A prospective observational study of postoperative follow‐ups and outcomes at a nonprofit, internationally supported pediatric surgery center in Guatemala
Abstract:Background: Global surgical access is unequally distributed, with the greatest surgical burden in low-and middle-income countries, where surgical care is often supplemented by nongovernmental organizations. Quality data from organizations providing this care are rarely collected or reported. The Moore Pediatric Surgery Center in Guatemala City, Guatemala, is unique in that it offers a permanently staffed, freestanding pediatric surgical center. Visiting surgical teams supplement the local permanent staff by pr… Show more
“…a total of 15 to 20 US surgical teams provide care annually. Visiting groups bring a multidisciplinary cohort of providers including surgeons, anesthesiologists, nurse anesthetists, operating room nurses, PACU nurses, and ancillary health care staff 22 …”
mentioning
confidence: 99%
“…Visiting groups bring a multidisciplinary cohort of providers including surgeons, anesthesiologists, nurse anesthetists, operating room nurses, PACU nurses, and ancillary health care staff. 22 The center performs outpatient surgical procedures and utilizes a standard postoperative follow-up plan. Pediatric Otolaryngology-Head and Neck procedures comprise the majority of surgeries.…”
ObjectiveThe frequency of humanitarian surgical mission trips has grown over recent decades. Unfortunately, research on patient outcomes from these trips has not increased proportionately. We aim to analyze the safety and efficacy of surgeries in a low‐ and middle‐income country missions‐based surgery center in Guatemala City, Guatemala, and identify factors that influence surgical outcomes.Study DesignRetrospective cohort study.SettingGuatemalan surgery center is called the Moore Center.MethodsPediatric patients underwent otolaryngology surgery between 2017 and 2019. All patients required follow up. We analyzed the effect of patient, surgical, and geographic factors on follow up and complications with univariate and multivariate analyses.Results A total of 1094 otolaryngologic surgeries were performed between 2017 to 2019, which comprised 37.4% adenotonsillectomies, 26.8% cleft lip (CL)/cleft palate (CP) repairs, 13.6% otologic, and 20% “other” surgeries. Patients traveled on average 88 km to the center (±164 km). Eighty‐nine percent attended their first follow up and 55% attended their second. The 11% who missed their first follow up lived farther from the center (p < .001) and had a higher ASA classification (p < .001) than the 89% who did attend. Sixty‐nine (6.3%) patients had 1 or more complications. CL/CP surgery was associated with more complications than other procedures (p < .001). Of 416 tonsillectomies, 4 patients (1%) had a bleeding episode with 2 requiring reoperation.ConclusionThis surgical center models effective surgical care in low‐resource areas. Complications and follow‐up length vary by diagnosis. Areas to improve include retaining complex patients for follow up and reducing complications for CL/CP repair.
“…a total of 15 to 20 US surgical teams provide care annually. Visiting groups bring a multidisciplinary cohort of providers including surgeons, anesthesiologists, nurse anesthetists, operating room nurses, PACU nurses, and ancillary health care staff 22 …”
mentioning
confidence: 99%
“…Visiting groups bring a multidisciplinary cohort of providers including surgeons, anesthesiologists, nurse anesthetists, operating room nurses, PACU nurses, and ancillary health care staff. 22 The center performs outpatient surgical procedures and utilizes a standard postoperative follow-up plan. Pediatric Otolaryngology-Head and Neck procedures comprise the majority of surgeries.…”
ObjectiveThe frequency of humanitarian surgical mission trips has grown over recent decades. Unfortunately, research on patient outcomes from these trips has not increased proportionately. We aim to analyze the safety and efficacy of surgeries in a low‐ and middle‐income country missions‐based surgery center in Guatemala City, Guatemala, and identify factors that influence surgical outcomes.Study DesignRetrospective cohort study.SettingGuatemalan surgery center is called the Moore Center.MethodsPediatric patients underwent otolaryngology surgery between 2017 and 2019. All patients required follow up. We analyzed the effect of patient, surgical, and geographic factors on follow up and complications with univariate and multivariate analyses.Results A total of 1094 otolaryngologic surgeries were performed between 2017 to 2019, which comprised 37.4% adenotonsillectomies, 26.8% cleft lip (CL)/cleft palate (CP) repairs, 13.6% otologic, and 20% “other” surgeries. Patients traveled on average 88 km to the center (±164 km). Eighty‐nine percent attended their first follow up and 55% attended their second. The 11% who missed their first follow up lived farther from the center (p < .001) and had a higher ASA classification (p < .001) than the 89% who did attend. Sixty‐nine (6.3%) patients had 1 or more complications. CL/CP surgery was associated with more complications than other procedures (p < .001). Of 416 tonsillectomies, 4 patients (1%) had a bleeding episode with 2 requiring reoperation.ConclusionThis surgical center models effective surgical care in low‐resource areas. Complications and follow‐up length vary by diagnosis. Areas to improve include retaining complex patients for follow up and reducing complications for CL/CP repair.
“…However, this study also introduces a potential issue with such mission trips: Only 29% of patients were reachable for follow-up. 7 It is evident that such structural barriers to care among rural and low-income communities must be addressed in the development of orthopaedic missions. Addressing this disparity in health care is a great first step, but studies have shown that mission trips may have some serious downfalls.…”
Many physicians chose to pursue years of rigorous medical training because of an innate desire to care for others, which often translates into volunteering in their local communities. Some physicians take this a step further by contributing their time and skills to global health delivery through medical mission trips. The need is apparent: a 40-year discrepancy in average life span, 36 deaths versus 4 deaths per 1,000 births in low-income versus high-income countries, and over 70% of preventable pediatric deaths occurring in solely 15 countries. In addition, a remarkable gap exists in the access of care and resources, with the world's poorest countries receiving only 4% of surgical services. Orthopaedic missions are seldom because the cost and complexity of these trips supersede many other specialties. However, the care that orthopaedic surgery can provide restores an individual's function, allowing them to increase productivity in their personal lives and in their community. Addressing this disparity in health care is a great first step, but studies have shown that mission trips may have some serious downfalls. We aim to discuss these downfalls and provide recommendations to mitigate them.
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