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Global Surgery

Effective Involvement of US Academic Surgery

Report of the American Surgical Association Working Group on Global Surgery

Mock, Charles, MD, PhD*; Debas, Haile, MD; Balch, Charles M., MD; Brennan, Murray, MD§; Buyske, Jo, MD; Cusack, James, MD||; DeMeester, Steven, MD**; Herndon, David, MD††; Le Holterman, Ai-Xuan, MD‡‡; Jaffe, Bernard, MD§§; Kandil, Emad, MD§§; Kauffman, Gordon, MD¶¶; Mazariegos, George, MD||||; sMerchant, Nipun, MD***; Numann, Patricia, MD†††; Oleynikov, Dmitry, MD‡‡‡; Olutoye, Oluyinka, MBChB, PhD§§§; O’Neill, James, MD¶¶¶; Shackford, Steven, MD||||||; Stock, Peter, MD, PhD; Tarpley, John L., MD¶¶¶; Tuttle, Todd, MD****; Wolf, Steven, MD††††; Wren, Sherry M., MD‡‡‡‡; Yang, George P., MD, PhD§§§§

doi: 10.1097/SLA.0000000000002934

There is an unacceptably high burden of death and disability from conditions that are treatable by surgery, worldwide and especially in low- and middle-income countries (LMICs). The major actions to improve this situation need to be taken by the surgical communities, institutions, and governments of the LMICs. The US surgical community, including the US academic surgical community, has, however, important roles to play in addressing this problem. The American Surgical Association convened a Working Group to address how US academic surgery can most effectively decrease the burden from surgically treatable conditions in LMICs. The Working Group believes that the task will be most successful (1) if the epidemiologic pattern in a given country is taken into account by focusing on those surgically treatable conditions with the highest burdens; (2) if emphasis is placed on those surgical services that are most cost-effective and most feasible to scale up; and (3) if efforts are harmonized with local priorities and with existing global initiatives, such as the World Health Assembly with its 2015 resolution on essential surgery. This consensus statement gives recommendations on how to achieve those goals through the tools of academic surgery: clinical care, training and capacity building, research, and advocacy. Through all of these, the ethical principles of maximally and transparently engaging with and deferring to the interests and needs of local surgeons and their patients are of paramount importance. Notable benefits accrue to US surgeons, trainees, and institutions that engage in global surgical activities.

*Department of Surgery, University of Washington, Seattle, WA

Department of Surgery, University of California at San Francisco, San Francisco, CA

Department of Surgical Oncology, University of Texas MD Anderson Cancer Center, Houston, TX

§Memorial Sloan Kettering Cancer Center, New York, NY

American Board of Surgery, Philadelphia, PA

||Division of Surgical Oncology, Harvard Medical School, Massachusetts General Hospital, Boston, MA

**The Oregon Clinic, Portland, OR

††Shriners Burn Hospital, University of Texas Medical Branch, Galveston, TX

‡‡Departments of Surgery and Pediatrics, University of Illinois, Chicago, IL

§§Department of Surgery, Tulane University, New Orleans, LA

¶¶Department of Surgery, Penn State Hershey Medical Center, Hershey, PA

||||Division of Pediatric Transplantation, University of Pittsburgh, Pittsburgh, PA

***Department of Surgery, Division of Surgical Oncology, University of Miami, Miami, FL

†††Department of Surgery, Upstate Medical University, Syracuse, NY

‡‡‡Department of Surgery, Nebraska Medical Center, Omaha, NE

§§§Department of Surgery, Baylor College of Medicine, Houston, TX

¶¶¶Department of Surgery, Vanderbilt University, Nashville, TN

||||||Department of Surgery, Scripps Mercy San Diego, San Diego, CA

****Division of Surgical Oncology, University of Minnesota, Minneapolis, MN

††††Department of Surgery, University of Texas, Galveston, TX

‡‡‡‡Department of Surgery, Stanford University, Palo Alto, CA

§§§§Department of Surgery, University of Alabama at Birmingham, Birmingham, AL.

Reprints: Charles Mock, MD, PhD, Department of Surgery, Harborview Medical Center, University of Washington, Box 359960, 325 Ninth Ave, Seattle, WA 98103. E-mail:

The authors report no conflicts of interest.

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