Surgery has become an integral part of global health care, with
an estimated 234 million operations performed yearly. The World
Bank in 2002 reported that an estimated 164 million
disability-adjusted life years, representing 11% of the entire
disease burden, were attributable to surgically treatable
conditions
If the surgery is categorized according to the medical
specialty/ system involved, among the 426 surgical procedures
reported it was seen maximum number of surgeries were Obstetrics
and Gynaecology related (32.4%). Next most common system was
abdominal surgery (29.3%), cardiovascular (14.3%), ophthalmic
(11%), orthopedic (5.4%), head & neck (3.5%) and surgeries
involving other systems (4%).
In this study 61.7% surgery were elective in nature and rest
38.3% were emergency type. These included 3.75% surgeries that had
been carried out on an emergency basis following an accident.
Majority of the surgeries (81.9%) were carried out in the private
hospitals, only 17.8% surgeries were done in a Government hospital
and rest were in other hospitals like ESI hospital
Common surgical procedures:
Some of the most common surgical operations performed in the
India include the following:
Gall bladder stones: It is the presence of stones in the gall
bladder that explains almost all of the ills inflicted by this
organ. The processof stone formation is thought to be the result of
a triple defect:
Patients with gall stones have even more unstable bile than the
rest of us
They have more sluggish activity of the gall bladder, which
allows crystals to grow into large stones
They are also more prone to nucleate crystals in the first
place, thereby initiating theprocess.
Cases: At Apollo Hospital, New Delhi, the author did a study on
urban affluent people ( see adjoining graph) coming to the hospital
for a routine health check and found that 18 percent of females and
9 percent of males suffered from gall stones ( Over all incidence
of 12% ). This is higher than the average incidence in US and
Western Europe of 8%. In New Delhi hospitals, a total of
approximately 100 operations are done every day for this
ailment.
Appendectomy/Appendicitis/Appendix An appendectomy is the
surgical removal of the appendix, a small tube that branches off
the large intestine, to treat acute appendicitis. Appendicitis is
the acute inflammation of this tube due to infection.
Cases:
Appendicitis is most common between the ages of 5 and 40;[58]
the median age is 28. It tends to affect males, those in lower
income groups, and, for unknown reasons, people living in rural
areas.[59] In 2013 it resulted in 72,000 deaths globally down from
88,000 in 1990
Cases:
India has now the world's third largest number of obese
individuals following USA and China. We have 20% of our population
classified as obese, 40% as malnourished and 40% normal weight.
Our diabetic population is world's highest and there is
correlation between diabetes, metabolic syndrome and obesity. India
has already been labelled as the Diabetes capital of the world with
nearly 80 million diabetics.
Cardiovascular disease
Ischemic heart disease (IHD) is the leading cause of death in
economically developed countries and is rapidly assuming serious
dimensions in developing countries. It is expected to be the single
most important cause of death in India by the year 2015
Cases: Cardiovascular disease According to recent estimates,
cases of CVD may increase
from about 2.9 crore in 2000 to as many as 6.60 crore in 2015,
and the number of deaths from CVD will also more
than double.
Cancer
Cases: Cancers account for 14% of the overall NCD mortality and
7% of the NCD related DALYs in India6 . The pooled estimates for
data of all six population based registries (Delhi, Mumbai,
Chennai, Barshi, Bangalore and Bhopal) were 25.19 per lakh for men
and 23.52 per lakh for women in 2004. The prevalence of cancer in
India is estimated to be around 2.5 million, with over 800,000 new
cases and 550,000 deaths occurring each year due to this disease in
the country17. In India, cancers account for about of 3.3% of the
disease burden and about 9% of all deaths.
There are about 2.8 million cases of cancer at any point of
time1 An estimated increase of 19.2 % cases in last 10 years1
Approx. 0.8 million new cases occur every year out of which 5 lakh
deaths occurs
Oral and dental diseases
Available data on the current prevalence and future projections
for oral health conditions suggest an increase by 25% over the next
decade.
Kidney stones are hard mass deposits that form in the kidney or
ureter. They are made up of tiny crystalline minerals and acid
salts that settle out of the urine and stick together.Cases:
Mental health disorders
Mental health was a much neglected field until recently.There
is, however, increasing realization that conditions
such as schizophrenia, mood disorders (bipolar, manic,
depressive and persistent mood disorders) and mental
retardation can impose a marked disease burden on Indians. This
was confirmed by a study conducted for the NCMH
which stated that at least 6.5% of the Indian population had
some form of serious mental disorder, with no discernibleruralurban
differences; women had slightly higherrates of mental disorder than
men.
COPD:
Chronic obstructive pulmonary disease(COPD), also known
aschronic obstructive lung disease(COLD)Chronic Obstructive
Pulmonary Disease (COPD) kills more than 3 million people every
year, making it the 4th largest cause of death in the world. It has
been estimated that by the year 2030, COPD will become the third
biggest cause of death. According to the World Health Organisation,
COPD kills more people than HIV-AIDS, Malaria and Tuberculosis all
put together in the South East Asian region
Cataract: A cataract is a clouding of the lens in the eye that
affects vision. Most cataracts are related to aging. Cataracts are
very common in older people. By age 80, more than half of all
Indians either have a cataract or have had cataractsurgery.
A cataract can occur in either or both eyes. It cannot spread
from one eye to theother.
Cases:
Using age-specific data for those aged 50+ years it was observed
that prevalence of blindness at different age cohorts (above 50
years) reduced over three decades with a peak in 1989. Projections
show that among those aged 50+ years, the quantum of
cataractsurgerywould double (3.38 million in 2001 to 7.63 million
in 2020) and cataractsurgicalrate would increase from 24025/million
50+ in 2001 to 27817/million 50+ in 2020. Though the prevalence of
cataract blindness would decrease, the absolute number of cataract
blind would increase from 7.75 million in 2001 to 8.25 million in
2020 due to a substantial increase in the population above 50 years
inIndiaover this period
Projections show that among those aged 50+ years, the quantum of
cataract surgery would double (3.38 million in 2001 to 7.63 million
in 2020) and cataract surgical rate would increase from
24025/million 50+ in 2001 to 27817/million 50+ in 2020.
Diabetes
Cases:Diabetes is also associated with an increased risk for
CVD,and is emerging as a serious health challenge in India.Even
though it accounted for only about 0.7% of Indias disease burden in
1998, data suggest a significant load of diabetes cases in
Indiarising from 2.6 crore in 2000 to approximately 4.6 crore by
2015, and particularly concentrated in the urban population.
Hernia : The lump of the hernia is due to the weakness in the
wall of the muscles of the abdomen or groin. The content of the sac
is usually a part of the intestine.About 25% of males and 2% of
females develop inguinal hernias; this is the most common hernia in
males and females. Approximately 75% of all hernias occur in the
groin; two thirds of these hernias are indirect and one third
direct.