As the global health community works towards the Sustainable Development Goals target of achieving universal health coverage by 2030, we must consider disparities in access to essential health care, including sexual and reproductive health, maternal health, and surgical care. The Lancet Commission on Global Surgery currently estimates that 5 billion people lack safe and affordable surgical and anesthesia care when needed.
To assess this inequity, the Commission seeks to refine the perioperative mortality ratio (POMR), an indicator that measures the number of all-cause deaths before discharge in patients who have undergone a surgical procedure. A recent commentary published in The Lancet Global Health, co-authored by Ana Langer, Director of the Women and Health Initiative at Harvard T.H. Chan School of Public Health and the Maternal Health Task Force, explores what policymakers who are working on improving the POMR can learn from the established maternal mortality ratio (MMR). The authors note that historical problems with the MMR — such as underreported and misclassified maternal deaths, inconsistent data sources, and varying definitions — provide insight into developing a valid tool for measuring perioperative mortality.
3 Lessons From the Maternal Mortality Ratio
Policymakers working on the POMR can implement the following strategies, gleaned from the MMR:
- Develop a clear definition. Constructing an accurate tool for tracking POMR (or any health outcome) requires a clear, standard, measurable definition. While varying surgical procedures and contexts make defining POMR challenging, the authors call for systematic accounting of types of procedures performed.
- Identify and utilize reliable and accessible sources of data. Using consistent data from reliable sources, such as facility-based databases, will help ensure a strong POMR.
- Anticipate institutional resistance. The authors note that, “For both POMR and MMR, institutional resistance to provide accurate but potentially self-damaging information may be a significant challenge.” To develop a successful POMR, policymakers must clearly convey their intentions of using POMR to classify problems and distribute resources.
The authors urge that over time, with support from global health and academic institutions as well as technical partners, the POMR will be important for measuring the global impact of surgery, an essential and cost-effective public health practice.
Has the MMR informed other health indicators? What lessons might the MMR measurement learn from other fields?