Barriers to Surgical Outcomes Research in Low- and Middle-Income Countries: A Scoping Review

Introduction: Systematic collection and analysis of surgical outcomes data is a cornerstone of surgical quality improvement. Unfortunately, there remains a dearth of surgical out-comes data from low-and middle-income countries (LMICs). To improve surgical outcomes in LMICs, it is essential to have the ability to collect, analyze, and report risk-adjusted postoperative morbidity and mortality data. This study aimed to review the barriers and challenges to developing perioperative registries in LMIC settings. Methods: We conducted a scoping review of all published literature on barriers to con-ducting surgical outcomes research in LMICs using PubMed, Embase, Scopus, and Goo-gleScholar.Keywords included 'surgery', 'outcomes research', 'registries', 'barriers', and synonymous Medical Subject Headings derivatives. Articles found were subsequently reference-mined. All relevant original research and reviews published between 2000 and 2021 were included. The performance of routine information system management framework was used to organize identified barriers into technical, organizational, or behavioral factors.Results: Twelve articles were identified in our search. Ten articles focused specifically on the creation, success, and obstacles faced during the implementation of trauma registries. Technical factors reported by 50% of the articles included limited access to a digital plat-form for data entry, lack of standardization of forms, and complexity of said forms. 91.7% articles mentioned organizational factors, including the availability of resources, financial constraints, human resources, and lack of consistent electricity. Behavioral factors high-lighted by 66.6% of the studies included lack of team commitment, job constraints, and clinical burden, which contributed to poor compliance and dwindling data collection over time.Conclusions: There is a paucity of published literature on barriers to developing and maintaining perioperative registries in LMICs. There is an immediate need to study and understand barriers and facilitators to the continuous collection of surgical outcomes in LMICs.& COPY; 2023 Elsevier Inc. All rights reserved.

Automated summary

Systematic collection and analysis of surgical outcomes data is crucial for improving surgical quality in low-and middle-income countries (LMICs). However, there is a lack of such data from LMICs. This study reviewed the barriers and challenges to developing perioperative registries in LMIC settings. Technical, organizational, and behavioral factors were identified as barriers, including limited access to digital platforms, lack of standardization and complexity of data entry forms, resource constraints, and poor compliance due to lack of team commitment and job constraints. The paucity of published literature on this topic calls for further research to understand and overcome these barriers.