Defining the critical pediatric surgical workforce density for improving surgical outcomes: a global study
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Published on: August 15, 2025
Doulia Hamad1, Yasmine Yousef1, Natasha G Caminsky1
1Division of Pediatric General and Thoracic Surgery, The Montreal Children's Hospital, McGill University Health Centre, Montreal, Quebec, Canada.
Insights
A pediatric surgical workforce density of at least 4 surgeons per million children is linked to an 80% survival rate for pediatric surgical conditions. Increasing this density in low- and middle-income countries could save lives.
Area of Science:
- Global Health
- Pediatric Surgery
- Surgical Workforce Development
Background:
- Low- and middle-income countries (LMICs) face a disproportionate burden of deaths from noncommunicable diseases, with limited surgical resources.
- The global pediatric surgical workforce is unevenly distributed, with LMICs possessing only 19% of surgeons.
Purpose of the Study:
- To investigate the relationship between pediatric surgical workforce density (PSWD) and survival rates for pediatric surgical conditions globally.
- To establish a benchmark for pediatric surgical workforce scale-up in LMICs.
Main Methods:
- Systematic review of online databases for outcome studies on gastroschisis, esophageal atresia, intestinal atresia, and typhoid perforation.
- Analysis of pediatric surgical workforce density (PSWD) data across low-income (LICs), middle-income (MICs), and high-income countries (HICs).
- Correlation of PSWD (per million children under 15) with surgical outcomes.
Main Results:
- PSWD varied widely, from zero in some African nations to over 125 in Poland.
- Mean survival rates were 42.3% in LICs, 69.4% in MICs, and 91.6% in HICs.
- A PSWD of ≥4 pediatric surgeons per million children correlated significantly with ≥80% survival (OR 16.8, p < 0.0001).
- Achieving a PSWD of 4 in studied LICs and MICs requires training 1427 additional surgeons.
Conclusions:
- A novel benchmark for pediatric surgical workforce scale-up has been established.
- Increasing PSWD is crucial for reducing childhood mortality from congenital and surgical conditions in LMICs.
Purpose:
Low- and middle-income countries (LMICs) have only 19% of the global surgical workforce yet see 80% of worldwide deaths from noncommunicable diseases. We aimed to interrogate the correlation between pediatric surgical workforce density (PSWD) and survival from pediatric surgical conditions worldwide.
Methods:
A systematic review of online databases identified outcome studies for key pediatric surgical conditions (gastroschisis, esophageal atresia, intestinal atresia, and typhoid perforation) as well as PSWD data across low-income (LICs), middle-income (MICs), and high-income countries (HICs). PSWD was expressed as the number of PSs/million children under 15 years of age and we correlated this to surgical outcomes for our case series.
Results:
PSWD ranged between zero (Burundi, The Gambia, and Mauritania) and 125.2 (Poland) across 86 countries. Outcomes for at least one condition were obtained in 61 countries: 50 outcomes in HICs, 52 in MICs and 8 in LICs. The mean survival in our case series was 42.3%, 69.4% and 91.6% for LICs, MICs, and HICs, respectively. A PSWD ≥4 PSs/million children under 15 years of age significantly correlated to odds of survival ≥80% (OR 16.8, p < 0.0001, 95% CI 5.66-49.88). Specifically in the studied LICs and MICs, increasing the PSWD to 4 would require training 1427 additional surgeons.
Conclusion:
Using a novel approach, we have established a benchmark for the scale-up of pediatric surgical workforce, which may support broader efforts to reduce childhood deaths from congenital disease.
Levels Of Evidence:
2c - Outcomes Research.
