author:"M. Mohammed" | Pollux - Fachinformationsdienst Politikwissenschaft

Abstract Social innovation (SI) impacts are long-term changes that affect different dimensions of territorial capital (i.e., economy, society, environment, governance) for the territory in which SI occurs. Yet, systematic empirical evidence and theoretically sound assessments of the impacts of SI are scarce. This paper aims to fill the gap and assess the different aspects of SI's impacts in European and Mediterranean areas that are characterized by marginalization processes. To assess the impacts of SI in marginalized areas, we use the evaluation framework developed within the Social Innovation in Marginalized Rural Areas (SIMRA) Horizon 2020 project and apply it to nine SI initiatives related to the fields of agriculture, fisheries, forestry, and rural development. Our findings show that SI produces cross-sectoral (societal, economic, environmental, and governmental) and multi-level impacts (on individuals, community, and society), which have improved the societal well-being, and contributed to the reduction of certain forms of marginality, mainly inside the territory in which SI occurred.

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Open Access#212017

Future and potential spending on health 2015-40: Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Dieleman, J.L. (Joseph L.); Campbell, M. (Madeline); Chapin, A. (Abigail); Eldrenkamp, E. (Erika); Fan, V.Y. (Victoria Y.); Haakenstad, A. (Annie); Kates, J. (Jennifer); Li, Z. (Zhiyin)

Dieleman, J.L. (Joseph L.); Campbell, M. (Madeline); Chapin, A. (Abigail); Eldrenkamp, E. (Erika); Fan, V.Y. (Victoria Y.); Haakenstad, A. (Annie); Kates, J. (Jennifer); Li, Z. (Zhiyin); Matyasz, T. (Taylor); Micah, A. (Angela); Reynolds, A. (Alex); Sadat, N. (Nafis); Schneider, M.T. (Matthew T.); Sorensen, R. (Reed); Abbas, K.M. (Kaja M.); Abera, S.F. (Semaw Ferede); Ahmad Kiadaliri, A. (Aliasghar); Ahmed, M.B. (Muktar Beshir); Alam, K. (Khurshid); Alizadeh-Navaei, R. (Reza); Alkerwi, A. (Ala'a); Amini, E. (Erfan); Ammar, W. (Walid); Antonio, C.A.T. (Carl Abelardo T); Atey, T.M. (Tesfay Mehari); Avila-Burgos, L. (Leticia); Awasthi, A. (Ashish); Barac, A. (Aleksandra); Berheto, T.M. (Tezera Moshago); Beyene, A.S. (Addisu Shunu); Beyene, T.J. (Tariku Jibat); Birungi, C. (Charles); Bizuayehu, H.M. (Habtamu Mellie); Breitborde, N.J.K. (Nicholas J.K.); Cahuana-Hurtado, L. (Lucero); Castro, R.E. (Ruben Estanislao); Catalá-López, F. (Ferrán); Dalal, K. (Koustuv); Dandona, L. (Lalit); Dharmaratne, R.D.S.D. (Rakhi Dandona Samath D.); Dubey, M. (Manisha); Faro, A. (Andé); Feigl, A.B. (Andrea B.); Fischer, F. (Florian); Fitchett, J.R.A. (Joseph R. Anderson); Foigt, N. (Nataliya); Giref, A.Z. (Ababi Zergaw); Gupta, R. (Rahul); Hamidi, S. (Samer); Harb, H.L. (Hilda L.); Hay, S.I. (Simon); Hendrie, D. (Delia); Horino, M. (Masako); Jürisson, M. (Mikk); Jakovljevic, M.B. (Mihajlo B.); Javanbakht, M. (Mehdi); John, D. (Denny); Jonas, J.B. (Jost B.); Karimi, S.M. (Seyed M.); Khang, Y.-H. (Young-Ho); Khubchandani, J. (Jagdish); Kim, Y.J. (Yun Jin); Kinge, J.M. (Jonas M); Krohn, K.J. (Kristopher J.); Kumar, G.A. (G. Anil); Leung, R. (Ricky); Magdy Abd El Razek, H. (Hassan); Magdy Abd El Razek, M. (Mohammed); Majeed, A. (Azeem); Malekzadeh, R. (Reza); Malta, D.C. (Deborah Carvalho); Meretoja, A. (Atte); Miller, T.R. (Ted R); Mirrakhimov, E.M. (Erkin M.); Mohammed, S. (Shafiu); Molla, G. (Gedefaw); Nangia, V. (Vinay); Olgiati, S. (Stefano); Owolabi, M.O. (Mayowa O.); Patel, T. (Tejas); Paternina Caicedo, A.J. (Angel J.); Pereira, D.M. (David M.); Perelman, J. (Julian); Polinder, S. (Suzanne); Rafay, A. (Anwar); Rahimi-Movaghar, V. (Vafa); Rai, R.K. (Rajesh Kumar); Ram, U. (Usha); Ranabhat, C.L. (Chhabi Lal); Roba, H.S. (Hirbo Shore); Savic, M. (Miloje); Sepanlou, S.G. (Sadaf G); Te Ao, B.J. (Braden J.); Tesema, A.G. (Azeb Gebresilassie); Thomson, A.J. (Alan J.); Tobe-Gai, R. (Ruoyan); Topor-Madry, R. (Roman); Undurraga, E.A. (Eduardo A.); Vargas, V. (Veronica); Vasankari, T. (Tuula); Violante, F.S. (Francesco S); Wijeratne, T. (Tissa); Yonemoto, N. (Naohiro); Younis, M.Z. (Mustafa Z.); Yu, C. (Chuanhua); Zaidi, Z. (Zoubida); El Sayed Zaki, M. (Maysaa); Murray, C.J.L. (Christopher)

