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

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Internationalpublic health experts estimate at least one million patients die eachyear as a result of surgical complications, deaths that might beavoided through proper procedures.

Atul Gawande is a surgeon atHarvard University in Boston, Massachusetts and lead author of thefirst international study of surgery and surgical practices:

"Peopleare living longer," said Atul Gawande. "And so you see in the parts ofthe world like Asia, the Middle East, South America that they are allplaces where now cancers are in the top 10 as killers, road trafficaccidents in the top five.  And so what we've seen around the world isan explosion in the use of surgical care."

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

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

In the United Statesand other developed countries, surgical complications led to death inless than one percent of cases.  In developing countries, the number ofdeaths following surgery ranged between five and 10 percent.

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

Gawandesays the checklist is intended for doctors and nurses in all countriesto make sure they follow all of the necessary steps in the operatingroom to ensure patient health.

For example, Gawande saysinfection following surgery is a leading cause of death that can beprevented by giving a patient an antibiotic an hour before an operation.

"What'sthe likelihood that we will give the antibiotic on time?  Globally, itis a less than one third chance," said Gawande. "And even in the bestcountries, 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.

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

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