Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-05T08:27:54.912Z Has data issue: false hasContentIssue false
  • English
  • Français

Application of Outcome Measures in International Humanitarian Aid: Comparing Indices through Retrospective Analysis of Corrective Surgical Care Cases

Published online by Cambridge University Press:  28 June 2012

K.A. Kelly McQueen ,
William Magee ,
Thomas Crabtree ,
Christopher Romano  and
Frederick M. Burkle Jr.
K.A. Kelly McQueen*
Affiliation:
Harvard Humanitarian Initiative, Harvard School of Public Health, Boston Massachusetts, USA
William Magee
Affiliation:
Operation Smile International, Norfolk, Virginia, USA
Thomas Crabtree
Affiliation:
Tripler Army Medical Center, US Pacific Command, Honolulu, Hawaii, USA
Christopher Romano
Affiliation:
Harrington Department of Bioengineering, Arizona State University, Tempe, Arizona, USA
Frederick M. Burkle Jr.
Affiliation:
Harvard Humanitarian Initiative, Harvard School of Public Health, Boston Massachusetts, USA
*
4134 N 49th PlacePhoenix, Arizona 85018USA E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

It is common for international organizations to provide surgical corrective care to vulnerable populations in developing countries. However, a current worsening of the overall surgical burden of disease in developing countries reflects an increasing lack of sufficient numbers of trained healthcare personnel, and renders outside volunteer assistance more desirable and crucial than ever. Unfortunately, program evaluation and monitoring, including outcome indices and measures of effectiveness, is not measured commonly. In 2005, Operation Smile International implemented an electronic medical record system that helps monitor a number of critical indices during surgical missions that are essential for quality assurance reviews. This record system also provided an opportunity to retrospectively evaluate cases from previous missions. Review of data sets from >8,000 cases in 2005 and 2006 has provided crucial information regarding the priority of surgery, perioperative and operative complications, and surgical program development.

The most common procedure provided was unilateral cleft lip repair, followed closely by cleft palate. A majority of these interventions occurred for patients who were older than routinely provided for in the western world. The average child treated had an age:weight ratio at or below the [US] Centers for Disease Control and Prevention (CDC) 50th percentile, with a small percentage falling below the CDC 20th percentile. A majority of children had acceptable levels of hemoglobin, but the relative decreased age:weight ratio nonetheless can reflect mild malnutrition. Complications requiring medical intervention were seen in 1.2% of cases in 2005 and 1.0% in 2006. Thirty percent were reported as anesthesia complications, and 61% reported as surgical complications. One death was reported, but occurred after discharge outside the perioperative period. Complication rates are similar to rates reported in the US and UK and emphasizes the importance of standardization with uniform indices to compare quality performance and equity of care. This study offers an important example of the importance of collecting, analyzing, and reporting measures of effectiveness in all surgical settings.

Keywords

cleft lipcleft palatehumanitarian aidOperation Smile Internationalrecoverysurgical care
Type
Original Research
Information
Prehospital and Disaster Medicine , Volume 24 , Issue 1 , February 2009 , pp. 39 - 46
Copyright
Copyright © World Association for Disaster and Emergency Medicine 2009

