Christopher D Hughes1, Alan Babigian, Susan McCormack, Blake C Alkire, Anselm Wong, Stephen A Pap, Jeffrey R Vincent, John G Meara, Charles Castiglione, Richard Silverman. 1. Farmington and Hartford, Conn.; Boston, Cambridge, Brighton, and Worcester, Mass.; Philadelphia, Pa.; and Durham, N.C. From the Departments of Surgery and Orthopedic Surgery, University of Connecticut School of Medicine; the Department of Plastic and Oral Surgery, Children's Hospital Boston, Harvard Medical School; the Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School; the Division of Plastic and Reconstructive Surgery, Hartford Hospital and Connecticut Children's Medical Center; The Children's Hospital of Philadelphia; the Massachusetts Eye and Ear Infirmary; the Division of Plastic and Reconstructive Surgery, Mt. Auburn Hospital, Harvard Medical School; the Nicholas School of the Environment and Sanford School of Public Policy, Duke University; the Division of Plastic and Reconstructive Surgery, St. Elizabeth's Medical Center; and the Division of Plastic and Reconstructive Surgery, University of Massachusetts School of Medicine.
Abstract
BACKGROUND: The development of surgery in low- and middle-income countries has been limited by a belief that it is too expensive to be sustainable. However, subspecialist surgical care can provide substantial clinical and economic benefits in low-resource settings. The goal of this study is to describe the clinical and economic impact of recurrent short-term plastic surgical trips in low- and middle-income countries. METHODS: The authors conducted a retrospective review of clinic and operative logbooks from Hands Across the World's surgical experience in Ecuador. The authors calculated the disability-adjusted life-years averted to estimate the clinical impact of cleft repair and then calculated the economic impact of surgical intervention for cleft disease. RESULTS: One thousand one hundred forty-two reconstructive surgical cases were performed over 15 years. Surgery was most commonly performed for scar contractures [449 cases (39.3 percent)], of which burn scars comprised a substantial amount [215 cases (18.8 percent)]. There were 40 postoperative complications within 7 days of operation (3.5 percent), and partial wound dehiscence was the most common complication [16 of 40 (40 percent)]. Cleft disorders constituted 277 cases (24.3 percent), and 102 cases were primary cleft lip and/or palate cases. Between 396 and 1042 total disability-adjusted life-years were averted through surgery for these 102 cases of primary cleft repair. This translates to an economic benefit between $4.7 million (human capital approach) and $27.5 million (value of a statistical life approach). CONCLUSIONS: Plastic surgical disease is a significant source of morbidity for patients in resource-limited regions. Dedicated programs that provide essential reconstructive surgery can produce substantial clinical and economic benefits to host countries.
BACKGROUND: The development of surgery in low- and middle-income countries has been limited by a belief that it is too expensive to be sustainable. However, subspecialist surgical care can provide substantial clinical and economic benefits in low-resource settings. The goal of this study is to describe the clinical and economic impact of recurrent short-term plastic surgical trips in low- and middle-income countries. METHODS: The authors conducted a retrospective review of clinic and operative logbooks from Hands Across the World's surgical experience in Ecuador. The authors calculated the disability-adjusted life-years averted to estimate the clinical impact of cleft repair and then calculated the economic impact of surgical intervention for cleft disease. RESULTS: One thousand one hundred forty-two reconstructive surgical cases were performed over 15 years. Surgery was most commonly performed for scar contractures [449 cases (39.3 percent)], of which burn scars comprised a substantial amount [215 cases (18.8 percent)]. There were 40 postoperative complications within 7 days of operation (3.5 percent), and partial wound dehiscence was the most common complication [16 of 40 (40 percent)]. Cleft disorders constituted 277 cases (24.3 percent), and 102 cases were primary cleft lip and/or palate cases. Between 396 and 1042 total disability-adjusted life-years were averted through surgery for these 102 cases of primary cleft repair. This translates to an economic benefit between $4.7 million (human capital approach) and $27.5 million (value of a statistical life approach). CONCLUSIONS: Plastic surgical disease is a significant source of morbidity for patients in resource-limited regions. Dedicated programs that provide essential reconstructive surgery can produce substantial clinical and economic benefits to host countries.
Authors: Emily R Smith; Tessa Concepcion; Stephanie Lim; Sam Sadler; Dan Poenaru; Anthony T Saxton; Mark Shrime; Emmanuel Ameh; Henry E Rice Journal: World J Surg Date: 2018-09 Impact factor: 3.352
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Authors: Anthony T Saxton; Dan Poenaru; Doruk Ozgediz; Emmanuel A Ameh; Diana Farmer; Emily R Smith; Henry E Rice Journal: PLoS One Date: 2016-10-28 Impact factor: 3.240
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