Background: The amount of resources, particularly prepaid resources, available for health can affect access to health care and health outcomes. Although health spending tends to increase with economic development, tremendous variation exists among health financing systems. Estimates of future spending can be beneficial for policy makers and planners, and can identify financing gaps. In this study, we estimate future gross domestic product (GDP), all-sector government spending, and health spending disaggregated by source, and we compare expected future spending to potential future spending. Methods: We extracted GDP, government spending in 184 countries from 1980-2015, and health spend data from 1995-2014. We used a series of ensemble models to estimate future GDP, all-sector government spending, development assistance for health, and government, out-of-pocket, and prepaid private health spending through 2040. We used frontier analyses to identify patterns exhibited by the countries that dedicate the most funding to health, and used these frontiers to estimate potential health spending for each low-income or middle-income country. All estimates are inflation and purchasing power adjusted. Findings: We estimated that global spending on health will increase from US$9.21 trillion in 2014 to $24.24 trillion (uncertainty interval [UI] 20.47-29.72) in 2040. We expect per capita health spending to increase fastest in upper-middle-income countries, at 5.3% (UI 4.1-6.8) per year. This growth is driven by continued growth in GDP, government spending, and government health spending. Lower-middle income countries are expected to grow at 4.2% (3.8-4.9). High-income countries are expected to grow at 2.1% (UI 1.8-2.4) and low-income countries are expected to grow at 1.8% (1.0-2.8). Despite this growth, health spending per capita in low-income countries is expected to remain low, at $154 (UI 133-181) per capita in 2030 and $195 (157-258) per capita in 2040. Increases in national health spending to reach the level of the countries who spend the most on health, relative to their level of economic development, would mean $321 (157-258) per capita was available for health in 2040 in low-income countries. Interpretation: Health spending is associated with economic development but past trends and relationships suggest that spending will remain variable, and low in some low-resource settings. Policy change could lead to increased health spending, although for the poorest countries external support might remain essential.

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Open Access#222017

Evolution and patterns of global health financing 1995-2014: Development assistance for health, and government, prepaid private, and out-of-pocket health spending in 184 countries

Dieleman, J. (Joseph); Campbell, M. (Madeline); Chapin, A. (Abigail); Eldrenkamp, E. (Erika); Fan, V.Y. (Victoria Y.); Haakenstad, A. (Annie); Kates, J. (Jennifer); Liu, Y. (Yingying)

