Results from the 2010 global burden of disease study and disease control priorities: What do the numbers tell us about surgical conditions?

The 2010 Global Burden of Disease(GBD) study uncovered an epidemiologic shift in disease pattern from communicable to noncommunicable diseases. Although diseases requiring surgical care constitute a significant burden, little awareness exist on their actual magnitude and out of all operations done annually, only 3.5% are performed in the poorest third of the world. Mortality and disability-adjusted life years (DALYs) for which surgical care plays a major role was reviewed in the GBD study in five major areas guided by the World Bank's Disease Control Priorities (DCP) framework. The proportion of DALYs due to lack of surgery was calculated based on estimates from the DCP. These were compared with traditional infectious disease estimates. In 2010, deaths and DALYs (in millions) due to malignancies (7.98, 188.5); injury (5.07, 278.7); other surgical conditions such as intestinal obstruction, gallbladder and bile duct disease, appendicitis, and hernias (0.29, 8.25); obstetric complications such as obstructed labor, abortion and hemorrhage (0.106, 2.41); and cleft lip and palate (.004, 0.57) were compared with malaria (1.17, 82.7), HIV/AIDS (1.47, 81.5), TB (1.2, 49.4), diarrheal diseases (1.45, 89.5), mental health (0.23, 185), and lower respiratory infections (2.81, 115.2). Deaths and DALYs from injuries were 24.48 and 23.36%, respectively, higher than HIV, TB and malaria combined. Diseases requiring surgical care, particularly injuries, have surpassed most infectious diseases without corresponding health infrastructure to meet the need. More attention needs to be focused on primary and secondary prevention of premature death and disability from lack of surgical care.