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Bakhach JY, Saba SC, Doghman JH. Shortage of Plastic Surgeons in Lebanon: Impact of the 2019 Economic Crisis. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2024; 12:e5593. [PMID: 38328270 PMCID: PMC10849455 DOI: 10.1097/gox.0000000000005593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Accepted: 12/15/2023] [Indexed: 02/09/2024]
Abstract
Background Lebanon's ongoing economic crisis since 2019 has seen an unprecedented migration of professional healthcare workers. This article analyzes the adequacy of registered plastic surgeons in Lebanon in 2023. Methods A list of registered plastic surgeons was obtained from the Lebanese Order of Physicians. Registered plastic surgeons were contacted via email or phone and were asked to fill in a survey questionnaire addressing their work status. Additionally, the number of plastic surgeon graduates, between 2018 and 2022, was obtained from Lebanese medical schools. Results Of the 162 plastic surgeons registered with the Lebanese Order of Physicians in 2023, 158 responded to the survey (97.5%). The work settings of the active plastic surgeons fell into three categories: working in Lebanon full time, splitting work between Lebanon and abroad, and exclusively working abroad. The ratio of plastic surgeons practicing full time in Lebanon is 1.11 per 100,000 inhabitants, which is significantly below the recommended ratio of 2.01. Twenty eight percent of the plastic surgeons working in Lebanon are aged between 65 and 75 years. Meanwhile, an average of only three graduates (2018-2022) enter the workforce annually after completing training in plastic and reconstructive surgery residency. Among the various subspecialties within plastic and reconstructive surgery, aesthetic surgery was the most commonly practiced by those surveyed. Conclusions There is a relative shortage of plastic surgeons in Lebanon that is compounded by a significant focus on aesthetic procedures. Implementation of strategies is needed to bridge this gap and meet the needs of the underserved people of Lebanon.
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Affiliation(s)
- Joseph Y. Bakhach
- From the American University of Beirut Medical Center, Beirut, Lebanon
| | - Salim C. Saba
- University of Kentucky College of Medicine, Lexington, Kent
| | - Jana H. Doghman
- From the American University of Beirut Medical Center, Beirut, Lebanon
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Ede CJ, Kruger D, Libhaber E, Moeng M, Crawford R, Achilleos K, Kodisang C, Pabu R, Stavrou C, Uzonwa G, Njiba B, Iwuji E, Nxumalo H, Moore R. A comparative study of outcomes of burns across multiple levels of care. Burns 2023; 49:1879-1885. [PMID: 37827938 DOI: 10.1016/j.burns.2023.03.005] [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: 07/13/2022] [Revised: 02/13/2023] [Accepted: 03/05/2023] [Indexed: 03/14/2023]
Abstract
BACKGROUND Burn injuries are a significant contributor to the burden of diseases. The management of burns at specialised burn centres has been shown to improve survival. However, in low- and middle-income countries (LMICs) major burns are managed at non-specialised burn centres due to resource constraints. There is insufficient data on survival from treatment at non-specialised burn centres in LMICs. This study aimed to compare the outcomes of burns treatment between a specialised burn centre and five non-specialised centres. METHODS A prospective cohort study was conducted on patients aged 18 years or above from January 1, 2021 to September 30, 2021. Participants were selected from the admission register at the emergency department. All burns irrespective of the mechanism of injury or %TBSA were included. Data were entered into REDCap. Statistical analysis of outcomes such as positive blood culture, length of hospital stay (LOHS) and 90-day mortality between specialised burn versus non-specialised centres was performed. Furthermore, an analysis of risk factors for mortality was performed and survival data computed. RESULTS Of the 488 study participants, 36% were admitted to a specialised burn centre compared to 64% admitted to non-specialised centres. The demographic characteristics were similar between centres. Patients at the specialised burn centre compared to non-specialised centres had a significantly higher inhalation injury of 30.9% vs 7.7% (p < 0.001), > 10%TBSA at 83.4% vs 45.7% (p < 0.001), > 20%TBSA at 46.9% vs 16.6% (p < 0.001), and a median (IQR) ABSI score of 6 (5-7) vs 5 (4-6) (p < 0.0001). Furthermore, patients from specialised burn vs non-specialised centres had a longer median (IQR) time from injury to first burn excision at 7 (4-11) vs 5 (2-10) days, higher rate of burn sepsis 69% vs 35%, increased LOHS 17 (11-27) vs 12 (6-22) days, and 90-day mortality rates at 19.4% vs 6.4%. After adjusting for cofounding variables, survival data showed no difference between specialised burn and non-specialised centres (HR 1.8 95% CI 1.0-3.2, p = 0.05). CONCLUSION Although it appears that the survival of burn patients managed at non-specialised centres in a middle-income country is comparable to those managed at specialised burn centres, there is uncounted bias in our survival data. Hence, a change in practice is not advocated. However, due to resource constraint specialised burn centres in addition to managing major burns should provide training and support to the non-specialised centres.
