{
  "abstract": "Introduction While health improvements drive economic growth, the specific macroeconomic impact of surgery remains unknown. Previous studies have quantified economic losses from unmet need but have not established whether surgery generates economic returns. This study investigates the association between surgical activity and economic growth across low- and middle-income countries (LMICs).Methods We analysed panel data from 95 LMICs (2000–2022) using System Generalised Method of Moments (GMM) estimation. Surgical volume was proxied by per capita suture consumption in kilograms (kg) measured by per capita suture imports (in kg), with gross domestic product (GDP) per capita adjusted for purchasing power parity as the outcome variable. We controlled for education, labour force, infrastructure, quality of governance, health expenditure, and credit availability while addressing endogeneity through internal instrumentation.Results Each 1% increase in per capita suture consumed corresponded to a 0.0083% increase in per capita GDP (p<0.05). Associations were concentrated and larger in middle-income countries (0.013%; p<0.05) and countries with surgical activity above the 75th percentile in a piecewise spline model (0.016%; p<0.05). No significant associations were found in low-income countries (−0.0039%; p>0.05) or below the 75th percentile surgical activity settings (0.0049%; p>0.05). In a secondary (non-log-transformed) model, a 1-kg increase in per capita sutures consumption corresponded to an increase of 89 international dollars in per capita GDP (p<0.05).Conclusion Surgical activity is positively associated with economic growth in LMICs, particularly in higher capacity settings. This provides novel empirical evidence suggesting that surgical investments may yield macroeconomic returns, supporting integration of surgical system strengthening into economic development strategies. Low-income countries may require coordinated investments to build capacity to levels where economic benefits become visible.",
  "authors": [
    {
      "affiliations": [
        "Global Surgery Policy Unit, LSE Health, The London School of Economics and Political Science, London, UK",
        "African Centre for Health Economics and Policy Research, Enugu, Nigeria"
      ],
      "name": "Martilord Ifeanyichi"
    },
    {
      "affiliations": [
        "African Centre for Health Economics and Policy Research, Enugu, Nigeria",
        "Department of Economics, University of Nigeria, Nsukka, Enugu State, Nigeria"
      ],
      "name": "Johnson Ezema Nchege"
    },
    {
      "affiliations": [
        "African Centre for Health Economics and Policy Research, Enugu, Nigeria",
        "Department of Economics, University of Africa, Toru-Orua, Bayelsa State, Nigeria"
      ],
      "name": "Ebikabowei Biedomo Aduku"
    },
    {
      "affiliations": [
        "Global Surgery Policy Unit, LSE Health, The London School of Economics and Political Science, London, UK"
      ],
      "name": "Meskerem Aleka Kebede"
    },
    {
      "affiliations": [
        "Global Surgery Policy Unit, LSE Health, The London School of Economics and Political Science, London, UK"
      ],
      "name": "Maeve Bognini"
    },
    {
      "affiliations": [
        "Global Surgery Policy Unit, LSE Health, The London School of Economics and Political Science, London, UK",
        "School of Medicine, University Hospital of Wales, Cardiff, UK"
      ],
      "name": "Rachel Hargest"
    },
    {
      "affiliations": [
        "Global Surgery Policy Unit, LSE Health, The London School of Economics and Political Science, London, UK",
        "Department of Health Policy, The London School of Economics and Political Science, London, UK"
      ],
      "name": "Rocco Friebel"
    }
  ],
  "title": "Association of surgery and economic development in low- and middle-income countries: evidence from a dynamic panel data analysis",
  "uid": "ea3442fb-21dc-5178-978c-94ddeb121512"
}