Association of surgery and economic development in low- and middle-income countries: evidence from a dynamic panel data analysis.

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.