Abstract：
BACKGROUND:Surgical care is not uniformly available worldwide. Inequities in surgical care and access may also vary within countries, and the present study aimed to explore these disparities in Pakistan. METHODS:The National Health Survey of Pakistan was analyzed. The proportion of people with a history of abdominal surgery (AS) was calculated and associated factors were determined by weighted multivariate logistic regression. Factors tested were age, gender, urban/rural residence, province, literacy, community development index (CDI), and economic status (ES). The CDI was developed for each sampling unit from select household and individual data. The ES was constructed from ownership of assets. RESULTS:A total of 59 million adults were represented. Abdominal surgery had been performed in 3.2 % adults (95 % confidence interval [CI] = 2.67, 3.84), which corresponded to an annual rate of 85.9 abdominal surgeries per 100,000 population. Wide disparities were noted, with annual rates of AS varying from 37.8 to 215.6 per 100,000 population. Urban residents were independently twice as likely as rural populations to have had AS (95 % CI = 1.3, 2.8). Higher age (OR = 2.6; 95 % CI = 1.7, 4.0), female gender (OR = 1.5; 95 % CI = 1.1, 2.1), and higher ES (OR = 1.9; 95 % CI = 1.2, 2.9) were also independently associated with AS. In rural populations ES was the only factor associated with surgery, whereas in urban populations gender and CDI had important roles to play. CONCLUSIONS:Access to surgical care is disparate and grossly inadequate in Pakistan. This likely contributes to significant preventable morbidity and death. Physical access to surgical facilities, especially in rural areas and for those with a low CDI, is an important concern and should be prioritized in any forthcoming national policies.
journal_name
World J Surgjournal_title
World journal of surgeryauthors
Zafar SN,Fatmi Z,Iqbal A,Channa R,Haider AHdoi
10.1007/s00268-012-1732-8subject
Has Abstractpub_date
2013-07-01 00:00:00pages
1470-7issue
7eissn
0364-2313issn
1432-2323journal_volume
37pub_type
杂志文章abstract：:There are now excellent data that patients with stage III colon cancer or stage II and III rectal cancer live longer if they receive, respectively, systemic or regional and systemic therapy after surgery. In addition, disease-free survival, particularly freedom from the symptoms of regional recurrence, in the high ris...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/BF00308633
更新日期：1995-03-01 00:00:00
abstract：BACKGROUND:A small remnant liver volume is an important risk factor for posthepatectomy liver failure and can be predicted accurately by computed tomography (CT) volumetry using radiologic image analysis software. Unfortunately, this software is expensive and usually requires support by a radiologist. ImageJ is a freel...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-007-9197-x
更新日期：2007-11-01 00:00:00
abstract：:Acute acalculous cholecystitis (AAC) is a well known complication in severely traumatized patients. Existing data of AAC originate from retrospective analyses and episodic case reports. In a prospective study 45 polytraumatized patients admitted to our intensive care unit from January 1989 to June 1990 were clinically...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/BF02067089
更新日期：1992-11-01 00:00:00
abstract：:Endoscopic management of polypoid early colonic cancer (malignant polyps and polypoid carcinomas) is no longer controversial. When the endoscopist is satisfied that excision is complete and histology is "favorable" (a resection margin of 2 mm and well or moderately well differentiated tumor), surgery is unnecessary. W...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/s002680010144
更新日期：2000-09-01 00:00:00
abstract：:Since the pathogenesis of endocrine ophthalmopathy is unclear, there has been little agreement on the treatment of the disease. The influence of thyroid surgery on endocrine ophthalmopathy is controversial. To evaluate the effect of thyroid surgery on the course of the disease, we developed a special ophthalmopathy in...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/BF01658552
更新日期：1990-05-01 00:00:00
abstract：:We have previously demonstrated that there are two subgroups of patients with different types of biliary bile acid output after relief of obstructive jaundice by percutaneous transhepatic biliary drainage (PTBD). The reason for two groups is not clear but is possibly the difference in hepatic reserve function. The aim...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-001-0249-3
更新日期：2002-04-01 00:00:00
abstract：INTRODUCTION:Jejunal diverticula are rare lesions, and when complications arise, they pose diagnostic difficulties. Perforation is a common complication resulting in an acute abdomen, although preoperative diagnosis is usually not possible. The "gold standard" for management for patients with complications is surgery. ...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-008-9469-0
