{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,28]],"date-time":"2026-09-28T20:48:20Z","timestamp":1790628500567,"version":"4.1.0"},"reference-count":22,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T00:00:00Z","timestamp":1669852800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T00:00:00Z","timestamp":1669852800000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"},{"start":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T00:00:00Z","timestamp":1669852800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.springernature.com\/gp\/researchers\/text-and-data-mining"}],"content-domain":{"domain":["link.springer.com"],"crossmark-restriction":false},"short-container-title":["World j. surg."],"published-print":{"date-parts":[[2023,3]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Brazil is a middle\u2010income country that aims to provide universal health coverage, but its surgical system's efficiency has rarely been analyzed. In an effort to strengthen surgical national systems, the Lancet Commission on Global Surgery proposed bellwether procedures as quality indicators of surgical workforces. This study aims to evaluate regional inequalities in access to bellwether procedures and their associated mortality across the five Brazilian geographical regions.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Using DATASUS, Brazil's national healthcare database, data were collected on the total amount of performed bellwether procedures\u2014cesarean section, laparotomy, and open fracture management\u2014and their associated mortality, by geographical region. We evaluated the years 2018\u20132020, both in emergent and elective conditions. Statistical analysis was performed by one\u2010way ANOVA test and Tukey's multiple comparisons test.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      During this period, DATASUS registered 2,687,179 cesarean sections, 1,036,841 laparotomies, and 648,961 open fracture treatments. The access and associated mortality related to these procedures were homogeneous between the regions in elective care. There were significant geographical inequalities in access and associated mortality in emergency care (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.05, 95% CI) for all bellwether procedures. The Southeast, the most economically developed region of the country, was the region with the lowest amount of bellwether procedures per 100,000\u00a0inhabitants.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Brazil's public surgical system is competent at promoting elective surgical care, but more effort is needed to fortify emergency care services. Public policies should encourage equity in the geographic allocation of the surgical workforce.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s00268-022-06855-9","type":"journal-article","created":{"date-parts":[[2022,12,1]],"date-time":"2022-12-01T14:35:49Z","timestamp":1669905349000},"page":"593-599","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Geographical Inequalities in Access to Bellwether Procedures in Brazil"],"prefix":"10.1002","volume":"47","author":[{"given":"Matheus Daniel","family":"Faleiro","sequence":"first","affiliation":[{"name":"Federal University of Minas Gerais Belo Horizonte Brazil"},{"name":"International Student Surgical Network Brazil Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Miguel Godeiro","family":"Fernandez","sequence":"additional","affiliation":[{"name":"International Student Surgical Network Brazil Belo Horizonte Brazil"},{"name":"Bahiana School of Medicine and Public Health (EBMSP) Salvador Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00e9ssica Moreira","family":"Santos","sequence":"additional","affiliation":[{"name":"International Student Surgical Network Brazil Belo Horizonte Brazil"},{"name":"Faculdade Ci\u00eancias M\u00e9dicas de Minas Gerais Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Catarina Ester Gomes","family":"Menezes","sequence":"additional","affiliation":[{"name":"International Student Surgical Network Brazil Belo Horizonte Brazil"},{"name":"State University of Bahia Salvador Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jo\u00e3o Vitor Sabadine","family":"Lima","sequence":"additional","affiliation":[{"name":"Federal University of Minas Gerais Belo Horizonte Brazil"},{"name":"International Student Surgical Network Brazil Belo Horizonte Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J\u00falia Oliveira Dabien","family":"Haddad","sequence":"additional","affiliation":[{"name":"International Student Surgical Network Brazil Belo Horizonte Brazil"},{"name":"Universidade de Ita\u00fana Ita\u00fana Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sofia Wagemaker","family":"Viana","sequence":"additional","affiliation":[{"name":"International Student Surgical Network Brazil Belo Horizonte Brazil"},{"name":"Kursk State Medical University Kursk Russia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nivaldo","family":"Alonso","sequence":"additional","affiliation":[{"name":"Division of Plastic Surgery University of S\u00e3o Paulo S\u00e3o Paulo Brazil"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2022,12]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2214\u2010109X(14)70384\u20105"},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140\u20106736(15)60160\u2010X"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010020\u201005607\u2010x"},{"key":"e_1_2_8_5_1","doi-asserted-by":"publisher","DOI":"10.1515\/jpm\u20102020\u20100305"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010014\u20102793\u20107"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/BOT.0000000000002094"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00268\u2010016\u20103614\u2010y"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1590\/1413\u201081232018236.06092018"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1590\/0102\u2010311X00151817"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1590\/1413\u201081232021266.1.43532020"},{"key":"e_1_2_8_12_1","first-page":"1","article-title":"Estimativas 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