Table 1.

Proposed indicators to monitor and evaluate surgical systems

Domain	Best for	Indicator	Reference
Access	Surgical system	Access to timely essential surgery†	WHO Core 100**
		Specialist surgical workforce density†	WHO Core 100**
	Trauma care	Estimated proportion of seriously injured patients transported by ambulance	WHO IMR
	Trauma and obstetrics	National whole blood donation rate	WHO GDBS
	Obstetrics	C-section rate	WHO Core 100+
	Anaesthesia	Proportion of operating theatres with pulse oximetry	WHO PSPOP
		Ratio of anaesthetists to surgeons	WHO Core 100**
Quality	Surgical system	Surgical Volume†	WHO Core 100**
		Perioperative mortality rate (POMR)†	WHO Core 100
	Trauma care	Inpatient trauma mortality rate	ACS COT
	Obstetrics	Maternal Mortality Ratio (proportion due to maternal haemorrhage, obstructed labour)	WHO Core 100**
		Neonatal mortality	WHO Core 100
	Anaesthesia	POMR on operative day	WHO Core 100**
Financial risk protection	Surgical system	Protection against impoverishing expenditure†	WHO Core 100**
		Protection against catastrophic expenditure†	WHO Core 100**

^†Core LCoGS measure for surgical systems strengthening, WHO Core 100: Worth Health Organization’s Global Reference List of 100 Core Health Indicators, 2015, WHO Core 100** the surgically relevant indicator can be disaggregated from existing Core 100 indicators, WHO Core 100+ signifies a Core 100 “Additional Indicator”, WHO IMR: WHO’s Indicator and Measurement Registry, WHO GBDS: WHO’s Global Database on Blood Safety, WHO PSPOP: WHO’s Patient Safety Pulse Oximetry Project, ACS COT: American College of Surgeons Committee on Trauma