indicator of surgeons, anesthesia providers, obstetricians, and
nurses would be affected.
Call to action
Achieving adequate surgical capacity within resource-poor
settings is a multidisciplinary challenge. Research efforts
have focused on surveying the scope of the issue, and the
next step is to explore effective methods to meet these capacity issues. Our early work, and the existing literature on the
global burden of surgical disease, prompts a call to action for
Latin America with a particular focus on trauma programs
and systems development. We assert that a focus on trauma
is relevant in light of the strength of regional relationships
between the trauma and surgical societies and the extent to
which trauma accounts for the burden of surgical disease in
the region. 13-16 The development of trauma systems regionally
will not only strengthen education, training, and the surgical workforce, but also will improve the global health care
community’s ability to collect data on surgical indicators,
thereby improving quality, value, and outcomes.
Given some of the challenges to reliable data collection, we
recommend the LCoGS core indicators be addressed through
a Latin America Surgical and Trauma Indicators Working
Group within existing organizations such as the Panamerican
Trauma Society. This group would be charged with identifying mechanisms that allow trauma and surgical systems to
implement measurement of indicators, and properly assess
strengths and weaknesses of regional and national surgical
Ultimately, this call to action will help strengthen comprehensive national surgical plans in countries where surgical
and trauma care improvement is interdependent. Given the
enormity of the challenge at hand—that is, building and
strengthening surgical systems globally—we recognize the
need for innovative mechanisms to evaluate, standardize,
and improve critical information, such as core surgical indicators, across Latin America. The integration of an enhanced
surgical system with trauma system development may be a
particularly effective approach. 7 ♦
10. American College of Surgeons Committee on
Trauma. Resources for Optimal Care of the Injured
Patient. Chicago, IL: American College of
11. Cowley RA. A total emergency medical system
for the State of Maryland. Md State Med J.
1975; 24( 7): 37-45.
12. The Lancet Commission on Global Surgery.
Global indicator initiative. Surgical indicators
report. December 2015. Available at: www.
February 27, 2017.
13. Peden M, McGee K, Krug E, eds. Injury: A
leading cause of the global burden of disease,
2000. World Health Organization. 2002.
Available at: www.who.int/violence_injury_
en/. February 27, 2017.
14. Pan American Health Organization. Statistics
on homicides, suicides, accidents, injuries, and
attitudes towards violence. Available at: www1.
paho.org/English/AD/DPC/NC/violence-graphs.htm. Accessed March 1, 2017.
15. Krug EG, Dahlberg LL, Mercy JA, et
al, eds. World report on violence and
health. World Health Organization.
2002. Available at: whqlibdoc.who.int/
March 1, 2017.
16. U.S. Centers for Disease Control and Prevention.
Web-based injury statistics query and reporting
system. Fatal injury data. Available at: www.
February 27, 2017.