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Overman K, Nicholson P, Nunziato C, Antunez M, Daly P, Forseth M. One World Surgery: The Evolution of a Locally Run Surgical Mission in Honduras. J Bone Joint Surg Am 2024; 106:370-378. [PMID: 37733878 DOI: 10.2106/jbjs.23.00258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
ABSTRACT One World Surgery (OWS) is a medical mission organization that treats a variety of orthopaedic conditions and focuses on local partnerships, education, capacity-building, and high-quality care. OWS runs a Honduran ambulatory surgery center (ASC) with >50 full-time local staff; it operates year-round and accommodates visiting surgical teams bimonthly. Across its 12-year history, 8,703 surgical procedures have been performed and 54,940 total consults have been completed, with increasing autonomy of the local medical staff. From 2009 through 2021, OWS has provided 74 million U.S. dollars in surgical and consult patient care. By addressing global surgical disparities via life-enhancing surgical care in low- and middle-income country (LMIC) settings, the OWS ASC mission model may be a useful blueprint for other medical missions.
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Affiliation(s)
- Kelsey Overman
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Peter Nicholson
- University of Minnesota Medical School, Minneapolis, Minnesota
| | - Carl Nunziato
- Department of Surgery and Perioperative Care, Dell Medical School, Austin, Texas
| | | | | | - Michael Forseth
- Department of Orthopedic Surgery, University of Minnesota, Minneapolis, Minnesota
- Summit Orthopedics, Eagan, Minnesota
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Frechette R, Colas N, Augustin M, Edema N, Pyram G, Louis S, Crevecoeur CE, Mathurin C, Louigne R, Patel B, Humphreys M, Chapital A, Martin M, Ayoub Q, Hottinger D, McCurdy MT, Tran Q, Skupski R, Zimmer D, Walsh M. Sustainable surgical resource initiative for Haiti: the SSRI-Haiti project. Glob Health Action 2023; 16:2180867. [PMID: 36856725 PMCID: PMC9980030 DOI: 10.1080/16549716.2023.2180867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023] Open
Abstract
In response to the 2010 earthquake and subsequent cholera epidemic, St Luke's Medical Center was established in Port-au-Prince, Haiti. Here, we describe its inception and evolution to include an intensive care unit and two operating rooms, as well as the staffing, training and experiential learning activities, which helped St Luke's become a sustainable surgical resource. We describe a three-phase model for establishing a sustainable surgical centre in Haiti (build facility and acquire equipment; train staff and perform surgeries; provide continued education and expansion including regular specialist trips) and we report a progressive increase in the number and complexity of cases performed by all-Haitian staff from 2012 to 2022. The results are generalised in the context of the 'delay framework' to global health along with a discussion of the application of this three-phase model to resource-limited environments. We conclude with a brief description of the formation of a remote surgical centre in Port-Salut, an unforeseen benefit of local competence and independence. Establishing sustainable and collaborative surgery centres operated by local staff accelerates the ability of resource-limited countries to meet high surgical burdens.
