1
|
Gachabayov M, Latifi LA, Rivera R, Baluyot FS, Latifi R. A Cost-Benefit Analysis of an Overseas Volunteer Mission to the Local Healthcare System. Am Surg 2021; 88:1680-1688. [PMID: 33635086 DOI: 10.1177/0003134821998683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The aim of this study was to comparatively evaluate the sustainability and cost-benefit of the Operation Giving Back Bohol surgical volunteerism mission (SVM) carried out in Bohol Province, Philippines, over twelve consecutive missions. METHODS This was a cost-benefit analysis of prospectively collected financial data from twelve consecutive surgical volunteerism missions held between 2006 and 2018. The overall cost of an SVM and cost per patient were the endpoints of interest. Disability-adjusted life years (DALYs) and costs thereof were calculated for each patient undergoing surgery in the twelve SVMs. RESULTS A mean of 112 ± 22 patients were included per year of the SVM. A statistically significant increasing trend in the overall cost of SVMs over time was found (R2 = .469; P = .014). A nonsignificant decreasing trend in the cost per patient over time was found (R2 = .007; P = .795). A total of 8811.71 DALYs were averted in the twelve SVMs. DALYs averted per year ranged between 474.02 (2009) and 969.16 (2012). Cost per a DALY averted ranged between $466.9 (2006) and $865.6 (2009). Comparison of the latter with GDP per capita showed that this SVM was "very cost-effective." CONCLUSION The SVM contributes substantially to the health care system both clinically and financially. A total of 8812 DALYs were averted in these twelve SVMs. Costs per a DALY averted did not significantly change over the mission years. Increasing the number of patients served has increased the total cost of the mission with no impact on the cost per patient.
Collapse
Affiliation(s)
- Mahir Gachabayov
- Department of Surgery, 8138Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Lulejeta A Latifi
- Department of Surgery, 8138Westchester Medical Center, New York Medical College, Valhalla, NY, USA
| | - Renato Rivera
- Operation Giving Back Bohol, USA.,Department of Surgery, St. Joseph Hospital, Breese, IL, USA
| | | | - Rifat Latifi
- Department of Surgery, 8138Westchester Medical Center, New York Medical College, Valhalla, NY, USA.,Operation Giving Back Bohol, USA
| |
Collapse
|
2
|
Padmanaban V, Fallah P, Jayaraman S, Peck GL, Sifri Z. Integrating a Novel Global Surgery and Health Inequity Course to the Surgical Clerkship. JOURNAL OF SURGICAL EDUCATION 2020; 77:1106-1112. [PMID: 32534939 DOI: 10.1016/j.jsurg.2020.03.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Accepted: 03/22/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Medical students report growing interest in health inequity and global surgery, subjects not currently integrated to their core curriculum. Currently, fundamental tenets of global surgical inequity are only available to students on an elective basis or in special interest groups. Therefore, an hour-long course with emphasis on global surgery was developed for third-year medical students. The aim of this study was to examine student response to this pilot course and to establish whether course content was applicable to clinical rotations. DESIGN A 1-hour structured curriculum was delivered to third-year medical students (MS3s) during the 2-day orientation phase of each rotation of an 8-week surgery clerkship from August 2018 to May 2019. The course targeted approximately 30 students per session in the preclinical orientation at Rutgers-New Jersey Medical School. Upon completion of the 8-week clerkship rotation, a paper survey was administered to evaluate student's exposure to previous content, attitudes toward global health, interest and engagement in course materials, and applicability of learned course content to local environments. SETTING Rutgers-New Jersey Medical School, an urban medical school located in Newark, New Jersey. PARTICIPANTS A total of 191 students attended the global surgery and health equity course; 146 participants participated in the postcourse survey. RESULTS When asked about baseline interest in global or public health, the majority (51%) were extremely interested or very interested. Nearly all participants found the course to be valuable (94%). When asked which educational modality was preferred, 23% of participants favored the traditional lecture component and 29% favored case-based discussions. Nearly half (48%) the respondents found both modalities to be valuable. Fifty students (34% of respondents) reported encounters with patients affected by barriers in access to surgical care during their clerkships. CONCLUSIONS Medical students responded favorably to this health inequity and global surgery pilot course and requested supplemental lectures. Additionally, course content was applicable to local clinical experiences. Therefore, 1 modality of integrating global surgery to the established curriculum is under the framework of health inequity and social determinants of health during surgical clerkships. This study demonstrates that meaningful inclusion of global surgery and health inequity can be implemented within the existing curricular structure.
Collapse
Affiliation(s)
- Vennila Padmanaban
- Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey.
| | | | - Sudha Jayaraman
- Department of Surgery, Virginia Commonwealth University School of Medicine, Richmond, Virginia
| | - Gregory L Peck
- Department of Surgery, Rutgers-Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Ziad Sifri
- Department of Surgery, Rutgers-New Jersey Medical School, Newark, New Jersey
| |
Collapse
|
3
|
Russell JO, Sahli ZT, Shaear M, Razavi C, Ali K, Tufano RP. Transoral thyroid and parathyroid surgery via the vestibular approach-a 2020 update. Gland Surg 2020; 9:409-416. [PMID: 32420266 DOI: 10.21037/gs.2020.03.05] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Transoral endoscopic thyroidectomy and parathyroidectomy via the vestibular approach (TOET/PVA or TOETVA-TOEPVA) is the latest remote-access technique employed in the central neck. As the only approach that does not leave any cutaneous incision, (TOET/PVA) has become popular in both the Far East and Western series since its original description in 2015. More than just a "scarless" surgery, (TOET/PVA) has been associated with a short learning curve, access to the bilateral central neck compartments, few surgical contraindications, minimal complications, and minimal additional instrumentation. To date, more than 2,000 cases have been completed, including more than 400 in North America, demonstrating brisk utilization of a novel technique relative to earlier remote access central neck approaches. Herein, we describe updates that continue to improve the safety and efficacy of the procedure.
