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The Clinical and Economic Impact of a Sustained Program in Global Plastic Surgery: Valuing Cleft Care in Resource-Poor Settings
*Christopher D. Hughes1,2,3, *Alan Babigian1,4, *Susan McCormack5, *Blake C. Alkire2,3,6, *Anselm Wong7, *Stephen A. Pap8, Jeffrey R. Vincent9, *John G. Meara2,3, Charles Castiglione1,4, *Richard Silverman10,11
1Department of Surgery, University of Connecticut School of Medicine, Farmington, CT; 2Department of Plastic and Oral Surgery, Children's Hospital Boston, Boston, MA; 3Department of Global Health and Social Medicine, Harvard Medical School; 4Division of Plastic and Reconstructive Surgery, Hartford Hospital and Connecticut Children’s Hospital, Hartford, CT; 5The Children's Hospital of Philadelphia, Philadelphia, PA; 6Massachusetts Eye and Ear Infirmary, Boston, MA; 7Department of Orthopedic Surgery, University of Connecticut School of Medicine, Farmington, CT; 8Division of Plastic and Reconstructive Surgery, Mt. Auburn Hospital, Harvard Medical School, Cambridge, MA; 9Nicholas School of Environment and Sanford School of Public Policy, Duke University, Durham, NC; 10Division of Plastic and Reconstructive Surgery, St. Elizabeth’s Medical Center, Brighton, MA; 11Division of Plastic and Reconstructive Surgery, University of Massachusetts School of Medicine, Worcester, MA
Objective: To describe the clinical impact of recurrent short-term plastic surgical trips, to define the disability adjusted life-years (DALYs)-averted through reconstructive cleft surgery in low-resource areas, and to provide an estimate of the monetary benefit of providing reconstructive surgery in this setting using a previously published economic modeling methodology. Design: A retrospective review of prospectively collected data from clinic and operative logbooks. Setting: District hospitals in resource-poor areas of rural Ecuador. Patients (or Other Participants): A consecutive sample of all patients presenting for reconstructive surgical care from 1996-2011. Main Outcome Measure(s): Post-operative complication(s), DALYs-averted, economic impact in US dollars. Results: 1142 reconstructive surgical cases were performed over 15 years. The mean patient age was 18.8 years and 45% were female. Surgery was most commonly performed for scar contractures (451 cases, 39.5%), of which burn scars comprised a significant amount (193 cases, 16.9% of total cases). There were 40 postoperative complications within 7 days of operation (3.5%), and partial wound dehiscence was the most common (16/40, 40%). Cleft disorders comprised 276 cases (24.2%), of which 17 were lip only, 38 were palate only, and 122 were lip and palate. 102 cases were primary cleft lip and/or palate cases. Between 395 and 1,035 total DALYs were averted through surgery for these 102 cases of primary cleft repair. This translates to an economic benefit between $5.0 million (human capital approach) and $67.4 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 significant clinical and economic benefits to host countries.
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