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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.

Plastic & Reconstructive Surgery: July 2012 - Volume 130 - Issue 1 - p 87e–94e
doi: 10.1097/PRS.0b013e318254b2a2
Pediatric/Craniofacial: Special Topics
Discussion

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.

Farmington 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.

Received for publication December 20, 2011; accepted January 20, 2012.

Presented at the 92nd Annual Meeting of the New England Surgical Society, in Bretton Woods, New Hampshire, September 23 through 25, 2011, and at the Annual Meeting of the Connecticut Chapter of the American College of Surgeons, in Farmington, Connecticut, November 4, 2011.

Disclosure: The authors have no financial interest to declare in relation to the content of this article.

Christopher D. Hughes, M.D., M.P.H.; Department of Plastic and Oral Surgery, Children's Hospital Boston, 300 Longwood Avenue, Enders 1, Boston, Mass. 02115, chughes414@gmail.com

©2012American Society of Plastic Surgeons