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Affiliation(s)
- Richard Frechette
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Nathalie Colas
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Marc Augustin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Nathalie Edema
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Gerson Pyram
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Stanley Louis
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Carl Eric Crevecoeur
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Carmeline Mathurin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Raphael Louigne
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Bhavesh Patel
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Mitchell Humphreys
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Alyssa Chapital
- Departments of Critical Care Medicine, Urology and Surgery, Mayo Clinic and Global, Surgical, Destination, Healthcare Inc., Phoenix, AZ, USA
| | - Mallory Martin
- Departments of Critical Care Medicine and Surgery, Saint Luke's Medical Center, Port-au-Prince, Haiti
| | - Qamarissa Ayoub
- Bamiyan Maternal and Child Health Project and the Andeshgah Library, Kabul, Afghanistan
| | - Daniel Hottinger
- Department of Anesthesia, Metropolitan Anesthesia Network, LLP, Plymouth, MN, USA
| | - Michael T McCurdy
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Quincy Tran
- Division of Pulmonary & Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD, USA
| | - Richard Skupski
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Department of Anesthesia, Memorial Hospital Beacon Medical Group of South Bend, South Bend, IN, USA
| | - Donald Zimmer
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Department of Emergency Medicine, Memorial Hospital Beacon Medical Group of South Bend, South Bend, IN, USA
| | - Mark Walsh
- Department of Medical Education, University of Indiana School of Medicine, South Bend/Notre Dame Campus, South Bend, IN, USA.,Departments of Emergency and Internal Medicine, Saint Joseph Regional Medical Center, Mishawaka, IN, USA
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Hakmi H, Moreno J, Petrone P, Sohail AH, Burbano G, Sbayi S. Crossing borders to change lives: Surgical mission amidst the COVID-19 pandemic. Cir Esp 2023; 101:594-598. [PMID: 36410642 DOI: 10.1016/j.cireng.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/31/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION During the COVID pandemic, elective global surgical missions were temporarily halted for the safety of patients and travelling healthcare providers. We discuss our experience during our first surgical mission amidst the pandemic. We report a safe and successful treatment of the patients, detailing our precautionary steps and outcomes. METHODS Retrospective manual chart review and data collection of patients' charts was conducted after IRB approval. We entail our experience and safety steps followed during screening, operating and postoperative care to minimize exposure and improve outcomes during a surgical mission in an outpatient setting during the pandemic. The surgical mission was from February 8 to February 12, 2022. RESULTS A total of 60 patients who were screened. 33 patients underwent surgical intervention. One patient required postoperative hospitalization for a biliary duct leak. No patient or healthcare provider tested positive for COVID at the end of the mission. The average age of patients was 46.9 years. The average operative time was 116 min, and all patients had local nerve blocks. It included 45 health work providers. CONCLUSIONS It is safe to perform outpatient international surgery during the pandemic while following pre-selected precautions.
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Affiliation(s)
- Hazim Hakmi
- NYU Langone Hospital-Long Island, Mineola, New York, USA
| | - Johnny Moreno
- Centro Clínico Quirúrgico Ambulatorio "Blanca's House Ecuador - Hospital del Día", Guayaquil, Ecuador
| | | | - Amir H Sohail
- NYU Langone Hospital-Long Island, Mineola, New York, USA
| | - Galo Burbano
- Centro Clínico Quirúrgico Ambulatorio "Blanca's House Ecuador - Hospital del Día", Guayaquil, Ecuador
| | - Samer Sbayi
- Stony Brook University Hospital, Stony Brook, New York, USA
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Goldfarb JH, Manteiga A, Wall LB. Cost-Effectiveness of Pediatric Hand International Medical Missions. J Hand Surg Am 2023; 48:310.e1-310.e11. [PMID: 34930629 DOI: 10.1016/j.jhsa.2021.10.014] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 08/11/2021] [Accepted: 10/06/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE Limited access and resources in low- and middle-income countries leave many individuals deprived of medical care. Surgical mission trips offer a solution to provide sound surgical care to underserved areas but require a sizable financial support. Previous analyses of such trips have not included values of donated supplies and costs borne by the host country. We hypothesized that the orthopedic mission trips, utilizing the World Pediatric Project (WPP) model, can be executed in a cost-effective manner according to the World Health Organization thresholds even when considering cost to the organizations and host country. METHODS World Pediatric Project records for the most recent pediatric upper extremity orthopedic mission trips of 2016, 2018, and 2019 were obtained. Cost estimates were based on documentation from each of the mission trips. Total costs included the costs borne by the WPP, estimates of the value of donated supplies, and costs borne by the host country. The cost-effectiveness of the surgical mission trips was determined by the total cost and potential benefit of performing the orthopedic surgeries using disability-adjusted life years averted. RESULTS Three separate mission trips to St. Vincent and the Grenadines were analyzed. Forty-five pediatric patients had received surgical care. The cost was calculated to be $431.50 per disability-adjusted life years averted when only the WPP costs are considered; including donated supplies and cost borne by the host country in the total cost, the cost was $6898.10 per disability-adjusted life years averted. After comparing the cost values to the per capita gross domestic product of St. Vincent and the Grenadines, $7,463.54, the WPP mission trips were determined to be cost-effective according to the WHO-CHOICE thresholds in all 5 categories. CONCLUSIONS Orthopedic medical mission trips can provide cost-effective surgical treatments for the upper extremity even when the costs to the organization and host country and trip donations are considered. TYPE OF STUDY/LEVEL OF EVIDENCE Economic/Decision Analysis III.