更新日期：2008-07-01 00:00:00
abstract：:Video-assisted thyroidectomy, although an increasingly used method to treat benign thyroid nodules, is rarely used to treat thyroid cancer. We performed gasless video-assisted total thyroidectomy for the treatment of papillary carcinoma of the thyroid. The patients were two men and five women with ages ranging from 29...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-004-7446-9
更新日期：2004-09-01 00:00:00
abstract：BACKGROUND:Gastroesophageal reflux is the main risk factor for esophageal adenocarcinoma, but there is no strong support for a protective effect of antireflux surgery. We tested the hypothesis that esophageal adenocarcinoma that develops with long latency after antireflux surgery might be due to persistent postoperativ...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-006-0386-9
更新日期：2007-03-01 00:00:00
abstract：BACKGROUND:Concerns remain unresolved regarding the safety of unplanned conversion to open thoracotomy during video-assisted thoracic surgery (VATS) lobectomy. We analyzed both early and late outcomes after thoracotomy conversion from VATS. METHODS:From December 2003 to December 2008, a total of 738 VATS lobectomies w...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-010-0913-6
更新日期：2011-03-01 00:00:00
abstract：:There are three basic roles of laparoscopic surgery for patients with colorectal cancer. First, although infrequently needed prior to therapy, diagnostic or staging laparoscopy may be valuable in certain colorectal cancer patients. Second, the laparoscopic approach may offer several attractive features for the palliat...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/s002689900294
更新日期：1997-09-01 00:00:00
abstract：:We have evaluated survival and tumor-related symptoms in the presence of mesenteric lymph node and liver metastases in relation to surgical procedures in 314 patients (148 women, mean age at diagnosis 61 years; 249 with liver metastases) treated for midgut carcinoid tumors. Of the operated patients, 46% presented with...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-002-6630-z
更新日期：2002-08-01 00:00:00
abstract：INTRODUCTION:Large incisional hernias with loss of domain (LIHLD) of the abdominal wall remain a therapeutic challenge due to the difficulty of replacing the contents of the hernia sac into the peritoneal cavity. Preoperative progressive pneumoperitoneum (PPP) is a valuable option. The purpose of this study was to eval...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-015-3206-2
更新日期：2015-12-01 00:00:00
abstract：:Fifty patients reoperated for failed Nissen fundoplication are presented; 29 patients (group 2) were operated between 1983 and 1988 while 21 patients (group 1) were operated before 1983. In group 1, the "slipped Nissen" had been the most frequent cause of reoperation (48%). In group 2, the most frequent causes for the...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/BF01658439
更新日期：1989-11-01 00:00:00
abstract：BACKGROUND:Accurate, complete and sustainable methods of tracking patients and outcomes in low-resource settings are imperative as we launch efforts to improve surgical care globally. The Surgical services QUality Assessment Database (SQUAD) at the Mbarara Regional Referral Hospital in Uganda is one of very few electro...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-017-4172-7
更新日期：2018-01-01 00:00:00
abstract：:Parathyroid carcinoma is a rare cause of primary hyperparathyroidism. However, to our best knowledge, at least 163 cases of functioning parathyroid carcinoma appeared in the English literature from 1981 to 1989. We summarize the available information obtained from the reports of those patients and compare it with prev...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/BF01665308
更新日期：1991-11-01 00:00:00
abstract：:The role of nitric oxide in mediating smooth muscle relaxation is well established. Less is known about the downstream signaling events inside the smooth muscle cell that produce relaxation of the contractile machinery. One possible effector molecule is the small heat shock protein HSP20. Increased phosphorylation of ...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/s00268-002-4052-6
更新日期：2002-07-01 00:00:00
abstract：BACKGROUND:Ultrasound (US) and sestamibi (MIBI) are traditionally considered positive or negative. The purpose of this study was to define and test a new scoring system for MIBI and US and to determine whether this can improve their accuracy for primary hyperparathyroidism. METHODS:This is a prospective study of 200 c...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-012-1666-1
更新日期：2012-10-01 00:00:00
