将来20年世界的癌症手术需要与最好手术及麻醉劳动力需要预计

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.

癌症手术需要的逐渐增长给世界卫生体系带来了压力。咱们须要对世界癌症手术需要和最好劳动力需要进行深入解析，以计划医疗服务的供应。咱们基于临床指南预计了世界癌症手术的需要并且最抱负的内科和麻醉劳动力的需要。

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.

通过根据临床指南需手术的基准模型，咱们以不同收益层级对183个国度拥有手术指征的癌症病例的比率进行了预计。应用2018年GLOBOCAN信息，按比率乘以经年纪调节的国度新癌症病例预计数并汇总获得了世界所需手术的预计数。将44个高收益国度的癌症手术数目除以各自国度的内科医师和麻醉师的实际人数，计算出每名内科医师和麻醉医生进行癌症手术的比率。应用这类比率的中位数(IQR)成为基准，咱们开发了一个三层最好内科和麻醉劳动力矩阵，并预判2040年的状况。

Findings 结果

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).

咱们的模型预计，在2018年(906.5万)至2040年(1382.1万)之间，世界有手术顺应症的癌症病例数目将加大500万例(52%)。34个低收益国度内科手术需要将产生最大的相对增长。同时咱们还观测到这类国度在劳动力需要方面的缺口最大。要到达高收益国度的中位数基准，这类国度的内科手术劳动力须要加大近4倍，麻醉劳动力须要加大近5.5倍。从2018年到2040年，最好劳动力需要的最大增长将产生在低收益国度(从28 000名内科医师加大到58 000名;增长107%)，其次是中低收益国度(从166 000名内科医师增至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.

估计在将来20年，世界对癌症手术和最好手术及麻醉劳动力的需要将会加大，此中低收益国度所受牵连将更大。这类预计为世界癌症手术服务的计划供应了一个恰当的框架。