將來(lái)20年世界的癌癥手術(shù)需要與最好手術(shù)及麻醉勞動(dòng)力需要預(yù)計(jì)

Global demand for cancer surgery and an estimate of the optimal surgical and anaesthesia workforce between 2018 and 2040: a population-based modelling studyPerera SK, Jacob S, Wilson BE, et al. Global demand for cancer surgery and an estimate of the optimal surgical and anaesthesia workforce between 2018 and 2040: a population-based modelling study. The Lancet Oncology.Correspondence to: Sathira Kasun Perera, Collaboration for Cancer Outcomes Research and Evaluation, Ingham Institute of Applied Medical Research, University of New South Wales, Sydney, NSW 170, Australia sathira_perera@yahoo.com

Background 布景

The growing demand for cancer surgery has placed a global strain on health systems. In-depth analyses of the global demand for cancer surgery and optimal workforce requirements are needed to plan service provision. We estimated the global demand for cancer surgery and the requirements for an optimal surgical and anaesthesia workforce, using benchmarks based on clinical guidelines.

癌癥手術(shù)需要的逐漸增長(zhǎng)給世界衛(wèi)生體系帶來(lái)了壓力。咱們須要對(duì)世界癌癥手術(shù)需要和最好勞動(dòng)力需要進(jìn)行深入解析，以計(jì)劃醫(yī)療服務(wù)的供應(yīng)。咱們基于臨床指南預(yù)計(jì)了世界癌癥手術(shù)的需要并且最抱負(fù)的內(nèi)科和麻醉勞動(dòng)力的需要。

Methods 方式

Using models of benchmark surgical use based on clinical guidelines, we estimated the proportion of cancer cases with an indication for surgery across 183 countries, stratified by income group. These proportions were multiplied by age-adjusted national estimates of new cancer cases using GLOBOCAN 2018 data and then aggregated to obtain the estimated number of surgical procedures required globally. The numbers of cancer surgical procedures in 44 high-income countries were divided by the actual number of surgeons and anaesthetists in the respective countries to calculate cancer procedures per surgeon and anaesthetist ratios. Using the median (IQR) of these ratios as benchmarks, we developed a three-tiered optimal surgical and anaesthesia workforce matrix, and the predictions were extrapolated up to 2040.

通過(guò)根據(jù)臨床指南需手術(shù)的基準(zhǔn)模型，咱們以不同收益層級(jí)對(duì)183個(gè)國(guó)度擁有手術(shù)指征的癌癥病例的比率進(jìn)行了預(yù)計(jì)。應(yīng)用2018年GLOBOCAN信息，按比率乘以經(jīng)年紀(jì)調(diào)節(jié)的國(guó)度新癌癥病例預(yù)計(jì)數(shù)并匯總獲得了世界所需手術(shù)的預(yù)計(jì)數(shù)。將44個(gè)高收益國(guó)度的癌癥手術(shù)數(shù)目除以各自國(guó)度的內(nèi)科醫(yī)師和麻醉師的實(shí)際人數(shù)，計(jì)算出每名內(nèi)科醫(yī)師和麻醉醫(yī)生進(jìn)行癌癥手術(shù)的比率。應(yīng)用這類比率的中位數(shù)(IQR)成為基準(zhǔn)，咱們開(kāi)發(fā)了一個(gè)三層最好內(nèi)科和麻醉勞動(dòng)力矩陣，并預(yù)判2040年的狀況。

Findings 結(jié)果

Our model estimates that the number of cancer cases globally with an indication for surgery will increase by 5 million procedures (52%) between 2018 (9 065 000) and 2040 (13 821 000). The greatest relative increase in surgical demand will occur in 34 low-income countries, where we also observed the largest gaps in workforce requirements. To match the median benchmark for high-income countries, the surgical workforce in these countries would need to increase by almost four times and the anaesthesia workforce by nearly 5·5 times. The greates increase in optimal workforce requirements from 2018 to 2040 will occur in low-income countries (from 28 000 surgeons to 58 000 surgeons; 107% increase), followed by lower-middle-income countries (from 166 000 surgeons to 277 000 surgeons; 67% increase).

咱們的模型預(yù)計(jì)，在2018年(906.5萬(wàn))至2040年(1382.1萬(wàn))之間，世界有手術(shù)順應(yīng)癥的癌癥病例數(shù)目將加大500萬(wàn)例(52%)。34個(gè)低收益國(guó)度內(nèi)科手術(shù)需要將產(chǎn)生最大的相對(duì)增長(zhǎng)。同時(shí)咱們還觀測(cè)到這類國(guó)度在勞動(dòng)力需要方面的缺口最大。要到達(dá)高收益國(guó)度的中位數(shù)基準(zhǔn)，這類國(guó)度的內(nèi)科手術(shù)勞動(dòng)力須要加大近4倍，麻醉勞動(dòng)力須要加大近5.5倍。從2018年到2040年，最好勞動(dòng)力需要的最大增長(zhǎng)將產(chǎn)生在低收益國(guó)度(從28 000名內(nèi)科醫(yī)師加大到58 000名;增長(zhǎng)107%)，其次是中低收益國(guó)度(從166 000名內(nèi)科醫(yī)師增至277 000名;加大67%)。

Interpretation 意思

The global demand for cancer surgery and the optimal workforce are predicted to increase over the next two decades and disproportionately affect low-income countries. These estimates provide an appropriate framework for planning the provision of surgical services for cancer worldwide.

估計(jì)在將來(lái)20年，世界對(duì)癌癥手術(shù)和最好手術(shù)及麻醉勞動(dòng)力的需要將會(huì)加大，此中低收益國(guó)度所受牽連將更大。這類預(yù)計(jì)為世界癌癥手術(shù)服務(wù)的計(jì)劃供應(yīng)了一個(gè)恰當(dāng)?shù)目蚣堋?/p>