Association of Surgical–Anaesthesia Workforce Density, Universal Health Coverage, and Macroeconomic Factors with Acute Abdominal Emergency Outcomes in 130 Low- and Middle-Income Countries (2000–2023): A Longitudinal Panel Study

Background: Acute abdominal emergencies—appendicitis, paralytic ileus/intestinal obstruction, incarcerated hernia, peptic ulcer, biliary disease, and mesenteric vascular disorders—are time-critical conditions. Although the Lancet Commission established a target of 20–40 specialist surgical, anaesthetic, and obstetric (SAO) providers per 100,000, longitudinal elasticities of mortality, disability-adjusted life-years (DALYs), and case-fatality (Mortality-to-Incidence Ratio [MIR]) remain unquantified. Aims: To evaluate macroeconomic determinants, Universal Health Coverage (UHC), and SAO workforce density associated with acute abdominal mortality, DALYs, and MIR across 130 low- and middle-income countries (LMICs) from 2000 to 2023. Study Design: Multi-repository longitudinal panel study. Place and Duration of Study: Global panel across 200 countries (130 LMICs, 70 high-income countries [HICs]) over 24 years (2000–2023; 4,800 country-years). Methodology: Data merged from the IHME GBD 2023, World Bank, and WHO Global Health Observatory repositories were analysed using autoregressive Generalized Estimating Equations (GEE AR[1]) with Huber–White standard errors and Restricted Maximum Likelihood Linear Mixed-Effects models with Mundlak within–between decomposition. Results: Across 4,800 country-years (3,120 LMIC country-years), mean SAO density was 2.04 per 100,000 (median 0.55) in low-income countries (LICs) versus 66.89 (median 60.81) in HICs. Despite lower LIC incidence (1,103.05 vs. 2,061.98 per 100,000), mortality was 2.09-fold higher (19.74 vs. 9.44), DALYs 2.10-fold higher (617.24 vs. 293.81), and MIR 3.71-fold higher (1.86% vs. 0.50%). In LMIC GEE AR(1) models, log SAO density independently reduced mortality by −5.58% (p = 0.0002), DALYs by −3.08% (p = 0.0065), Total 6 MIR by −10.84% (p = 1.73 × 10-8), and Core 3 surgical MIR by −11.33% (p = 2.30 × 10-7). Achieving ≥20 SAO/100,000 across 89 deficit LMICs prevents 102,254 deaths and 3,259,619 DALYs annually. Conclusion: Expanding surgical–anaesthesia workforce density and UHC financial protection is essential to eliminate preventable acute abdominal mortality across LMICs.