Dieleman, J. (Joseph); Campbell, M. (Madeline); Chapin, A. (Abigail); Eldrenkamp, E. (Erika); Fan, V.Y. (Victoria Y.); Haakenstad, A. (Annie); Kates, J. (Jennifer); Liu, Y. (Yingying); Matyasz, T. (Taylor); Micah, A. (Angela); Reynolds, A. (Alex); Sadat, N. (Nafis); Schneider, M.T. (Matthew T.); Sorensen, R. (Reed); Evans, T. (Tim); Evans, D. (David); Kurowski, C. (Christoph); Tandon, A. (Ajay); Abbas, K.M. (Kaja M.); Abera, S.F. (Semaw Ferede); Ahmad Kiadaliri, A. (Aliasghar); Ahmed, K.Y. (Kedir Yimam); Ahmed, M.B. (Muktar Beshir); Alam, K. (Khurshid); Alizadeh-Navaei, R. (Reza); Alkerwi, A. (Ala'a); Amini, E. (Erfan); Ammar, W. (Walid); Amrock, S.M. (Stephen Marc); Antonio, C.A.T. (Carl Abelardo T); Atey, T.M. (Tesfay Mehari); Avila-Burgos, L. (Leticia); Awasthi, A. (Ashish); Barac, A. (Aleksandra); Bernal, O.A. (Oscar Alberto); Beyene, A.S. (Addisu Shunu); Beyene, T.J. (Tariku Jibat); Birungi, C. (Charles); Bizuayehu, H.M. (Habtamu Mellie); Breitborde, N.J.K. (Nicholas J.K.); Cahuana-Hurtado, L. (Lucero); Castro, R.E. (Ruben Estanislao); Catalá-López, F. (Ferrán); Dalal, K. (Koustuv); Dandona, L. (Lalit); Dandona, R. (Rakhi); De Jager, P. (Pieter); Dharmaratne, S.D. (Samath D.); Dubey, M. (Manisha); Farinha, C.S.E.S. (Carla Sofia E. Sa); Faro, A. (Andre); Feigl, A.B. (Andrea B.); Fischer, F. (Florian); Fitchett, J.R.A. (Joseph Robert Anderson); Foigt, N. (Nataliya); Giref, A.Z. (Ababi Zergaw); Gupta, R. (Rahul); Hamidi, S. (Samer); Harb, H.L. (Hilda L.); Hay, S.I. (Simon); Hendrie, D. (Delia); Horino, M. (Masako); Jürisson, M. (Mikk); Jakovljevic, M.B. (Mihajlo B.); Javanbakht, M. (Mehdi); John, D. (Denny); Jonas, J.B. (Jost B.); Karimi, S.M. (Seyed M.); Khang, Y.-H. (Young-Ho); Khubchandani, J. (Jagdish); Kim, Y.J. (Yun Jin); Kinge, J.M. (Jonas M); Krohn, K.J. (Kristopher J.); Kumar, G.A. (G. Anil); Magdy Abd El Razek, H. (Hassan); Magdy Abd El Razek, M. (Mohammed); Majeed, A. (Azeem); Malekzadeh, R. (Reza); Masiye, F. (Felix); Meier, T. (Toni); Meretoja, A. (Atte); Miller, T.R. (Ted R); Mirrakhimov, E.M. (Erkin M.); Mohammed, S. (Shafiu); Nangia, V. (Vinay); Olgiati, S. (Stefano); Osman, A.S. (Abdalla Sidahmed); Owolabi, M.O. (Mayowa O.); Patel, T. (Tejas); Paternina Caicedo, A.J. (Angel J.); Pereira, D.M. (David M.); Perelman, J. (Julian); Polinder, S. (Suzanne); Rafay, A. (Anwar); Rahimi-Movaghar, V. (Vafa); Rai, R.K. (Rajesh Kumar); Ram, U. (Usha); Ranabhat, C.L. (Chhabi Lal); Roba, H.S. (Hirbo Shore); Salama, J. (Joseph); Savic, M. (Miloje); Sepanlou, S.G. (Sadaf G); Shrime, M.G. (Mark G.); Talongwa, R.T. (Roberto Tchio); Te Ao, B.J. (Braden J.); Tediosi, F. (Fabrizio); Tesema, A.G. (Azeb Gebresilassie); Thomson, A.J. (Alan J.); Tobe-Gai, R. (Ruoyan); Topor-Madry, R. (Roman); Undurraga, E.A. (Eduardo A.); Vasankari, T. (Tommi); Violante, F.S. (Francesco S); Werdecker, A. (Andrea); Wijeratne, T. (Tissa); Xu, G. (Gelin); Yonemoto, N. (Naohiro); Younis, M.Z. (Mustafa Z.); Yu, C. (Chuanhua); Zaidi, Z. (Zoubida); El Sayed Zaki, M. (Maysaa); Murray, C.J.L. (Christopher)

