International Journal for Quality in Health Care, 2019, 31(3), 166–172 doi: 10.1093/intqhc/mzy141 Advance Access Publication Date: 18 July 2018 Review Review Quality of essential surgical care in low- and middle-income countries: a systematic review of the literature SAURABH SALUJA 1,2 , SWAGOTO MUKHOPADHYAY 1,3 , JULIA R. AMUNDSON 1,4 , ALLISON SILVERSTEIN 1 , JESSICA GELMAN 4 , HILLARY JENNY 1,5 , YIHAN LIN 1,6 , ANTHONY MOCCIA 7 , RAMY RASHAD 8 , RACHITA SOOD 1,4 , NAKUL P. RAYKAR 1,9 , and MARK G. SHRIME 1 1 Program in Global Surgery and Social Change, Harvard Medical School, 641 Huntington Ave, Boston, MA 02115, USA, 2 Department of Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10025, USA, 3 Department of Surgery, University of Connecticut, 263 Farmington Avenue, Farmington, CT 06030, USA, 4 Department of Education, Miller School of Medicine, University of Miami, 1600 NW 10th Avenue #1140, Miami, FL 33136, USA, 5 Icahn School of Medicine at Mt. Sinai, 1 Gustav Levy Place, New York, NY 10029, USA, 6 Department of Surgery, University of Colorado, 12631 E 17th Avenue, Aurora, CO 80045, USA, 7 Harvard Initiative on Global Health Quality, Harvard Global Health Institute, 42 Church St, Cambridge, MA 02138, USA, 8 Tufts University School of Medicine, 145 Harrison Ave, Boston, MA 02111, USA, and 9 Department of Surgery, Beth Israel Deaconess Medical Center, 110 Francis St, Boston, MA 02215, USA Address reprint requests to: Saurabh Saluja, Department of Surgery, Weill Cornell Medicine, 525 E 68th St, New York, NY 10025, USA. Tel: +1-608-772-2985; Fax: +1-646-697-0074; E-mail: sausaluja@gmail.com Editorial Decision 17 May 2018; Accepted 13 June 2018 Abstract Purpose: Quality of care is an emerging area of focus in the surgical disciplines. However, much of the emphasis on quality is limited to high-income countries. To address this gap, we conducted a systematic review of the literature on the quality of essential surgical care in low- and middle- income countries (LMIC). Data sources: We searched PubMed, Cinahl, Embase and CAB Abstracts using three domains: quality of care, surgery and LMIC. Study selection: We limited our review to studies of essential surgeries that pertained to all three search domains. Data extraction: We extracted data on study characteristics, type of surgery and the way in which quality was studied. Results of data synthesis: 354 studies were included. 281 (79.4%) were single-center studies and nearly half (n = 169, 46.9%) did not specify the level of facility. 207 studies reported on mortality (58.47%) and 325 reported on a morbidity (91.81%), most commonly surgical site infection (n = 190, 53.67%). Of the Institute of Medicine domains of quality, studies were most commonly of safety (n = 310, 87.57%) and effectiveness (n = 180, 50.85%) and least commonly of equity (n = 21, 5.93%). Conclusion: We find that while there are numerous studies that report on some aspects of quality of care, much of the data is single center and observational. Additionally, there is variability on which outcomes are reported both within and across specialties. Finally, we find under-reporting of parameters of equity and timeliness, which may be critical areas for research moving forward. Key words: patient outcomes, public Health, developing countries, surgery © The Author(s) 2018. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com 166 Downloaded from https://academic.oup.com/intqhc/article-abstract/31/3/166/5055360 by guest on 02 June 2020