{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,6]],"date-time":"2026-02-06T09:02:58Z","timestamp":1770368578096,"version":"3.49.0"},"reference-count":35,"publisher":"Walter de Gruyter GmbH","issue":"1","license":[{"start":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T00:00:00Z","timestamp":1766448000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,2,1]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Metrics for surgery, obstetrics, and anesthesia are crucial for implementing programs and monitoring progress toward safe and effective healthcare systems in pursuit of universal healthcare. A suite of metrics put forward by the Lancet Commission on Global Surgery has been adopted in principle by global health, anaesthesia, and surgical leadership in diverse settings. However, barriers to implementation limit their value. Barriers include inconsistencies in definitions and methodologies such as inadequate consideration given to sampling frames, representativeness, categorizations, missing data, and data collection infrastructure. Using the Utstein consensus methodology, we developed a uniform approach to collecting metrics in surgery, obstetrics, and anesthesia. We created a standard toolkit to facilitate the rapid implementation of the Lancet Commission indicators. The metadata and data dictionaries allow a standardized assessment of preparedness for, delivery of, and the effect of care at the population level.<\/jats:p>","DOI":"10.2478\/jdis-2025-0053","type":"journal-article","created":{"date-parts":[[2025,12,23]],"date-time":"2025-12-23T07:58:37Z","timestamp":1766476717000},"page":"46-62","source":"Crossref","is-referenced-by-count":0,"title":["From definitions to implementation \u2013 A guide to collect and apply the Lancet Commission on Global Surgery indicators: An Utstein consensus report"],"prefix":"10.2478","volume":"11","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6235-5892","authenticated-orcid":false,"given":"John","family":"Rose","sequence":"first","affiliation":[{"name":"Division of Plastic and Reconstructive Surgery, Department of Surgery, UC San Francisco Medical Center , San Francisco , California , USA"}]},{"given":"Adrian W.","family":"Gelb","sequence":"additional","affiliation":[{"name":"Department of Anesthesia and Perioperative Care, Center for Health Equity in Surgery and Anesthesia, UC San Francisco Medical Center , San Francisco , California , USA"}]},{"given":"Justine I.","family":"Davies","sequence":"additional","affiliation":[{"name":"Department of Applied Health Sciences, University of Birmingham , Birmingham , United Kingdom"}]},{"given":"Janet","family":"Martin","sequence":"additional","affiliation":[{"name":"Departments of Anesthesia & Perioperative Medicine and Epidemiology & Biostatistics, Western University , Ontario , Canada"}]},{"given":"Kevin","family":"McIntyre","sequence":"additional","affiliation":[{"name":"Department of Epidemiology & Biostatistics, Schulich School of Medicine and Dentistry, Western University , Ontario N6A 5A5 , Canada"}]},{"given":"Jannicke","family":"Mellin-Olsen","sequence":"additional","affiliation":[{"name":"Department of Anesthesia, Baerum Hospital , Oslo , Norway"}]},{"name":"on behalf of the Utstein Surgical Metrics Group*","sequence":"additional","affiliation":[]}],"member":"374","published-online":{"date-parts":[[2025,12,23]]},"reference":[{"key":"2026020519150312723_j_jdis-2025-0053_ref_001","doi-asserted-by":"crossref","unstructured":"Alkire, B. C., Raykar, N. P., Shrime, M. G., Weiser, T. G., Bickler, S. W., Rose, J. A., \u2026 Farmer, P. E. (2015). Global access to surgical care: a modelling study. The Lancet Global Health, 3(6), e316-e323.","DOI":"10.1016\/S2214-109X(15)70115-4"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_002","doi-asserted-by":"crossref","unstructured":"Biccard, B. M., Madiba, T. E., Kluyts, H.-L., Munlemvo, D. M., Madzimbamuto, F. D., Basenero, A., \u2026 Zoumenou, E. (2018). Perioperative patient outcomes in the African Surgical Outcomes Study: A 7-day prospective observational cohort study. The Lancet, 391(10130), 1589-1598.","DOI":"10.1016\/S0140-6736(18)30001-1"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_003","doi-asserted-by":"crossref","unstructured":"Bickler, S. W., Weiser, T. G., Kassebaum, N., Higashi, H., Chang, D. C., Barendregt, J. J., \u2026 Vos, T. (2015). Global burden of surgical conditions. In H. T. Debas, P. Donkor, A. Gawande, D. T. Jamison, M. E. Kruk, & C. N. Mock (Eds.), Disease control priorities (3rd ed., Vol. 1, pp. 19-40). World