Background: An adequate amount of prepaid resources for health is important to ensure access to health services and for the pursuit of universal health coverage. Previous studies on global health financing have described the relationship between economic development and health financing. In this study, we further explore global health financing trends and examine how the sources of funds used, types of services purchased, and development assistance for health disbursed change with economic development. We also identify countries that deviate from the trends. Methods: We estimated national health spending by type of care and by source, including development assistance for health, based on a diverse set of data including programme reports, budget data, national estimates, and 964 National Health Accounts. These data represent health spending for 184 countries from 1995 through 2014. We converted these data into a common inflation-adjusted and purchasing power-adjusted currency, and used non-linear regression methods to model the relationship between health financing, time, and economic development. Findings: Between 1995 and 2014, economic development was positively associated with total health spending and a shift away from a reliance on development assistance and out-of-pocket (OOP) towards government spending. The largest absolute increase in spending was in high-income countries, which increased to purchasing power-adjusted $5221 per capita based on an annual growth rate of 3.0%. The largest health spending growth rates were in upper-middle-income (5.9) and lower-middle-income groups (5.0), which both increased spending at more than 5% per year, and spent $914 and $267 per capita in 2014, respectively. Spending in low-income countries grew nearly as fast, at 4.6%, and health spending increased from $51 to $120 per capita. In 2014, 59.2% of all health spending was financed by the government, although in low-income and lower-middle-income countries, 29.1% and 58.0% of spending was OOP spending and 35.7% and 3.0% of spending was development assistance. Recent growth in development assistance for health has been tepid; between 2010 and 2016, it grew annually at 1.8%, and reached US$37.6 billion in 2016. Nonetheless, there is a great deal of variation revolving around these averages. 29 countries spend at least 50% more than expected per capita, based on their level of economic development alone, whereas 11 countries spend less than 50% their expected amount. Interpretation: Health spending remains disparate, with low-income and lower-middle-income countries increasing spending in absolute terms the least, and relying heavily on OOP spending and development assistance. Moreover, tremendous variation shows that neither time nor economic development guarantee adequate prepaid health resources, which are vital for the pursuit of universal health coverage.

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Open Access#232020

Elective surgery cancellations due to the COVID-19 pandemic. Global predictive modelling to inform surgical recovery plans

Nepogodiev, D; Omar, O. M; Glasbey, J. C; Li, E; Simoes, J. F. F; Abbott, T. E. F; Ademuyiwa, A. O; Biccard, B. M