Collapse
Affiliation(s)
- Jonathon O Russell
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Zeyad T Sahli
- Department of Surgery, The University of Virginia Health System, Charlottesville, VA, USA
| | - Mohammad Shaear
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Christopher Razavi
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Khalid Ali
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ralph P Tufano
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
4
|
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.
Collapse
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
| |
Collapse
|
5
|
Park D, Shaear M, Chen YH, Russell JO, Kim HY, Tufano RP. Transoral robotic thyroidectomy on two human cadavers using the Intuitive da Vinci single port robotic surgical system and CO 2 insufflation: Preclinical feasibility study. Head Neck 2019; 41:4229-4233. [PMID: 31469475 DOI: 10.1002/hed.25939] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2019] [Revised: 07/15/2019] [Accepted: 08/15/2019] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Transoral vestibular approach endoscopic thyroidectomy has gained popularity worldwide because it avoids a cutaneous incision. Some surgeons have expressed reservations about operating with only 2 instruments in the endoscopic technique, and some therefore utilize an axillary incision as an adjunct to facilitate dissection. The Intuitive da Vinci single port robotic system offers the potential to overcome this limitation without an axillary incision. METHODS In this study, the Intuitive da Vinci single port robotic surgical system was used to perform transoral thyroidectomy on 2 human cadavers. RESULTS A total thyroidectomy was performed in 2 cadavers using the da Vinci single port (SP) robot via transoral vestibular technique. The dissections were performed with removal of the thyroid gland and preservation of the recurrent laryngeal nerves and parathyroid glands. CONCLUSION In our evaluation, transoral vestibular approach robotic thyroidectomy using the Intuitive da Vinci SP system facilitated dissection without the need for an axillary incision.
Collapse
Affiliation(s)
- Dawon Park
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Mohammad Shaear
- Head and Neck Endocrine Surgery Division, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Yu-Hsien Chen
- Department of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan
| | - Jonathon O Russell
- Head and Neck Endocrine Surgery Division, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Hoon Yub Kim
- Department of Surgery, KUMC Thyroid Center, Korea University Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Ralph P Tufano
- Head and Neck Endocrine Surgery Division, Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Maryland
| |
Collapse
|
6
|
Gachabayov M, Latifi R. Patient satisfaction following thyroidectomy in surgical mission: a prospective study. Gland Surg 2019; 8:385-388. [PMID: 31538063 PMCID: PMC6723003 DOI: 10.21037/gs.2019.06.06] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 06/10/2019] [Indexed: 01/08/2023]
Abstract
BACKGROUND Surgical volunteer mission is a well-recognized approach for reducing the burden of surgical disease worldwide. The aim of this study was to evaluate safety and patient satisfaction of thyroid surgery in the context of surgical mission carried out in Bohol Province, Philippines. METHODS This was a prospective study involving consecutive patients undergoing thyroid surgery in the surgical mission held in 2018. Informed consent was obtained from the patients. Safety defined as observed serious postoperative complication rate as compared to its expected based on American College of Surgeons National Surgical Quality Improvement Program (NSQIP) was the primary endpoint, whereas patient satisfaction rated on a 5-point Likert scale was the secondary endpoint. Expected serious complication rate was calculated using the surgical risk calculator of NSQIP. Thyroid surgery included partial resections, hemi-, subtotal, and total thyroidectomies. RESULTS Thirty-eight patients underwent thyroidectomy performed by 4 surgeons in 2018 mission. Mean age of the patients was 40.6±11.3 years. Male to female ratio was 2:36. Goiter was the indication for surgery in 33 (86.8%) patients, whereas 5 (13.2%) patients were operated for thyroid malignancy. Postoperative serious complication and reoperation occurred in 1/38 (2.6%) for hematoma on first postoperative day. Expected and observed serious complication rates did not differ (1.1% vs. 2.6%; P=0.385). Ninety-seven percent of patients were satisfied with outcomes of surgery. CONCLUSIONS This prospective cohort study found thyroid surgery performed within a surgical mission to be safe. Patient satisfaction rate was 97%. Further research is needed to develop and validate patient satisfaction assessment tools in surgical missions.
Collapse
Affiliation(s)
- Mahir Gachabayov
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
| | - Rifat Latifi
- Department of Surgery, Westchester Medical Center and New York Medical College, Valhalla, NY, USA
- Operation Giving Back Bohol, Philippines
| |
Collapse
|
7
|
Safety of hernia repairs in the setting of surgical volunteerism missions. Hernia 2019; 23:631-632. [DOI: 10.1007/s10029-019-01906-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 02/04/2019] [Indexed: 10/27/2022]
|