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Affiliation(s)
- Jake H Goldfarb
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | | | - Lindley B Wall
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
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Asfaw ZK, Todd R, Abasi U, Marcela Bailez M, Narvaez J, Carrasquilla A, Hernandez Centeno R, Yanowsky Reyes G, Zhang LP. Use of virtual platform for delivery of simulation-based laparoscopic training curriculum in LMICs. Surg Endosc 2023; 37:1528-1536. [PMID: 35852623 DOI: 10.1007/s00464-022-09438-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2022] [Accepted: 07/04/2022] [Indexed: 12/01/2022]
Abstract
BACKGROUND Laparoscopic surgery is rapidly expanding in low-and middle-income countries (LMICs), yet many surgeons in LMICs have limited formal training in laparoscopy. In 2017, the Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) implemented Global Laparoscopic Advancement Program (GLAP), an in-person simulation-based laparoscopic training curriculum for surgeons in LMICs. In light of COVID-19, SAGES adapted GLAP to a virtual format with telesimulation. This study explores the feasibility and efficacy of virtual laparoscopic simulation training in resource-limited settings. METHODS Participants from San Jose, Costa Rica, Leon, México, and Guadalajara, México enrolled in the virtual GLAP curriculum, meeting biweekly for 2-h didactic classes and 2-h hands-on live simulation practice. Surgical residents' laparoscopic skills were evaluated using the five Fundamentals of Laparoscopic Surgery (FLS) tasks during the initial and final weeks of the program. Participants also completed pre-and post-program surveys assessing their perception of simulation-based training. RESULTS The study cohort consisted of 16 surgical attendings and 20 general surgery residents. A minimum 70% response rate was recorded across all surveys in the study. By the end of GLAP, residents completed all five tasks of the FLS exam within less time relative to their performance at the beginning of the training program (p < 0.05). Respondents (100%) reported that the program was a good use of their time and that education via telesimulation was easily reproduced. Participants indicated that the practice sessions, guidance, and feedback offered by mentors were their favorite elements of the training. CONCLUSION A virtual simulation-based curriculum can be an effective strategy for laparoscopic skills training. Participants demonstrated an improvement in laparoscopic skills, and they appreciated the mentorship and opportunity to practice laparoscopic skills. Future programs can expand on using a virtual platform as a low-cost, effective strategy for providing laparoscopic skills training to surgeons in LMICs.
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Affiliation(s)
- Zerubabbel K Asfaw
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Rachel Todd
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Unwana Abasi
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Maria Marcela Bailez
- Hospital de Pediatría Dr. J.P. Garrahan, Buenos Aires, Argentina.,Society of American Gastrointestinal and Endoscopic Surgeons (SAGES): Global Affairs Committee, Los Angeles, USA
| | - Jacqueline Narvaez
- Society of American Gastrointestinal and Endoscopic Surgeons (SAGES): Global Affairs Committee, Los Angeles, USA
| | | | | | | | - Linda P Zhang
- Department of Surgery, Icahn School of Medicine at Mount Sinai, New York, NY, USA. .,Society of American Gastrointestinal and Endoscopic Surgeons (SAGES): Global Affairs Committee, Los Angeles, USA.
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Perea Del Pozo E, Bustos Jimenez M, Butrón Vila T, Senent Boza A, Kingsnorth A. Hernia research in developing countries: are we looking for needles in haystacks? Surgeons in action. Hernia 2020; 25:1371-1373. [PMID: 33068203 DOI: 10.1007/s10029-020-02317-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/28/2020] [Indexed: 10/23/2022]
Affiliation(s)
- E Perea Del Pozo
- Unit of Emergency and Trauma Surgery, Hospital Universitario Virgen del Rocío, University of Seville, C/Manuel Siurot SN, 41013, Seville, Spain.