Bank.","DOI":"10.1596\/978-1-4648-0346-8_ch2"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_004","doi-asserted-by":"crossref","unstructured":"Cossa, M., Rose, J., Berndtson, A. E., Noormahomed, E., & Bickler, S. W. (2021). Assessment of surgical care provided in national health services hospitals in mozambique: the importance of subnational metrics in global surgery. World journal of surgery, 45(5), 1306-1315.","DOI":"10.1007\/s00268-020-05925-0"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_005","doi-asserted-by":"crossref","unstructured":"Davies, J. I., Gelb, A. W., Gore-Booth, J., Martin, J., Mellin-Olsen, J., \u00c5kerman, C., \u2026 & Weiser, T. G. (2021). Global surgery, obstetric, and anaesthesia indicator definitions and reporting: an Utstein consensus report. PLoS Medicine, 18(8), e1003749.","DOI":"10.1371\/journal.pmed.1003749"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_006","unstructured":"DHIS2. (n.d.). DHIS2. Retrieved November 17, 2023, from https:\/\/dhis2.org\/"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_007","unstructured":"Disease Control Priorities Network. (n.d.). Disease control priorities (3rd ed.). Retrieved March 23, 2024, from https:\/\/www. dcp-3.org\/"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_008","doi-asserted-by":"crossref","unstructured":"Gajewski, J., Bijlmakers, L., & Brugha, R. (2018). Global surgery\u2013informing national strategies for scaling up surgery in sub-Saharan Africa. International journal of health policy and management, 7(6), 481-484.","DOI":"10.15171\/ijhpm.2018.27"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_009","doi-asserted-by":"crossref","unstructured":"Hanna, J. S., Herrera-Almario, G. E., Pinilla-Roncancio, M., Tulloch, D., Valencia, S. A., Roa, L., Meara, J. G., & Dossett, L. A. (2020). Use of the six core surgical indicators from the Lancet Commission on Global Surgery in Colombia: A situational analysis. The Lancet Global Health, 8(5), e699-e710. https:\/\/doi.org\/10.1016\/S2214-109X(20)30090-5","DOI":"10.1016\/S2214-109X(20)30090-5"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_010","unstructured":"Harvard Business School Online. (n.d.). A beginner\u2019s guide to data & analytics. Retrieved from https:\/\/info.email. online.hbs.edu\/data-analytics-ebook"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_011","doi-asserted-by":"crossref","unstructured":"Holmer, H., Bekele, A., Hagander, L., Harrison, E. M., Kamali, P., Ng-Kamstra, J. S., Khan, A. A., Knowlton, L. M., Leather, A. J., & Meara, J. G. (2019). Evaluating the collection, comparability and findings of six global surgery indicators. British Journal of Surgery, 106(2), e138-e150. https:\/\/doi.org\/10.1002\/bjs.11061","DOI":"10.1002\/bjs.11061"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_012","doi-asserted-by":"crossref","unstructured":"Juran, S., Gruendl, M., Marks, I. H., Broer, P. N., Guzman, J. M., Davies, J., \u2026 Ljungman, D. (2019). The need to collect, aggregate, and analyze global anesthesia and surgery data. Canadian Journal of Anesthesia, 66(2), 218-229.","DOI":"10.1007\/s12630-018-1261-5"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_013","unstructured":"Laerdal Foundation. (n.d.). Utstein Guidelines. Retrieved August 6, 2024, from https:\/\/laerdalfoundation.org\/utstein-meetings\/"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_014","doi-asserted-by":"crossref","unstructured":"Meara, J. G., Leather, A. J., Hagander, L., Alkire, B. C., Alonso, N., Ameh, E. A., \u2026 Yip, W. (2015). Global surgery 2030: Evidence and solutions for achieving health, welfare, and economic development. The Lancet, 386(9993), 569-624. https:\/\/doi.org\/10.1016\/S0140-6736(15)60160-X","DOI":"10.1016\/S0140-6736(15)60160-X"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_015","doi-asserted-by":"crossref","unstructured":"Moher, D., Schulz, K. F., Simera, I., & Altman, D. G. (2010). Guidance for developers of health research reporting guidelines. PLoS Medicine, 7(2), e1000217.","DOI":"10.1371\/journal.pmed.1000217"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_016","doi-asserted-by":"crossref","unstructured":"Odland, M. L., Nepogodiev, D., Morton, D., Martin, J., Bekele, A., Ghosh, D., \u2026 Weiser, T. G. (2021). Identifying a basket of surgical procedures to standardize global surgical metrics: an international Delphi study. Annals of surgery, 274(6), 1107-1114.","DOI":"10.1097\/SLA.0000000000004611"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_017","doi-asserted-by":"crossref","unstructured":"Otto, Q., Nolan, J. P., Chamberlain, D. A., Cummins, R. O., & Soar, J. (2021). Utstein Style for emergency care\u2014 the first 30 years. Resuscitation, 163, 