abstract：:In 141 patients with chronic pancreatitis and an inflammatory enlargement of the head of the pancreas, a duodenum-preserving resection of the head of the pancreas was performed within a 16-year period. The hospital mortality was 0.7%; the late mortality was 5%. Seventy-seven percent of the patients were completely fre...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/BF01670550
更新日期：1990-01-01 00:00:00
abstract：BACKGROUND:Little is known of the oncological outcomes after adjuvant FOLFOX chemotherapy in patients with stage III colon cancer showing microsatellite instability high (MSI-H). In the present study we investigated the prognostic impact of MSI-H in patients with stage III colon cancer receiving FOLFOX chemotherapy. M...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-013-2120-8
更新日期：2013-10-01 00:00:00
abstract：:At the time of laparotomy, peritoneal washings were collected from 155 gastric cancer patients and the levels of carcinoembryonic antigen (CEA) determined. The CEA levels in peritoneal washings were statistically independent of those in sera and could more reliably predict the presence of peritoneal metastasis than a ...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/BF00316997
更新日期：1995-01-01 00:00:00
abstract：INTRODUCTION TO THE PROBLEM:Though declining in the recent decades, high-energy musculoskeletal trauma remains a major contributor to the burden of disease in high-income countries (HICs). However, due to limitations in the available body of the literature, evaluation of this burden is challenging. The purpose of this ...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/s00268-018-4742-3
更新日期：2020-04-01 00:00:00
abstract：BACKGROUND:The role of preoperative imaging and the usability of different imaging modalities is highly variable and controversial in reduction mammaplasty patients. Our study describes the imaging process in a single center in regard to modality selection, age and timing, and of the association between imaging and his...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-017-3920-z
更新日期：2017-08-01 00:00:00
abstract：INTRODUCTION:Although seemingly straightforward, tube thoracostomy (TT) has been associated with complication rates as high as 30 %. A lack of a standardized nomenclature for reporting TT complications makes comparison and evaluation of reports impossible. We aim to develop a classification method in order to standardi...
journal_title：World journal of surgery
pub_type： 杂志文章,评审
doi：10.1007/s00268-015-3158-6
更新日期：2015-11-01 00:00:00
abstract：BACKGROUND:Organ shortage is the greatest challenge facing the field of organ transplantation today. Use of more organs of marginal quality has been advocated to address the shortage. METHOD:We examined the pattern of donation and organ use in the United States as shown in the Organ Procurement and Transplantation Net...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-012-1748-0
更新日期：2012-12-01 00:00:00
abstract：:We conducted a prospective case series study to investigate the causes of and factors influencing morbidity and mortality in 102 consecutive patients after elective infrarenal abdominal aneurysm (AAA) surgery between 1992 and 1995. Preoperative factors (demographics, risk factor indexes, electrocardiographic findings,...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s002689900382
更新日期：1998-03-01 00:00:00
abstract：BACKGROUND:Critical illness disproportionately affects people in low-income countries (LICs). Efforts to improve critical care in LICs must account for differences in demographics and infrastructure compared to high-income settings. Part of this effort includes the development and validation of intensive care unit (ICU...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-019-05078-9
更新日期：2019-10-01 00:00:00
abstract：BACKGROUND:Nonoperative management (NOM) of kidney gunshot injuries as an alternative to surgical exploration is rarely reported. The aim of this study was to assess the feasibility and safety of selective NOM of such injuries. METHODS:A 4-year prospective study was conducted that included all patients admitted to a L...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-008-9888-y
更新日期：2009-03-01 00:00:00
abstract：BACKGROUND:The Acute Surgical Unit (ASU) is a recent change in management of acute general surgical patients in hospitals worldwide. In contrast to traditional management of acute surgical presentations by a rotating on-call system, ASUs are shown to deliver improved efficiency and patient outcomes. This study investig...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/s00268-014-2497-z
更新日期：2014-08-01 00:00:00
abstract：:Frequently, several multiple abdominal reexplorations are needed in patients with acute necrotizing hemorrhagic pancreatitis (ANP) or with persistent intraabdominal sepsis (PIAS). Residual undrained necrotic and septic foci lead to multiple organ failure. To provide wide-open drainage of the abdominal cavity, since 19...
journal_title：World journal of surgery
pub_type： 杂志文章
doi：10.1007/BF01658968
更新日期：1991-01-01 00:00:00