| | - M Bustos Jimenez
- Unit of Abdominal Wall and Ambulatory Surgery, Hospital Universitario Virgen del Rocío, University of Seville, Seville, Spain
| | - T Butrón Vila
- Unit of Abdominal Wall Surgery, Hospital Universitario 12 de Octubre, University of Madrid, President NGO "Surgeons in Action", Madrid, Spain
| | - A Senent Boza
- Unit of Emergency and Trauma Surgery, Hospital Universitario Virgen del Rocío, University of Seville, C/Manuel Siurot SN, 41013, Seville, Spain
| | - A Kingsnorth
- Unit of Abdominal Wall Surgery, Derriford Hospital, Level 7, Plymouth, UK
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Assessing the capacity of Ghana to introduce health technology assessment: a systematic review of economic evaluations conducted in Ghana. Int J Technol Assess Health Care 2020; 36:500-507. [PMID: 32981532 DOI: 10.1017/s0266462320000689] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Ghana is in the process of formally introducing health technology assessment (HTA) for health decision making. Similar to other low- and middle-income countries, evidence suggests that the lack of data and human capacity is a major barrier to the conduct and use of HTA. This study assessed the current human and data capacity available in Ghana to undertake HTA. METHODS As economic evaluation (EE) forms an integral part of HTA, a systematic review of EE studies undertaken in Ghana was conducted to identify the quality and number of studies available, methods and source of data used, and local persons involved. The literature search was undertaken in EMBASE (including MEDLINE), PUBMED, and Google Scholar. The quality of studies was evaluated using the Consolidated Health Economics Evaluation Reporting Standards. The number of local Ghanaians who contributed to authorship were used as a proxy for assessing human capacity for HTA. RESULTS Thirty-one studies were included in the final review. Overall, studies were of good quality. Studies derived their effectiveness, resource utilization and cost data mainly from Ghana. The most common source of cost data was from the National Health Insurance Scheme pricing list for medicines and tariffs. Effectiveness data were mostly derived from either single study or intervention programs. Sixty out of 199 authors were Ghanaians (30 percent); these authors were mostly involved in data collection and study conceptualization. CONCLUSIONS Human capacity for HTA in Ghana is limited. To introduce HTA successfully in Ghana, policy makers would need to develop more local capacity to undertake Ghanaian-specific HTA.
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Patient Experience and Outcomes of the Locally Organized ApriDec Medical Outreach Group. World J Surg 2019; 44:1039-1044. [PMID: 31848675 DOI: 10.1007/s00268-019-05288-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Access to safe and effective surgery is limited in low and middle-income countries. Short-term surgical missions are a common platform to provide care, but the few published outcomes suggest unacceptable morbidity and mortality. We sought to study the safety and effectiveness of the ApriDec Medical Outreach Group (AMOG). METHODS Data from the December 2017 and April 2018 outreaches were prospectively collected. Patient demographics, characteristics of surgery, complications of surgery, and patient quality of life were collected preoperatively and on postoperative days 15 and 30. Data were analyzed to determine complication rates and trends in quality of life. RESULTS 260/278 (93.5%) of patients completed a 30-day follow-up. Of these, surgical site infection was the most common complication (8.0%), followed by hematoma (4.1%). Rates of urinary tract infection were 1.2% while all other complications occurred in less than 1% of patients. There were no mortalities. With increasing time after surgery (0 to 15 days to 30 days), there was a significant improvement across each of the dimensions of quality of life (p < 0.001). All patients reported satisfaction with their procedure. CONCLUSION This study demonstrated that the care provided by AMOG group to the underserved populations of northern Ghana, yielded complication rates similar to others in low-resourced communities, leading to improved quality of life.
