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J Neurosurg. 2018 May 1:1-9. doi: 10.3171/2017.10.JNS17347. [Epub ahead of print]

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

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1Global Neurosurgery Initiative, Program in Global Surgery and Social Change, Department of Global Health and Social Medicine.
2Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville.
3Meharry Medical College, School of Medicine, Nashville, Tennessee.
4University of the Philippines College of Medicine-Philippine General Hospital, Manila, Republic of the Philippines.
5Department of Neurosurgery, Brigham and Women's Hospital, Boston, Massachusetts.
6Emergency & Essential Surgical Care Programme Lead, World Health Organization, Geneva, Switzerland.
7Department of Neurological Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin; and.
8Division of Global Neurosurgery and Neurology, Department of Neurosurgery and Duke Global Health Institute, Duke University, Durham, North Carolina.
9Office of Global Surgery and Health.
10Department of Neurological Surgery, Boston Children's Hospital, Harvard Medical School.
11Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.


OBJECTIVEThe 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.METHODSAn 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.RESULTSEighty-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).CONCLUSIONSWith 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.


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; burden; global; neurosurgery; surgeon; survey


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