Closing the Surgical Gap by 2035
- FHS Communications
The Lancet's recent publication ‘Surgical health policy 2025–35: strengthening essential services for tomorrow's needs’outlines a critical roadmap for strengthening essential surgical services globally between 2025 and 2035. The paper highlights the growing burden of unmet surgical needs, persistent inequities, and the urgent need for systemic reform to ensure safe, accessible, and sustainable surgical care.
Study overview
Using synthesised data to identify key evidence gaps and future priorities, this publication is essential in assessing global progress since the 2015 Lancet Commission on Global Surgery, identifying the persistent barriers preventing surgery from gaining priority within global health agendas, and outlining the actions needed to advance global surgical care over the next decade.
Rising Global Burden
The unmet need for surgical procedures has escalated to 160 million annually, up from 143 million in 2015. The research found that postoperative deaths now total 3.5 million adults per year, surpassing the annual mortality rates of leading global diseases, i.e. HIV, malaria, and tuberculosis. Additionally, 50 million adults experience postoperative complications annually. Wits researcher and Head of Research & Laboratories in the Wits Department of Surgery, Associate Professor Deirdre Kruger, says these figures “will, in turn, leave a substantial proportion of these patients facing long-term reductions in quality of life, heightened mortality risk, prolonged recovery, and persistent physical and psychological burdens.”
Progress and Gaps in Global Surgery Indicators
Progress remains uneven. Only 26% of low- and middle-income countries (LMICs) are keeping up with providing access to timely essential surgery. Although workforce density has increased by 41% in LMICs, the 75% lag in low-income countries is still concerning. None of the countries have met the benchmark of 5000 procedures per 100,000 population annually, which may be explained by several factors. Ruger says that meeting this benchmark requires addressing economic constraints, improving healthcare infrastructure in addition to workforce, standardising data collection, and ensuring equitable access to surgical care. “Increased political commitment and financial investment are crucial to overcoming these barriers and achieving the goals set by The Lancet Commission on Global Surgery,” she adds.
The financial benefits of investing in surgical treatment are also substantial. Increasing the number of important cancer surgeries performed in LMICs could boost productivity by $80 billion annually, helping more people return to work. The median number of surgeons in first-referral hospitals is one, while tertiary hospitals have twenty. Over a million surgeons and anaesthetists are in short supply worldwide.
Disparities in Access and Outcomes
Generally, surgical access remains deeply inequitable. Elective procedures account for only 58% of surgical volume in the lowest HDI quintile countries, compared to 79% in the highest. Obstetric procedures (related to childbirth) make up a disproportionately large share of surgeries in low-HDI countries (35% vs. 7%). This reflects a focus on urgent maternal health needs. Although this was not explored in this paper, Kruger says it points to several interrelated reasons. “Some include higher maternal and neonatal mortality rates in low-HDI [Human Development Index] countries necessitating emergency surgery, higher prevalence of obstetric complications such as pre-eclampsia and infections, lack of access to adequate prenatal care as suggested, etc,” she explains.
Despite this, women face disproportionate barriers and unmet surgical needs. Only 16% of consultant surgeons in the UK and 33% in East, Central, and Southern Africa are women. Racial and socioeconomic disparities persist in cancer care and outcomes.
COVID-19 Disruption
Surgical services were significantly hampered by the pandemic. An estimated 28 million surgeries were cancelled during the first twelve weeks of the pandemic. This meant that one in four cancer procedures in LMICs were not performed during the initial wave.
Sustainability and Environmental Impact
Surgical services must align with climate goals. Unknown to most, operating surgical theatres contribute the most carbon emissions in hospitals. Power outages affect 40% of hospitals globally, and 90% in low-income countries. Balancing the need for life-saving surgeries with environmental sustainability in low-income countries is challenging and will only be feasible through innovative, cost-effective solutions and international cooperation. She says implementing sustainable practices and leveraging global partnerships can help low-income countries improve surgical care while minimising their environmental impact.
Vision for 2025–2035
The paper calls for reducing postoperative mortality by 30% and surgical site infections by 50%. Expanding the surgical workforce and improving financial protection are key priorities to achieve this benchmark. Surgery must be integrated into broader health systems and infrastructure. Promoting female leadership and environmental sustainability is also essential.
This policy framework offers a transformative vision for global surgery, emphasising equity, resilience, and sustainability.
“Surgery is not a luxury. It is a lifesaving, cost-effective intervention that underpins resilient health systems. Without urgent investment, millions will continue to suffer and die from treatable conditions.”
- Senior author, Professor Aneel Bhangu, University of Birmingham