ABBREVIATIONS HIC = high-income country; IQR = interquartile range; LIC = low-income country; MIC = middle-income country; TBI = traumatic brain injury; TSI = traumatic spinal injury; WB = World Bank; WFNS = World Federation of Neurosurgical Societies.

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Article Information

Correspondence Michael C. Dewan: Vanderbilt University Medical Center, Nashville, TN. michael.dewan@vumc.org.

INCLUDE WHEN CITING Published online May 11, 2018; DOI: 10.3171/2017.10.JNS17347.

Disclosures The results outlined in this manuscript do not necessarily reflect the official opinions or policies of the WHO. Dr. Haglund has received support from NuVasive for non–study-related clinical or research effort.

© AANS, except where prohibited by US copyright law.

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    Estimated proportion of neurosurgical conditions requiring consultation. For all disease categories, each circle represents aggregated data from every WHO region and WB income group. The diameter of each circle is directly proportional to the percentage of neurosurgical cases that respondents believe requires consultation. On the other hand, color represents the mean confidence of the respondents. The light-to-dark spectrum corresponds to a confidence range from 60% to 100%. AFR = African Region; AMR-L = Region of the Americas–Latin America; AMR-US/Can = Region of the Americas–United States and Canada; CNSI = central nervous system infection; DSD = degenerative spine disease; EMR = Eastern Mediterranean Region; EUR = European Region; HC = hydrocephalus; HIC = high-income country; LIC = low-income country; MIC = middle-income country; NTD = neural tube defect; SEAR = Southeast Asia Region; TBI = traumatic brain injury; TSI = traumatic spinal injury; WHO = World Health Organization; WPR = Western Pacific Region. Figure is available in color online only.

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    Estimated proportion of cases requiring neurosurgical operation. For all disease categories, each circle represents aggregated data from every WHO region and WB income group. The diameter of each circle is directly proportional to the percentage of cases that respondents believe requires neurosurgical operation. On the other hand, color represents the mean confidence of the respondents. The light-to-dark spectrum corresponds to a confidence range from 60% to 100%. See the legend for Fig. 1 for definitions of abbreviations. Figure is available in color online only.

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    Number of neurosurgical operations per annum and surgeon workload. The horizontal axis represents the estimated number of cases for each surgeon, relative to the surgeons’ perceived workload on the vertical axis. Workload was rated on a continuous scale from 0 (not at all busy) to 100 (extremely busy, overworked). The hollow diamond represents the intersection between the median number of cases (190) and the median workload (79). The solid triangle represents the intersection of the mean number of cases (245) and the mean workload (75 on a 100-point scale). The dotted line represents the regression line of fit [y = 65.7 + 0.042(x)]. The vertical dashed arrow indicates the number of annual operations (223) that correlates with the mean perceived workload by respondent neurosurgeons (75/100). Figure is available in color online only.

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