Nepogodiev, D; Omar, O. M; Glasbey, J. C; Li, E; Simoes, J. F. F; Abbott, T. E. F; Ademuyiwa, A. O; Biccard, B. M; Chaudhry, D; Davidson, G. H; Di Saverio, S; Gallo, G; Ghosh, D; Harrison, E. M; Hutchinson, P. J; Kamarajah, S. K; Keller, D. S; Lawani, I; Minaya-Bravo, A; Moore, R; Morton, D. G; Ntirenganya, F; Pata, F; Pearse, R. M; la Medina, A. R. -D; Tabiri, S; Venn, M. L; Omar, A. B. O. M; Bhangu, A; Siaw-Acheampong, K; Adamina, M; Agarwal, A; Alameer, E; Alderson, D; Alakaloko, F; Alser, O; Arnaud, A. P; Augestad, K. M; Bankhead-Kendall, B. K; Barlow, E; Benson, R. A; Blanco-Colino, R; Brar, A; Breen, K. A; Buarque, I. L; Caruana, E. J; Chakrabortee, S; Cox, D; Cunha, M. F; Dawson, B. E; Desai, A; Drake, T. D; Edwards, J. G; Elhadi, M; Evans, J. P; Farik, S; Fiore, M; Fitzgerald, J. E; Ford, S; Gomes, G. M. A; Griffiths, E. A; Gujjuri, R. R; Halkias, C; Heritage, E; Isik, A; Jenkinson, M. D; Jones, C. S; Khatri, C; Keatley, J. M; Kolias, A; Lawday, S; Lederhuber, H; Leventoglu, S; Loffler, M. W; Martin, J; Mashbari, H. N; Mazingi, D; Mckay, S. C; Metallidis, S; Mohan, H. M; Moszkowicz, D; Moug, S; Ng-Kamstra, J. S; Niquen, M; Outani, O; Pellino, G; Pinkney, T. D; Pockney, P; Radenkovic, D; Roberts, K; Roslani, A. C; Santos, I; Schache, A; Schnitzbauer, A. A; Stewart, G. D; Shaw, R; Shu, S; Soreide, K; Spinelli, A; Sundar, S; Tiwari, A; Townend, P; Trout, I. M; Tsoulfas, G; van Ramshorst, G. H; Vidya, R; Vimalachandran, D; Warren, O; Wilkin, R. J. W; Wright, N; Hoste, E; Huyghens, L; Jacobs, R; Opdenacker, G; Poelaert, J; Rijckaert, D; De Decker, K; Foubert, L; De Neve, N; Biston, P; Piagnerelli, M; Collin, V; den Blauwen, N; Clauwaert, C; De Crop, L; Verbeke, A; Derumeaux, P; Gardin, C; Kindt, S; Louage, S; Verhamme, B; Druwe, P; Lahaye, I; Rosseel, F; Rutsaert, R; Vanlinthout, L; De Kock, M; Forget, P; Georges, P; Grosu, I; Kahn, D; Lois, F; Momeni, M; Yemnga, A. P. B; Jadoul, J. -L; Malbrain, M; Bosinceanu, D; Collard, E; Jorens, P; Reyntiens, D; Smitz, C; Vercauteren, M; Fagnoul, D; Toplice, K; Oremus, K; Beslic, G; Duzel, V; Hauptman, A; Peremin, S; Sribar, A; Zupcic, M; Brod, S; Mirkovic, I; Bauer, Z. S; Belavic, M; Blazanin, B; Katusin, M. L; Krijan, A. B; Miskovic, P; Simic-Korac, N; Topic, J; Zilic, A; Zunic, J; Acan, I; Adanic, M; Ivanov, N; Saric, J. P; Tomulic, K; Viskovic, N; Bosnjak, S; Drenjancevic, I. H; Kristek, G; Kvolik, S; Markic, S; Rakipovic, A. S; Tot, O. K; Fabris, L. K; Bacak-Kocman, I; Balenovic, I; Bandic, D; Deutsch, P. A. J; Divjak, L; Filipovic, I. G; Guzvinec, Z; Krznaric, Z; Loncaric, Y; Magas, J. V; Mitrovic, M; Okic, M; Pavlek, M; Ramov, E; Rezek, K; Sekulic, A; Tomasevic, B; Miric, M; Tomasevic, A; Mahecic, T. T; Vrbanovic, V; Bobinac, M; Bozic, A; Debelic, D; Frkovic, V; Batinica, I. M; Baranovic, S; Gavranovic, Z; Kikec, M; Maldini, B; Maric, S; Agnic, I; Delic, N; Dropulic, N; Gaspic, T. K; Ilic, D; Ivancev, B; Karanovic, N; Kuscevic, D; Marovic, Z; Milic, M; Nevescanin, A; Petkovic, T; Smoje, M; Brozovic, G; Goranovic, T; Jelisavac, M; Matolic, M; Mazul-Sunko, B; Oberhofer, D; Pavicic, A. M; Sakic, K; Bozovic, M. D; Krecek, Z. K; Krobot, R; Andabaka, T; Bratanic, M; Dzepina, O; Kraljev, M; Seric, J; Simurina, T; Grujic, R; Nacevski-Bulaja, B; Barizon, M; Danira, V; Drazen, B; Dusanka, K; Haluzan, M. B; Josko, Z; Katica, R; Labor, M; Marinkovic, T. G; Mihovilcevic, D; Marija, B; Srecko, M; Drab, M; Hudacek, K; Krikava, I; Stourac, P; Brabcova, M; Klozova, R; Vajter, J; Vymazal, T; Toft, P; Blichfeldt, L; Hansen, B. D; Moller, K; Nielsen, J. S; Frederiksen, J; Andersen, J. D; Kuhne, J. P; Leivdal, S; Stendell, L; Simonsen, M; Zoltowski, M. K; Ali, Z. S; Freundlich, M; Pilypaite, J; Clausen, N. G; Thorup, L; Hansen, F; Bestle, M; Hansen, C. S; Afshari, A; Bille, A. B; Lefort, M; Secher, E. L; Liboriussen, L; Herodes, V; Harma, E; Marvet, K; Pool, K; Kallas, P; Magi, T. -K; Sutt, J; Vijar, K; Visk, E; Vinnal, M; Ellermaa, J; Liibusk, L; Hovilehto, S; Kirsi, A; Mustola, S; Tiainen, P; Toivonen, J; Dabnell, S; Kaminski, T; Sysimetsa, A; Kaukonen, M; Silvasti, P; Vainio, K; Lund, V; Sjovall, S; Saarinen, K; Viitanen, M; Ahonen, T; Alaspaa, A; Zittling, R; Saarinen, A; Moisander, A; Wagner, B; Laru-Sompa, R; Elomaa, E; Lavonen, L; Nevantaus, J; Geier, K; Kavasmaa, T; Koorits, U; Kubjas, M; Lauritsalo, S; Ottelin, L; Palve, M; Pynnonen, J; Raabis, I; Saarelainen, M; Heikkila, T; Kontula, T; Lehtimaki, M; Liimatainen, J; Moilanen-Oikarinen, M; Pakarinen, M; Palanne, R; Seppanen, H; Pulkkinen, A; Vaaraniemi, H; Kajaani; Paananen, S; Koskenkari, J; Salkio, S; Vakkala, M; Koskue, T; Loisa, P; Laitio, R; Hautamaki, R; Koivisto, S. -P; Leon, A; Bonnet, F; Marret, E; Spielvogel, C; Papageorgiou, C; Szymkiewicz, O; Tounou-Akue, F; Aubrun, F; Bonnet, A; Gazon, M; Guiraud, M; Laurent, V; Tachon, G; Demars, N; Dumenil, A. -S; Mercier, F. J; Landais, A; Mentec, H; Bazin, M; Futier, E; Gonnu, S; Petit, A; Albaladejo, P; Almeras, L; Rossi-Blancher, A. B. M; Lefrant, J. Y; Barthel, F; Hallel, D; Sbai, H; Khalifeh, P; Lidzborski, L; Jully, M; Platon, E; Pottecher, J; Baumgarten, R; Schultz, C; ElMiloudi, F; Lefebvre, J; Waton, K; Sprunck, A; Steib, A; Thibaud, A; Thuet, V; Kieffer, V; Dubois-Vallaud, D; Jacob, L; Becanne, X; Cherfaoui, S; Gauzit, R; Godier, A; Lakhdari, M; Samma, C. M; Halchini, C; Lacroix, M; Pinna, F; Barbes, A; Just, B; Mateu, P; Benayoun, L; Berger, P; Granier, N; Perrigault, P. F; Libert, N; De Rudnicki, S; Merat, S; Bourdet, B; Ferre, F; Minville, V; Piriou, V; Rague, P; Wallet, F; Lebuffe, G; Desbordes, J; Robin, E; Ichai, C; Orban, J. -C; Gottschalk, A; Piontek, A; Unterberg, M; Hilpert, J; Kees, M; Triltsch, A; Wiegand-Lohnert, C; Glockner, C; Hohn, A; Rose, E; Schroder, S; Wiese, O; Awlakpui, E; Hoeft, A; Scheidemann, M; Wittmann, M; Ramminger, A; Dresden, C; de Abreu, M. G; Heller, A. 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M; Omoshoro-Jones, J; Murray, R; Basson, C. H; de Wet, J. B; Skinner, G. C; Kransingh, S; Kuhn, W; Madsen, A. S. M; Matubatuba, J. T; Mayeza, S; Naidoo, L. C; Narain, S. J; Nkuebe, T. N; Nabela, L; Nkunjana, M; Mhatu, S; Thomas, B. P; Wynne, E. E; Davids, J. G; Grunewald, K. K; Kruger, S; Ras, W. A. P; Venter, P. J; Cacala, S. R. C; Kruse, C; Mahomva, O; Marais, L. C; Semenya, E. M; Rayne, S. R; Alphonsus, C. S; Mbuyisa, M. W; Torborg, A. M; De Lange, J. T; Drummond, L. W; Dullab, K. D; Enicker, B. C; Gigabhoy, R; Hardcastle, T. C; Maharaj, A; Majola, N; Moopanar, M; Mukama, I. F; Naicker, K; Ngcobo, G. K; Ramnarain, H; Rocher, A. G. L; Singh, S; Stoltenkamp, H. L; Alberts, A. N. J. D; Luthuli, L; Lumbamba, A. J. M; Anderson, P. G. R; du Plessis, W. M; Ellis, S; Ford, L. M; Rousseau, F. J; Rousseau, N; Steyn, G; Steyn, H. C; Weideman, M; Church, B; Holford, E. B; Szpytko, A. J; Brouckaert, N. T; Freeman, Y. B. M; Ehouni, A; Jithoo, S; Naidoo, L; Peter, A. M; Belhaj, S; Tun, M; Kapp, P; Bwambale, Y. B; Holder, H; Kasongo, K. J. P; Makhanya, V; Morapedi, M; Mahomedy, N. A; Pillay, V; Reddy, S. R; Mgoqo, N; Mrara, B; Nibe, Z; Ninise, E; Pahlana, S. M; Usenbo, A. O; Malongwe, S. M; Giles, D. G; Porrill, O. S

