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Plastic & Reconstructive Surgery:
doi: 10.1097/PRS.0b013e318254b2a2
Pediatric/Craniofacial: Special Topics

The Clinical and Economic Impact of a Sustained Program in Global Plastic Surgery: Valuing Cleft Care in Resource-Poor Settings

Hughes, Christopher D. M.D., M.P.H.; Babigian, Alan M.D.; McCormack, Susan M.A., C.C.C./S.L.P.; Alkire, Blake C. M.D., M.P.H.; Wong, Anselm M.D.; Pap, Stephen A. M.D.; Vincent, Jeffrey R. M.S., Ph.D.; Meara, John G. M.D., D.M.D., M.B.A.; Castiglione, Charles M.D.; Silverman, Richard M.D.

Discussion
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Abstract

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.

©2012American Society of Plastic Surgeons

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