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The clinical and economic impact of a sustained program in global plastic surgery: valuing cleft care in
Christopher D Hughes1, Alan Babigian, Susan McCormack
1Farmington 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.
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.