Background: The COVID-19 pandemic has disrupted routine hospital services globally. This study estimated the total number of adult elective operations that would be cancelled worldwide during the 12 weeks of peak disruption due to COVID-19. Methods: A global expert response study was conducted to elicit projections for the proportion of elective surgery that would be cancelled or postponed during the 12 weeks of peak disruption. A Bayesian β-regression model was used to estimate 12-week cancellation rates for 190 countries. Elective surgical case-mix data, stratified by specialty and indication (surgery for cancer versus benign disease), were determined. This case mix was applied to country-level surgical volumes. The 12-week cancellation rates were then applied to these figures to calculate the total number of cancelled operations. Results: The best estimate was that 28 404 603 operations would be cancelled or postponed during the peak 12 weeks of disruption due to COVID-19 (2 367 050 operations per week). Most would be operations for benign disease (90·2 per cent, 25 638 922 of 28 404 603). The overall 12-week cancellation rate would be 72·3 per cent. Globally, 81·7 per cent of operations for benign conditions (25 638 922 of 31 378 062), 37·7 per cent of cancer operations (2 324 070 of 6 162 311) and 25·4 per cent of elective caesarean sections (441 611 of 1 735 483) would be cancelled or postponed. If countries increased their normal surgical volume by 20 per cent after the pandemic, it would take a median of 45 weeks to clear the backlog of operations resulting from COVID-19 disruption. Conclusion: A very large number of operations will be cancelled or postponed owing to disruption caused by COVID-19. Governments should mitigate against this major burden on patients by developing recovery plans and implementing strategies to restore surgical activity safely.