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Latifi R, Gachabayov M, Gogna S, Rivera R. Thyroidectomy in a Surgical Volunteerism Mission: Analysis of 464 Consecutive Cases. J Thyroid Res 2019; 2019:1026757. [PMID: 31871616 PMCID: PMC6906867 DOI: 10.1155/2019/1026757] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2019] [Accepted: 11/08/2019] [Indexed: 12/12/2022] Open
Abstract
Although surgical volunteer missions (SVMs) have become a popular approach for reducing the burden of surgical disease worldwide, the outcomes of specific procedures in the context of a mission are underreported. The aim of this study was to evaluate outcomes and efficiency of thyroid surgery within a surgical mission. This was a retrospective analysis of medical records of all patients who underwent thyroid surgery within a SVM from 2006 to 2019. Postoperative complication rate was the safety endpoint, whereas length of hospital stay (LOS) was the efficiency endpoint. Serious complications were defined as Clavien-Dindo class 3-5 complications. Expected safety and efficiency outcomes were calculated using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) surgical risk calculator and compared to their observed counterparts. A total of 464 thyroidectomies were performed during the study period. Mean age of the patients was 40.3 ± 10.8 years, and male-to-female ratio was 72 : 392. Expected overall (p=0.127) and serious complication rates (p=0.738) were not significantly different from their observed counterparts. Expected LOS was found to be significantly shorter as compared to its observed counterpart (0.6 ± 0.2 vs. 2.5 ± 1.0 days; p < 0.001). This study found thyroid surgery performed within a surgical mission to be safe. NSQIP surgical risk calculator underestimates the LOS following thyroidectomy in surgical missions.
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Affiliation(s)
- Rifat Latifi
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, USA
- Department of Surgery, New York Medical College, Valhalla, NY 10595, USA
- Operation Giving Back, Bohol, Philippines
| | - Mahir Gachabayov
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, USA
- Department of Surgery, New York Medical College, Valhalla, NY 10595, USA
| | - Shekhar Gogna
- Department of Surgery, Westchester Medical Center, Valhalla, NY 10595, USA
- Department of Surgery, New York Medical College, Valhalla, NY 10595, USA
| | - Renato Rivera
- Operation Giving Back, Bohol, Philippines
- Department of Surgery, St. Joseph Hospital, Breese, IL 62230, USA
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Evaluating the Economic Impact of Plastic and Reconstructive Surgical Efforts in the Developing World: The ReSurge Experience. Plast Reconstr Surg 2019; 144:485e-493e. [PMID: 31461047 DOI: 10.1097/prs.0000000000005984] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND As the global burden of disease continues to rise, it becomes increasingly important to determine the sustainability of specialty surgery in the developing world. The authors aim to (1) evaluate the cost-effectiveness of plastic and reconstructive surgery in the developing world and (2) quantify the economic benefit. METHODS In this study, the authors performed a retrospective analysis of surgical trips performed by ReSurge International from 2014 to 2017. The organization gathered data on trip information, cost, and clinical characteristics. The authors measured the cost-effectiveness of the interventions using cost per disability-adjusted life-years and defined cost-effectiveness using World Health Organization Choosing Interventions That Are Cost-Effective thresholds. The authors also performed a cost-to-benefit analysis using the human capital approach. RESULTS A total of 22 surgical trips from eight different developing countries were included in this study. The authors analyzed a total of 756 surgical interventions. The cost-effectiveness of the surgical trips ranged from $52 to $11,410 per disability-adjusted life-year averted. The economic benefit for the 22 surgical trips was $9,795,384. According to World Health Organization Choosing Interventions That Are Cost-Effective thresholds, 21 of the surgical trips were considered very cost-effective or cost-effective. CONCLUSIONS Plastic and reconstructive operations performed during short-term surgical trips performed by this organization are economically sustainable. High-volume trips and those treating complex surgical conditions prove to be the most cost-effective. To continue to receive monetary funding, providing fiscally sustainable surgical care to low- and middle-income countries is imperative.
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Gyedu A, Stewart B, Wadie R, Antwi J, Donkor P, Mock C. Population-based rates of hernia surgery in Ghana. Hernia 2019; 24:617-623. [PMID: 31429025 DOI: 10.1007/s10029-019-02027-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2019] [Accepted: 08/04/2019] [Indexed: 11/25/2022]
Abstract
PURPOSE To estimate the population-based annual rate of hernia surgery in Ghana, so as to better define the met and unmet need and to identify opportunities to decrease the unmet need. METHODS Data on operations performed from June 2014 to May 2015 were obtained from representative samples of 48 of 124 district (first-level) hospitals, 9 of 11 regional (referral) hospitals, and 3 of 5 tertiary hospitals, and scaled-up to nationwide estimates. Rates of hernia surgery were compared to previously published annual incidence of symptomatic hernia in Ghana (210/100,000 population) and to published annual rates of hernia surgery in high-income countries (120-275/100,000). RESULTS Estimated 17,418 [95% uncertainty interval (UI) 8154-26,683] hernia operations were performed nationally. The annual rate of hernia operations was 65 operations/100,000 population (95% UI 30.2-99.0). The rate was considerably less than the annual incidence of new symptomatic hernia or rates of hernia surgery in high-income countries. Hernia operations represented 7.5% of all operations. Most hernia operations (74%) were performed at district hospitals. Most district hospitals (54%) did not have fully trained surgeons, but nonetheless performed 38% of district-level hernia operations. CONCLUSIONS The rate of hernia operations fell short of estimated need. Most hernia repairs were performed at district hospitals, many without fully trained surgeons. Future global surgery benchmarking needs to address both overall surgical rates as well as rates for specific highly important operations. Countries can strengthen their planning for surgical care by defining their total, met, and unmet need for hernia surgery.