16-25.","DOI":"10.1016\/j.resuscitation.2021.03.022"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_018","doi-asserted-by":"crossref","unstructured":"Patil, P., Nathani, P., Bakker, J. M., van Duinen, A. J., Bhushan, P., Shukla, M., \u2026 Gadgil, A. (2023). Are LMICs achieving the Lancet commission global benchmark for surgical volumes? A systematic review. World Journal of Surgery, 47(8), 1930-1939. https:\/\/doi.org\/10.1007\/s00268-023-07029-x","DOI":"10.1007\/s00268-023-07029-x"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_019","doi-asserted-by":"crossref","unstructured":"Perez-Iglesias, C. T., Hill, S. K., Jhunjhunwala, R., A-Baki, I., Uribe-Leitz, T., Park, K. B., \u2026 Vega, A. B. (2023). Strengthening surgical, obstetric, and anesthesia care in the Americas: a call to action. The Lancet Regional Health\u2013Americas, 22, 100499.","DOI":"10.1016\/j.lana.2023.100499"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_020","unstructured":"Program in Global Surgery and Social Change (n.d.). National Surgical, Obstetric, and Anaesthesia Planning. Accessed June 20, 2023, from: https:\/\/www.pgssc.org\/national-surgical-planning"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_021","doi-asserted-by":"crossref","unstructured":"Roa, L., Jumbam, D. T., Makasa, E., & Meara, J. G. (2019). Global surgery and the sustainable development goals. Journal of British Surgery, 106(2), e44-e52.","DOI":"10.1002\/bjs.11044"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_022","doi-asserted-by":"crossref","unstructured":"Rose, J., Long, C., & Meara, J. G. (2021). Comment on \u201cManaging COVID-19 in Surgical Systems\u201d: An Opportunity for Global Surgery to Advance Global Health. Annals of Surgery, 274(6), e766-e767.","DOI":"10.1097\/SLA.0000000000003966"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_023","doi-asserted-by":"crossref","unstructured":"Rose, J., Weiser, T. G., Hider, P., Wilson, L., Gruen, R., & Bickler, S. W. (2015). Estimated need for surgery worldwide based on prevalence of diseases: implications for public health planning of surgical services. The Lancet. Global health, 3(Suppl 2), S13-20.","DOI":"10.1016\/S2214-109X(15)70087-2"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_024","doi-asserted-by":"crossref","unstructured":"Shrime, M. G., Bickler, S. W., Alkire, B. C., & Mock, C. (2015). Global burden of surgical disease: an estimation from the provider perspective. The Lancet Global Health, 3, S8-S9.","DOI":"10.1016\/S2214-109X(14)70384-5"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_025","doi-asserted-by":"crossref","unstructured":"Truch\u00e9, P., Shoman, H., Reddy, C. L., Jumbam, D. T., Ashby, J., Mazhiqi, A., \u2026 Meara, J. G. (2020). Globalization of national surgical, obstetric and anesthesia plans: The critical link between health policy and action in global surgery. Globalization and health, 16(1), 1.","DOI":"10.1186\/s12992-019-0531-5"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_026","unstructured":"United Nations. (2015). Transforming our world: The 2030 agenda for sustainable development. Retrieved August 6, 2024, from https:\/\/sdgs.un.org\/2030agenda"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_027","unstructured":"United Nations. (n.d.). Sustainable Development Goals Indicators: Metadata Repository. Retrieved November 17, 2023, from https:\/\/unstats.un.org\/sdgs\/metadata\/"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_028","unstructured":"United Nations Institute for Training and Research. (2020). National surgical, obstetric, and anaesthesia planning manual (2020 ed.). United Nations Institute for Training and Research. Switzerland."},{"key":"2026020519150312723_j_jdis-2025-0053_ref_029","doi-asserted-by":"crossref","unstructured":"Van Panhuis, W. G., Paul, P., Emerson, C., Grefenstette, J., Wilder, R., Herbst, A. J., \u2026 Burke, D. S. (2014). A systematic review of barriers to data sharing in public health. BMC public health, 14(1), 1144.","DOI":"10.1186\/1471-2458-14-1144"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_030","doi-asserted-by":"crossref","unstructured":"Watters, D. A., Hollands, M. J., Gruen, R. L., Maoate, K., Perndt, H., McDougall, R. J., Morriss, W. W., Tangi, V., Casey, K. M., & McQueen, K. A. (2015). Perioperative mortality rate (POMR): A global indicator of access to safe surgery and anaesthesia. World Journal of Surgery, 39(4), 856-864. https:\/\/doi.org\/10.1007\/s00268-014-2638-4","DOI":"10.1007\/s00268-014-2638-4"},{"key":"2026020519150312723_j_jdis-2025-0053_ref_031","unstructured":"World Bank. (2016). World development indicators, 2016. 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