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

1. Rinsky, L: Personal experiences with overseas volunteerism. Clin Orthop Related Res 2002;392:89–97.CrossRefGoogle Scholar
2. Wurlitzer, F: Volunteering in Western Africa. West J Med 1991;154(6):730–732.Google Scholar
3. Spann, SJ: Family practice in the tropics. Fam Med 1986;18:84–96.Google ScholarPubMed
4. Driftmeyer, JE, Llewellyn, CH: Toward more effective humanitarian assistance. Mil Med 2004;169(3):161–168.CrossRefGoogle Scholar
5. Burkle, FM, McGrady, K, Newett, SL, et al. : Complex, humanitarian, emergencies III. Measures of effectiveness. Prehospital Disast Med 1995;10(1):48–56.Google Scholar
6. Burkle, FM, Greenough, PG: Measures of Effectiveness in Disaster Management. In: Ciottone, GR (ed), Disaster Medicine. Boston: Harvard University and Mosby Publishers, 2006, pp 333–335.CrossRefGoogle Scholar
7. World Health Organization (WHO): The World Health Report 2006: Working together for health. Available at http://www.who.int/whr/2006/en/index.html. Accessed 05 September 2007.Google Scholar
8. WHO: World Health Report 2004: Changing history. Available at http://www.who.int/whr/2004/cr. Accessed 30 June 2007.Google Scholar
9. Debas, HT: Surgery: A Nobel profession in a changing world. Ann Surg 2002;236(3):263–269.Google Scholar
10. Debas, HT, Gosselin, R, McCord, C et al. : Surgery. In: Jamison, DT, Breman, JG, Measham, AR, et al. (eds), Disease Control Priorities in Developing Countries. 2nd ed. New York: Oxford University Press, 2006, pp 1245–1260.Google Scholar
11. Massey, B, Howard, A: The burden of othopaedic disease in developing countires. J Bone Joint Surg Am 2004;86A(8):1819–1822.Google Scholar
12. Duda, RB, Hill, AG: Surgery in developing countries: Should surgery have a role in population-based healthcare? Bull Am Coll Surg 2007;92(5):12–19.Google Scholar
13. Schecter, WP, Farmer, D: Surgery and global health: A mandate for training, research and service—A faculty perspective from UCSF. Bull Am Coll Surg 2006;91(5):36–38.Google Scholar
14. Baiden, F, Hodgson, A, Binka, FN: Demographic surveillance sites and emerging challenges in international health. Bull World Health Organ 2006;84(3):163–164.Google Scholar
15. Operation Smile International: Consent and Release of Data Form. Available at http://www.operationsmile.org. Accessed 10 August 2007.Google Scholar
16. Davies, D: Cleft lip and palate. BMJ 1985;290:625–628.Google Scholar
17. Shah, deft palate, Wong, D: Management of children with cleft lip and palate. Can Med Assoc J 1980;122:19–25.Google Scholar
18. Martinelli, S, Scapoli, L, Pezzetti, F, et al. : Study of four genes belonging to the folate pathway: Transcobalamin 2 is involved in the onset of non-syndromic cleft lip with or without cleft palate. Hum Mutat 2006;27(3):294.Google Scholar
19. Lidral, AC, Moreno, LM: Progress toward discerning the genetics of cleft lip. Curr Opin Pediatr 2005;17:731–739.Google Scholar
20. Murray, JE, Mullikan, JB, Kaban, LB, et al. : Twenty year experience in maxillocraniofacial surgery: An evaluation of early surgery on growth, function and body image. Ann Surg 1979;190(3):320–330.Google Scholar
21. Kahn, JP: Operations for harelip and cleft palate: The emotional complications in children. Calif Med 1956;84(5):333–338.Google Scholar
22. Burkle, FM: Delta Medical: A fitting memorial. US Naval Institute Proceedings 1970;96:36–39.Google Scholar
23. Hoover, EL, Cole-Hoover, G, Berry, PK, et al. : Private volunteer medical organizations: How effective are they? J Natl Med Assoc 2005;(97)2:270–275.Google Scholar
24. Wolfberg, AJ: Volunteering overseas: Lessons from the surgical brigades. N Engl J Med 2006;354(5):443–445.Google Scholar
25. Einterz, E: International aid and medical practice in the less-developed world: Doing it right. Lancet 2001;357:1524–1525.Google Scholar
26. Dupuis, CC: Humanitarian missions in the third world: A polite dissent. Plast Reconstr Surg 2004;113(1):433–435.Google Scholar
27. Operation Smile International: Global Standards. Available at http://www.operationsmile.org. Accessed 10 August 2007.Google Scholar
28. Lees, VC, Pigott, RW: Early postoperative complication in primary cleft lip and palate surgery–How soon may we discharge patients from the hospital? Br J Plast Surg 1992;45:232–234.CrossRefGoogle Scholar
29. Tiret, L, Desmonts, JM, Hatton, F, Vourc'h, G: Complications associated with anesthesia —A prospective survey in France. Can Anaesth Soc J 1986;33(3):336–344.Google Scholar
30. Tiret, L, Nivoche, Y, Hatton, F, et al. : Complications related to anaesthesia in infants and children: A prospective survey of 40,240 anaesthetics. Br J Anaesth 1988;61:263–269.CrossRefGoogle Scholar
31. Canady, JW: Complication outcomes based on preoperative admission and length of stay for primary palatoplasty and cleft lip/palate revision in children aged 1 to 6 years. Ann Plast Surg 1994;33(6):576–580.Google Scholar
32. Wilhelmsen, HR, Musgrave, RH: Complications of cleft lip surgery. Cleft Palate J 1966;3:223–230.Google Scholar
33. Crysdal, WS, Russel, D: Complications of tonsillectomy and adenoidectomy in 9,404 children observed overnight. Can Med Assoc J 1986;135:1139–1141.Google Scholar
34. Fillies, T, Homann, C, Meyer, U, et al. : Perioperative complications in infant cleft repair. Head Face Med 2007;3:9.Google Scholar
35. Takemura, H, Yasumoto, K, Toi, T, et al. : Correlation of cleft lip type with the incidence of perioperative respiratory complications in infants with cleft lip and palate. Paediatr Anaesth 2003;13(7):646.Google Scholar
36. Hodges, SC, Mijumbi, C, Okello, M, et al. : Anaesthesia services in developing countries: Defining the problems. Anaesthesia 2007;62:4–41.Google Scholar