Abstract
Background and aims: Surgery plays a vital role in reducing morbidity and mortality, yet many patients in low- and middle-income countries face barriers to accessing surgical care; context-specific evidence from urban tertiary centers in Pakistan remains scarce, limiting the ability to design locally targeted interventions. Understanding patient perceptions and identifying these barriers is essential to inform targeted interventions, improve hospital environments, and enhance equitable surgical service utilization. This study aimed to evaluate patient perceptions and identify these barriers at a tertiary hospital in Lahore, Pakistan.
Methodology: A cross-sectional study was conducted from January to June 2025, enrolling 607 surgical patients aged ≥ 18 years via convenience sampling. Data were collected through a validated, interview-administered questionnaire. Analyses were performed using descriptive statistics, Chi-square tests, and binary logistic regression in SPSS v27.
Results: Among participants (61.8% male, 63.9% aged 18-30), perceptions were mixed: 38.7% agreed that surgery improves health, 41.5% preferred non-surgical alternatives, and 36.1% reported that cultural beliefs influenced their decisions. A majority (58.3%) reported experiencing significant barriers. Multivariate analysis identified key predictors: males (AOR: 2.015, p = 0.002) and those with a past family history of surgery (AOR: 3.79, p = 0.001) were more likely to report barriers. Conversely, graduates (AOR: 0.205, p = 0.007) and employed participants (AOR: 0.147, p = 0.007) were less likely to report barriers. Marital status was a strong predictor, with single participants facing significantly higher barriers than married ones (AOR: 3.417, p < 0.001).
Conclusion: Patient willingness to undergo surgery is shaped by complex socio-cultural and economic factors. The paradox of individuals with easier access reporting more barriers suggests that proximity alone is insufficient without trust, quality, and positive prior experiences. Targeted interventions should focus on patient education, improving hospital environments, and providing culturally sensitive counseling to enhance surgical uptake and equity.