Impact of short-term reconstructive surgical missions: a systematic review

Abstract

IntroductionShort-term missions providing patients in low-income countries with reconstructive surgery are often criticised because evidence of their value is lacking. This study aims to assess the effectiveness of short-term reconstructive surgical missions in low-income and middle-income countries.MethodsA systematic review was conducted according to PRISMA guidelines. We searched five medical databases from inception up to 2 July 2018. Original studies of short-term reconstructive surgical missions were included, which reported data on patient safety measurements, health gains of individual patients and sustainability. Data were combined to generate overall outcomes, including overall complication rates.ResultsOf 1662 identified studies, 41 met full inclusion criteria, which included 48 546 patients. The overall study quality according to Oxford CEBM and GRADE was low. Ten studies reported a minimum of 6 months’ follow-up, showing a follow-up rate of 56.0% and a complication rate of 22.3%. Twelve studies that did not report on duration or follow-up rate reported a complication rate of 1.2%. Fifteen out of 20 studies (75%) that reported on follow-up also reported on sustainable characteristics.ConclusionsEvidence on the patient outcomes of reconstructive surgical missions is scarce and of limited quality. Higher complication rates were reported in studies which explicitly mentioned the duration and rate of follow-up. Studies with a low follow-up quality might be under-reporting complication rates and overestimating the positive impact of missions. This review indicates that missions should develop towards sustainable partnerships. These partnerships should provide quality aftercare, perform outcome research and build the surgical capacity of local healthcare systems.PROSPERO registration numberCRD42018099285.

The Effectiveness of Burn Scar Contracture Release Surgery in Low- and Middle-income Countries

“…Compared with studies conducted in similar settings, our complication rate also seems high, as such studies report complication rates between 15% and 56%. 28 , 46 , 47 The reason for that may be the strict registration of complications and longer follow-up period of our study. However, even with the complications, surgery was effective.…”

“…Such missions, which provide patients with reconstructive surgical care in LMICs, are often criticized for their lack of quality of care or sustainability, although data to substantiate this are frequently not available. 26 – 28 , 48 A recent systematic review found 5 studies reporting on contracture release surgery performed during missions. The quality of these studies was indeed generally low, with short-term follow-up and none using ROM as an outcome measure.…”

“…The quality of these studies was indeed generally low, with short-term follow-up and none using ROM as an outcome measure. 28 …”

“… 25 – 27 A recent systematic review of the effectiveness of reconstructive surgical missions showed that currently no quality studies are available. 28 …”

Anaesthesia care providers employed in humanitarian settings by Médecins Sans Frontières: a retrospective observational study of 173 084 surgical cases over 10 years

“…There is an increasing body of literature outlining the surgical needs of populations in humanitarian settings 3–6. The recognition that the humanitarian sector is not immune from the need to demonstrate safe surgical care has led to calls for more robust outcome data and clearer accountability 7–9. Only few studies, limited by small study size and limited external validity, have addressed the composition of the surgical workforce employed by humanitarian organisations 10 11.…”