Scalable, Sustainable Cost-Effective Surgical Care

Campbell, Alex; Restrepo, Carolina; Mackay, Donald R.; Sherman, Randy; Varma, Ajit; Ayala, Ruben; Sarma, Hiteswar; Deshpande, Gaurav; Magee, William P.

doi:10.1097/scs.0000000000001207

Cited by 27 publications

(14 citation statements)

References 12 publications

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“…Follow up in this study was 44%, which is comparable with other studies investigating surgical outcome in LMICs [ 26 – 30 ]. Most studies evaluate immediate outcome (1–4 weeks), with very few evaluating longer term follow up [ 28 ].…”

Section: Discussionsupporting

confidence: 88%

Measurement of patient reported disability using WHODAS 2.0 before and after surgical intervention in Madagascar

White

Randall

Alcorn

et al. 2018

BMC Health Serv Res

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BackgroundPatient reported outcomes (PRO) measure the quality of care from the patient’s perspective. PROs are an important measure of surgical outcome and can be used to calculate health gains after surgical treatment. The World Health Organisation Disability Assessment Schedule (WHODAS) 2.0 is a PRO used to evaluate pre and post-operative disability across a range of surgical specialities. In this study, Mercy Ships, a non-governmental organisation (NGO), used WHODAS 2.0 to evaluate patient reported disability in 401 consecutive patients in Madagascar. We hypothesised that surgical interventions would decrease pre-operative patient reported disability across a range of specialties (maxillofacial, plastic, orthopaedic, general and obstetric fistula surgery).MethodWHODAS 2.0 was administered preoperatively by face-to-face interview, and at 3 months post-operatively by telephone. Demographic data, American Society of Anesthesiologists (ASA) physical classification score, duration of surgery, length of hospital stay, and in-hospital post-operative complications were collected from a separately maintained patient database. The primary outcome measure was difference in pre- and post-operative WHODAS 2.0 scores.ResultsNo differences were seen between the two groups in preoperative disability (p = 0.25), ASA score (p = 0.46), or duration of surgery (p = 0.85). At 3 months 44% (176/401) of patients were available for telephone for postoperative evaluation. All had a significant reduction in their disability score from 8.4% to 1.0% (p < 0.001), 17 experienced a post-operative complication, but none had residual disability and there were no deaths. The group lost to follow-up were more likely to be female (65% versus 50%, p < 0.05), were younger (mean age 31 versus 35, p < 0.05), had longer hospital stays (10 versus 4 days, p < 0.001), and were more likely to have experienced post-operative complications (p < 0.05).ConclusionThis study demonstrates that surgical intervention in a LMIC decreases patient reported disability as measured by WHODAS 2.0.

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Section: Discussionsupporting

confidence: 88%

Measurement of patient reported disability using WHODAS 2.0 before and after surgical intervention in Madagascar

White

Randall

Alcorn

et al. 2018

BMC Health Serv Res

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“…Physician empowerment and education are critical to achieve autonomy in patient care within developing countries where deficits in cleft care exist. Numerous foundations have described training local surgeons from these countries by integrating them in the workflow of mission work, outreach cleft centers that they have established, or even by sponsoring them to attend training programs at their headquarters in developed countries (Zbar et al, 2000;Campbell et al, 2010;Campbell et al, 2014).…”

Section: Introductionmentioning

confidence: 99%

Sustainable Cleft Care Through Education: The First Simulation-Based Comprehensive Workshop in the Middle East and North Africa Region

Kantar

Ramly

Almas

et al. 2018

The Cleft Palate-Craniofacial Journal

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Objective: To describe the conduct of the first multidisciplinary simulation-based workshop in the Middle East/North Africa region and evaluate participant satisfaction. Design: Cross-sectional survey-based evaluation. Setting: Educational comprehensive multidisciplinary simulation-based cleft care workshop. Participants: Total of 93 workshop participants from over 20 countries. Interventions: Three-day educational comprehensive multidisciplinary simulation-based cleft care workshop. Main Outcome Measures: Number of workshop participants, number of participants stratified by specialty, satisfaction with workshop, number of workshop staff, and number of workshop staff stratified by specialty. Results: The workshop included 93 participants from over 20 countries. The response rate was 47.3%, and participants reported high satisfaction with all aspects of the workshop. All participants reported they would recommend it to colleagues (100.0%) and participate again (100.0%). No significant difference was detected based on participant specialty or years of experience. The majority were unaware of other cleft practitioners in their countries (68.2%). Conclusion: Multidisciplinary simulation-based cleft care workshops are well received by cleft practitioners in developing countries, serve as a platform for intellectual exchange, and are only possible through strong collaborations. Advocates of international cleft surgery education should translate these successes from the regional to the global arena in order to contribute to sustainable cleft care through education.

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“…There is a backlog of around 4,000,000 untreated CLP patients worldwide, 26 the majority of whom live in the developing world. 8 These people live with the physical, psychological and socioeconomic consequences of clefts throughout their lives 27 - 29 and cause a tremendous cost to productivity 27 - 30 (Figure 3).…”

Section: Introductionmentioning

confidence: 99%

“…In humanitarian plastic surgical initiatives there has been a shift from supporting missions to building care centers, which prioritize sustainability and build quantity, capacity and availability of the local health care systems through education or financial support. 29 , 30 Developing healthcare infrastructure involves empowering medical staff, improving education and training of in-country personnel and construction of new units, such as cleft centers 51 (Figure 7). Supporting local surgeons in their care for their indigent patients is the most cost-effective method of increasing access to care.…”

Section: Introductionmentioning

confidence: 99%

“…7 , 40 Developing the health system as a whole only has minimally distortive effects on local health care as compared to mission models, and may stimulate the local microeconomy. 30 Multilateral partnerships between local and international teams are of primary importance in building sustainable surgical efforts in developing countries. 28 Collaboration generates a gateway for cross-cultural education exchange and the introduction of new surgical practice techniques 17 (Figure 7).…”

Section: Introductionmentioning

confidence: 99%

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What Is the Role of Plastic Surgery in Global Health? A Review

Borrelli

2018

wjps

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There is growing awareness of the substantial global burden of surgical disease. Conditions treated effectively by plastic and reconstructive procedures make a large proportion of the global surgical diseases, and disproportionately affect individuals at the lower end of the economic spectrum. This article reviews the role of plastic surgery in global health, highlights the ongoing need for plastic and reconstructive surgery globally, and increasing efforts that have been made to meet these needs. There global shortage of plastic surgeons in low and middle income countries, but plastic surgery has a long tradition of humanitarian aid, has been a leader in global surgery development. Plastic and reconstructive surgical care has increasingly been shown to be cost effective and to have an immense impact on the economy of a region, delivering a substantial return on investment. More sustainable global surgical care is essential in future, requiring ongoing efforts from the plastic surgery community, greater recognition of the problems that can be addressed at policy level, and research to help guide policy-makers when facing the decision of allocating scarce resources. There is a fundamental role of plastic surgery in global health.

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Scalable, Sustainable Cost-Effective Surgical Care

Cited by 27 publications

References 12 publications

Measurement of patient reported disability using WHODAS 2.0 before and after surgical intervention in Madagascar

Measurement of patient reported disability using WHODAS 2.0 before and after surgical intervention in Madagascar

Sustainable Cleft Care Through Education: The First Simulation-Based Comprehensive Workshop in the Middle East and North Africa Region

What Is the Role of Plastic Surgery in Global Health? A Review

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