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Affiliation(s)
- A Gyedu
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana.
| | - B Stewart
- Department of Surgery, University of Washington, Seattle, WA, USA.,Department of Interdisciplinary Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - R Wadie
- School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana
| | - J Antwi
- Komfo Anokye Teaching Hospital, Kumasi, Ghana
| | - P Donkor
- Department of Surgery, School of Medicine and Dentistry, Kwame Nkrumah University of Science and Technology, Private Mail Bag, University Post Office, Kumasi, Ghana
| | - C Mock
- Department of Surgery, University of Washington, Seattle, WA, USA.,Harborview Injury Prevention and Research Center, Seattle, WA, USA.,Department of Global Health, University of Washington, Seattle, WA, USA
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Qiu X, Nasser JS, Sue GR, Chang J, Chung KC. Cost-Effectiveness Analysis of Humanitarian Hand Surgery Trips According to WHO-CHOICE Thresholds. J Hand Surg Am 2019; 44:93-103. [PMID: 30579691 DOI: 10.1016/j.jhsa.2018.10.027] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Revised: 10/25/2018] [Accepted: 10/31/2018] [Indexed: 02/02/2023]
Abstract
PURPOSE Hand surgery outreach programs to low- and middle-income countries (LMICs) provide much-needed surgical care to the underserved populations and education to local providers for improved care. The cost-effectiveness of these surgical trips has not been studied despite a long history of such efforts. This study aimed to examine the economic impact of hand surgery trips to LMICs using data from the Touching Hands Project and ReSurge International. We hypothesized that hand surgery outreach would be cost-effective in LMICs. METHODS We analyzed data on the cost of each trip and the surgical procedures performed. Using methods from the World Health Organization (WHO-Choosing Interventions That Are Cost-Effective [WHO-CHOICE]), we determined whether the procedures performed during the outreach trips would be cost-effective. RESULTS For the 14 hand surgery trips, 378 patients received surgical treatment. Trips varied in the country where interventions were provided, the number of patients served, the severity of the conditions, and the total cost. The cost per disability-adjusted life-year averted ranged from United States (US)$222 to $1,525, all of which were very cost-effective according to WHO-CHOICE thresholds. The cost-effectiveness of global hand surgery was comparable to that of other medical interventions such as multidrug-resistant tuberculosis treatment in similar regions. We also identified a lack of standardized record keeping for these surgical trips. CONCLUSIONS Hand surgeries performed in LMICs are cost-effective based on WHO-CHOICE criteria. However, a standardized record-keeping method is needed for future research and longitudinal comparison. Understanding the economic impact of hand surgery global outreach is important to the success and sustainability of these efforts, both to allocate resources effectively and to identify areas for improvement. TYPE OF STUDY/LEVEL OF EVIDENCE Economic/Decision Analysis III.
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Affiliation(s)
- Xuan Qiu
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Jacob S Nasser
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI
| | - Gloria R Sue
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, CA
| | - James Chang
- Section of Plastic and Reconstructive Surgery, Department of Surgery, Stanford University, Palo Alto, CA
| | - Kevin C Chung
- Section of Plastic Surgery, Department of Surgery, University of Michigan Medical School, Ann Arbor, MI.
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In-Country Training by the Ghana College of Physicians and Surgeons: An Initiative that has Aided Surgeon Retention and Distribution in Ghana. World J Surg 2018; 43:723-735. [DOI: 10.1007/s00268-018-4840-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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