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63 Overuse of surgical procedures in low- and middle- income countries (LMICs): a scoping review of the extent, drivers, consequences, and solutions
  1. Loai Albarqouni
  1. Institute for Evidence-Based Healthcare, Bond University, Gold Coast, Australia


Objective Overuse of surgical procedures causes harm to both individuals and healthcare systems, by taking resources that could be used to address the underuse of effective healthcare interventions.

Overuse of surgical and other invasive procedures is increasingly recognised around the world. In LMICs, there is some limited country-specific evidence showing that overuse of surgical procedures may be increasing, at least for certain procedures. To identify gaps in knowledge, inform future agendas for research and action, and help build a global network to advance this work, we conducted a scoping review of the evidence around the overuse of surgical procedures in LMICs, their extent, drivers, consequences, and potential solutions.

Methods We searched 4 electronic databases: PubMed, Embase, PsycINFO, and Global Index Medicus for relevant studies published until 27 April 2022, with no restrictions on date or language. We used a combination of MeSH terms and free text words around the overuse of surgical procedures. We included studies that examined the problem of overuse of surgical procedures in LMICs and categorised them by major focus: the extent of overuse, its drivers, consequences, and solutions.

Results We identified 4276 unique records and included 117 studies across 38 countries, involving reported on >9.1 million surgical procedures (a median of 894; IQR 97-4259) and >10.5 million participants (a median of 989; IQR 200-4762). Eleven studies were multinational. Of the 106 studies originating from single countries, 232 (63%) were from upper-middle-income countries and 28 (26%) were from East Asia & Pacific.

Of the 117 included studies, 31 (26.5%) reported on the extent of overuse of surgical procedures in LMICs. The majority of these studies reported on the extent of unnecessary caesarean sections (n=25; 80.6%) – with estimates of unnecessary caesarean sections in LMIC ranging from 12% in a retrospective study of 300 low-risk women underwent CS at 10 referral hospitals in Burkina Faso to 81% in a cross-sectional study of 416 primary CS in 4 hospitals in Colombia (IQR 19.5% to 50%).

Conclusions There is growing evidence of overuse of surgical procedures in LMICs which generate significant harm and waste. A better understanding of the problems and robust evaluation of solutions is needed.

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