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Providing care to children from low and middle-income countries with complex surgical problems: An 18 year review
Hae Sung Kang1, Emily Robertson2, Hiba Vohra2
1Division of Pediatric Surgery, Virginia Commonwealth University Health, Richmond, VA.
Insights
Providing complex pediatric surgical care in the US for children from low and middle-income countries (LMICs) through partnerships like World Pediatric Project (WPP) shows excellent outcomes with low complication rates.
Area of Science:
- Global Health
- Pediatric Surgery
- International Medical Partnerships
Background:
- The burden of surgical disease in children from low and middle-income countries (LMICs) is significant and undertreated.
- Quaternary-level surgical care is often inaccessible in LMICs.
Purpose of the Study:
- To review the experience of providing quaternary-level surgical care to children from LMICs.
- To assess outcomes, complications, and follow-up for pediatric patients from LMICs.
Main Methods:
- Retrospective review of World Pediatric Project (WPP)-sponsored patients from LMICs.
- Analysis of surgical procedures, length of stay, and postoperative outcomes from July 2000 to August 2018.
Main Results:
- 255 children from 14 countries underwent 371 complex operations across 10 pediatric surgical subspecialties.
- Average hospital stay was 10.7 days, with a 2.0% mortality rate at the institution.
- Postoperative complications occurred in 8.2% of patients, with good follow-up rates.
Conclusions:
- Complex surgical care for LMIC children in the US can address a global health burden.
- Multispecialty care yields excellent outcomes, low complication rates, and good follow-up.
- A supportive healthcare system, volunteer surgeons, and logistical/financial support are crucial for success.
Purpose:
The burden of surgical disease in children from low and middle-income countries (LMICs) is becoming more recognized as significant and undertreated. We recently reviewed our health system's experience with providing quaternary-level surgical care to children from LMICs through a partnership with World Pediatric Project (WPP), a not-for-profit organization.
Methods:
A retrospective review was performed of all WPP-sponsored patients who received surgical care at our children's hospital from LMICs in the Caribbean and Central America from July 2000 to August 2018.
Results:
Two hundred and fifty-five patients (average age: 5.9 ± 5.3 years; range: <1-18 years) from 14 countries received a total of 371 moderately to significantly complex operations from 10 pediatric surgical subspecialties, with cardiac, neurosurgery, craniofacial and general/thoracic surgical subspecialties being the most common. The average length of hospital stay was 10.7 ± 18.9 days. All patients had the opportunity to follow-up with local providers and/or visiting WPP-sponsored surgical teams. 227 patients (93.8%) were seen by WPP providers or released to an in-country physician partnering with WPP. There were 21 (8.2%) total, minor and major, postoperative complications. Five deaths (2.0%) occurred at our institution and 7 from disease progression, after returning to their home country.
Conclusions:
Providing complex surgical care to LMIC children in the US may help address a significant global burden. This care can be provided by multiple subspecialists with excellent outcomes, good follow-up, and low complication and mortality rates. Having a supportive health care system, volunteer surgeons, and an organization that manages logistics and provides financial support is essential.
Type Of Study:
Clinical research, retrospective review LEVEL OF EVIDENCE: Level IV.
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