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Affiliation(s)
- Chikwendu J Ede
- Johnson and Johnson Adult Burn Treatment Centre, Department of Surgery, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa; Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa.
| | - Deirdre Kruger
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Elena Libhaber
- Research Office, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Maeyane Moeng
- Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa; Charlotte Maxeke Johannesburg Academic Hospital, 7 York Road, Parktown, Johannesburg, South Africa
| | - Richard Crawford
- Johnson and Johnson Adult Burn Treatment Centre, Department of Surgery, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Katerina Achilleos
- Johnson and Johnson Adult Burn Treatment Centre, Department of Surgery, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa
| | - Chris Kodisang
- Leratong Hospital,1 Adcock Street, Chamdor, Krugersdorp, South Africa
| | - Remy Pabu
- Pholosong Hospital, 1067 Indaba Street Extension One, Brakpan, Johannesburg, South Africa
| | - Christopher Stavrou
- Tambo Memorial Hospital, Cnr Hospital Road and Railway Street, Boksburg, South Africa
| | - Godson Uzonwa
- Thelle Mogoerane Regional Hospital, Nguza Street, Extension 14, Vosloorus 12390, South Africa
| | - Busanga Njiba
- Thelle Mogoerane Regional Hospital, Nguza Street, Extension 14, Vosloorus 12390, South Africa
| | - Eunice Iwuji
- Wits Health Consortium, 31 Princess of Wales Terrace, Parktown, Johannesburg, South Africa
| | - Hlengiwe Nxumalo
- Wits Health Consortium, 31 Princess of Wales Terrace, Parktown, Johannesburg, South Africa
| | - Rachel Moore
- Johnson and Johnson Adult Burn Treatment Centre, Department of Surgery, Chris Hani Baragwanath Academic Hospital, Soweto, South Africa; Department of Surgery, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
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Lo CH, Tracy LM, Lam C, Kimble R, Wong She RB. In-hospital outcomes of paediatric burn injuries managed in children's hospitals compared to general hospitals. Burns 2023; 49:1289-1297. [PMID: 37005141 DOI: 10.1016/j.burns.2023.03.010] [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: 07/30/2022] [Revised: 03/11/2023] [Accepted: 03/16/2023] [Indexed: 03/28/2023]
Abstract
INTRODUCTION In Australia and New Zealand, children with burn injuries are cared for in either general hospitals which cater to both adult and paediatric burn injuries or in children's hospitals. Few publications have attempted to analyse modern burn care and outcomes as a function of treating facilities. AIM The aim of this study was to compare in-hospital outcomes of paediatric burn injuries managed in children's hospitals to those treated in general hospitals that regularly treated both adult and paediatric burn patients. METHODS A retrospective cohort study of cases was undertaken using data from the Burns Registry of Australia and New Zealand (BRANZ). All paediatric patients with data for an acute or transfer admission to a BRANZ hospital and registered with BRANZ with a date of admission between 1 July 2016 and 30 June 2020 were included in the study. The primary outcome of interest was the acute admission length of stay. Secondary outcome measures of interest included admission to the intensive care unit and readmission to a specialist burn service within 28 days. The Alfred Hospital Ethics Committee granted ethical approval for this study (project 629/21). RESULTS A total of 4630 paediatric burn patients were included in the analysis. Approximately three quarters of this cohort (n = 3510, 75.8%) were admitted to a paediatric only hospital, while the remaining quarter (n = 1120, 24.2%) were admitted to a general hospital. A greater proportion of patients admitted to general hospitals underwent burn wound management procedures in the operating theatre (general hospitals 83.9%, children's hospitals 71.4%, p < 0.001). Patients admitted to children's hospitals had a longer median time to their first episode of grafting (children's hospitals 12.4 days, general hospitals 8.3 days, p < 0.001). The adjusted regression model for hospital LOS indicate that patients admitted to general hospitals had a 23% shorter hospital LOS, compared to patients admitted to children's hospitals. Neither the unadjusted or adjusted model for intensive care unit admission was significant. After accounting for relevant confounding factors, there was no association between service type and hospital readmission rates. CONCLUSIONS Comparing children's hospitals and general hospitals, different models of care seem to exist. Burn services in children's hospitals adopted a more conservative approach and were more inclined to facilitate healing by secondary intention rather than surgical debridement and grafting. General hospitals are more "aggressive" in managing burn wounds in theatre early, and debriding and grafting the burn wounds whenever considered necessary.
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Affiliation(s)
- Cheng Hean Lo
- Victorian Adult Burns Service, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, Australia; Department of Surgery, Central Clinical School, Monash University, 99 Commercial Rd, Melbourne, Victoria 3004, Australia.
| | - Lincoln M Tracy
- School of Public Health and Preventive Medicine, Monash University, 553 St Kilda Road, Melbourne, Victoria 3004, Australia.
| | - Caroline Lam
- Victorian Adult Burns Service, The Alfred, 55 Commercial Rd, Melbourne, Victoria 3004, Australia.
| | - Roy Kimble
- Pegg Leditschke Children's Burns Centre, Queensland Children's Hospital, 501 Stanley St, South Brisbane, Queensland 4101, Australia.
| | - Richard B Wong She
- National Burn Centre, Middlemore Hospital, 100 Hospital Rd, Otahuhu, Auckland 1640, New Zealand.
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