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Open Access#242021

Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study

J. Glasbey; A. Ademuyiwa; A. Adisa; E. AlAmeer; A. P Arnaud; F. Ayasra; J. Azevedo; A. Minaya-Bravo

Background: Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods: This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings: Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16-30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77-0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50-0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80-0·88; p<0·001), and full lockdowns (0·57, 0·54-0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation: Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services.

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Open Access#252021

Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study

Glasbey, J; Ademuyiwa, A; Adisa, A; AlAmeer, E; Arnaud, AP; Ayasra, F; Azevedo, J; Minaya-Bravo, A

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Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11 827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long-term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.

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Open Access#262021

Effect of COVID-19 pandemic lockdowns on planned cancer surgery for 15 tumour types in 61 countries: an international, prospective, cohort study

Glasbey, James; Ademuyiwa, Adesoji; Adisa, Adewale; AlAmeer, Ehab; Arnaud, Alexis P; Ayasra, Faris; Azevedo, José; Minaya-Bravo, Ana

Glasbey, James; Ademuyiwa, Adesoji; Adisa, Adewale; AlAmeer, Ehab; Arnaud, Alexis P; Ayasra, Faris; Azevedo, José; Minaya-Bravo, Ana; Costas-Chavarri, Ainhoa; Edwards, John; Elhadi, Muhammed; Fiore, Marco; Fotopoulou, Christina; Gallo, Gaetano; Ghosh, Dhruva; Griffiths, Ewen A; Harrison, Ewen; Hutchinson, Peter; Lawani, Ismail; Lawday, Samuel; Lederhuber, Hans; Leventoglu, Sezai; Li, Elizabeth; Gomes, Gustavo Mendonça Ataíde; Mann, Harvinder; Marson, Ella J; Martin, Janet; Mazingi, Dennis; McLean, Kenneth; Modolo, Maria; Moore, Rachel; Morton, Dion; Ntirenganya, Faustin; Pata, Francesco; Picciochi, Maria; Pockney, Peter; Ramos-De la Medina, Antonio; Roberts, Keith; Roslani, April Camilla; Kottayasamy Seenivasagam, Rajkumar; Shaw, Richard; Simões, Joana Filipa Ferreira; Smart, Neil; Stewart, Grant D; Sullivan, Richard; Sundar, Sudha; Tabiri, Stephen; Taylor, Elliott H; Vidya, Raghavan; Nepogodiev, Dmitri; Bhangu, Aneel; Glasbey, James C; Bhangu, Aneel A; Siaw-Acheampong, Kwabena; Benson, Ruth A; Bywater, Edward; Chaudhry, Daoud; Dawson, Brett E; Evans, Jonathan P; Gujjuri, Rohan R; Heritage, Emily; Jones, Conor S; Kamarajah, Sivesh K; Khatri, Chetan; Khaw, Rachel A; Keatley, James M; Knight, Andrew; Mann, Harvinder S; McLean, Kenneth A; Mckay, Siobhan C; Mills, Emily C; Pellino, Gianluca; Tiwari, Abhinav; Simoes, Joana FF; Trout, Isobel M; Venn, Mary L; Wilkin, Richard JW; Smart, Neil J; Moug, Susan; Di Saverio, Salomone; Vallance, Abigail; Vimalchandran, Dale; Evans, Richard PT; Townend, Philip; McKay, Siobhan; Isaac, John; Satoi, Sohei; Coonar, Aman S; Marchbank, Adrian; Caruana, Edward J; Layton, Georgia R; Patel, Akshay; Brunelli, Alessandro; Ford, Samuel; Desai, Anant; Gronchi, Alessandro; Almond, Max; Tirotta, Fabio; Dumitra, Sinziana; Kolias, Angelos; Price, Stephen J; Fountain, Daniel M; Jenkinson, Michael D; Marcus, Hani J; Piper, Rory J; Lippa, Laura; Servadei, Franco; Esene, Ignatius; Freyschlag, Christian; Neville, Iuri; Rosseau, Gail; Schaller, Karl; Demetriades, Andreas K; 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Background Surgery is the main modality of cure for solid cancers and was prioritised to continue during COVID-19 outbreaks. This study aimed to identify immediate areas for system strengthening by comparing the delivery of elective cancer surgery during the COVID-19 pandemic in periods of lockdown versus light restriction. Methods This international, prospective, cohort study enrolled 20 006 adult (≥18 years) patients from 466 hospitals in 61 countries with 15 cancer types, who had a decision for curative surgery during the COVID-19 pandemic and were followed up until the point of surgery or cessation of follow-up (Aug 31, 2020). Average national Oxford COVID-19 Stringency Index scores were calculated to define the government response to COVID-19 for each patient for the period they awaited surgery, and classified into light restrictions (index 60). The primary outcome was the non-operation rate (defined as the proportion of patients who did not undergo planned surgery). Cox proportional-hazards regression models were used to explore the associations between lockdowns and non-operation. Intervals from diagnosis to surgery were compared across COVID-19 government response index groups. This study was registered at ClinicalTrials.gov, NCT04384926. Findings Of eligible patients awaiting surgery, 2003 (10·0%) of 20 006 did not receive surgery after a median follow-up of 23 weeks (IQR 16–30), all of whom had a COVID-19-related reason given for non-operation. Light restrictions were associated with a 0·6% non-operation rate (26 of 4521), moderate lockdowns with a 5·5% rate (201 of 3646; adjusted hazard ratio [HR] 0·81, 95% CI 0·77–0·84; p<0·0001), and full lockdowns with a 15·0% rate (1775 of 11 827; HR 0·51, 0·50–0·53; p<0·0001). In sensitivity analyses, including adjustment for SARS-CoV-2 case notification rates, moderate lockdowns (HR 0·84, 95% CI 0·80–0·88; p<0·001), and full lockdowns (0·57, 0·54–0·60; p<0·001), remained independently associated with non-operation. Surgery beyond 12 weeks from diagnosis in patients without neoadjuvant therapy increased during lockdowns (374 [9·1%] of 4521 in light restrictions, 317 [10·4%] of 3646 in moderate lockdowns, 2001 [23·8%] of 11827 in full lockdowns), although there were no differences in resectability rates observed with longer delays. Interpretation Cancer surgery systems worldwide were fragile to lockdowns, with one in seven patients who were in regions with full lockdowns not undergoing planned surgery and experiencing longer preoperative delays. Although short-term oncological outcomes were not compromised in those selected for surgery, delays and non-operations might lead to long-term reductions in survival. During current and future periods of societal restriction, the resilience of elective surgery systems requires strengthening, which might include protected elective surgical pathways and long- term investment in surge capacity for acute care during public health emergencies to protect elective staff and services. Funding National Institute for Health Research Global Health Research Unit, Association of Coloproctology of Great Britain and Ireland, Bowel and Cancer Research, Bowel Disease Research Foundation, Association of Upper Gastrointestinal Surgeons, British Association of Surgical Oncology, British Gynaecological Cancer Society, European Society of Coloproctology, Medtronic, Sarcoma UK, The Urology Foundation, Vascular Society for Great Britain and Ireland, and Yorkshire Cancer Research.

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