A new study for the first time puts the number of surgeries performed globally each year at just over 234 million, with an increasing number of procedures now being performed in the developing world.  As the number of operations goes up, experts say so do the number of surgical complications, which the World Health Organization hopes to reduce with a checklist for operating room personnel. VOA's Jessica Berman explains.

International public health experts estimate at least one million patients die each year as a result of surgical complications, deaths that might be avoided through proper procedures.

"People are living longer," said Atul Gawande, a surgeon at Harvard University in Boston, Massachusetts and lead author of the first international study of surgery and surgical practices. "And so you see in the parts of the world like Asia, the Middle East, South America that they are all places where now cancers are in the top 10 as killers, road traffic accidents in the top five.  And so what we've seen around the world is an explosion in the use of surgical care."

Gawande led a study in which investigators analyzed the surgical data of 56 countries.

According to 2004 records, the greatest number of surgical procedures, 172 million, were performed in wealthy countries, while eight million operations were performed in the poorest.

In the United States and other developed countries, surgical complications led to death in less than one percent of cases.  In developing countries, the number of deaths following surgery ranged between five and 10 percent.

Gawande heads the WHO's Surgery Saves initiative, an effort to reduce the number of surgical complications worldwide.  The centerpiece of the initiative is a checklist for operating room personnel.

Gawande says the checklist is intended for doctors and nurses in all countries to make sure they follow all of the necessary steps in the operating room to ensure patient health.

For example, Gawande says infection following surgery is a leading cause of death that can be prevented by giving a patient an antibiotic an hour before an operation.

"What's the likelihood that we will give the antibiotic on time?  Globally, it is a less than one third chance," said Gawande. "And even in the best countries, it is missed about one third of the time."

Gawande says he's been using the checklist in the operating room and has caught some missed steps.  

But he says there's some resistance among surgeons who wonder whether taking the extra time is worth it.

"But talk to patients and they are puzzled," he said. "Pilots use a checklist before they take off.  You mean my surgeon isn't using a checklist already?  And I think it's sort of a no-brainer on one level.  These things work, they help and they help ensure that teams work as effectively as possible."

The study on worldwide surgeries is published on line in the medical journal The Lancet.