Skip to main content Accessibility help
×
Home

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

  • K.A. Kelly McQueen (a1), William Magee (a2), Thomas Crabtree (a3), Christopher Romano (a4) and Frederick M. Burkle (a1)...

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.

Copyright

Corresponding author

4134 N 49th Place Phoenix, Arizona 85018 USA E-mail: kamcqueen@gmail.com

References

Hide All
1. Rinsky, L: Personal experiences with overseas volunteerism. Clin Orthop Related Res 2002;392:8997.
2. Wurlitzer, F: Volunteering in Western Africa. West J Med 1991;154(6):730732.
3. Spann, SJ: Family practice in the tropics. Fam Med 1986;18:8496.
4. Driftmeyer, JE, Llewellyn, CH: Toward more effective humanitarian assistance. Mil Med 2004;169(3):161168.
5. Burkle, FM, McGrady, K, Newett, SL, et al. : Complex, humanitarian, emergencies III. Measures of effectiveness. Prehospital Disast Med 1995;10(1):4856.
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 333335.
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.
8. WHO: World Health Report 2004: Changing history. Available at http://www.who.int/whr/2004/cr. Accessed 30 June 2007.
9. Debas, HT: Surgery: A Nobel profession in a changing world. Ann Surg 2002;236(3):263269.
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 12451260.
11. Massey, B, Howard, A: The burden of othopaedic disease in developing countires. J Bone Joint Surg Am 2004;86A(8):18191822.
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):1219.
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):3638.
14. Baiden, F, Hodgson, A, Binka, FN: Demographic surveillance sites and emerging challenges in international health. Bull World Health Organ 2006;84(3):163164.
15. Operation Smile International: Consent and Release of Data Form. Available at http://www.operationsmile.org. Accessed 10 August 2007.
16. Davies, D: Cleft lip and palate. BMJ 1985;290:625628.
17. Shah, deft palate, Wong, D: Management of children with cleft lip and palate. Can Med Assoc J 1980;122:1925.
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.
19. Lidral, AC, Moreno, LM: Progress toward discerning the genetics of cleft lip. Curr Opin Pediatr 2005;17:731739.
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):320330.
21. Kahn, JP: Operations for harelip and cleft palate: The emotional complications in children. Calif Med 1956;84(5):333338.
22. Burkle, FM: Delta Medical: A fitting memorial. US Naval Institute Proceedings 1970;96:3639.
23. Hoover, EL, Cole-Hoover, G, Berry, PK, et al. : Private volunteer medical organizations: How effective are they? J Natl Med Assoc 2005;(97)2:270275.
24. Wolfberg, AJ: Volunteering overseas: Lessons from the surgical brigades. N Engl J Med 2006;354(5):443445.
25. Einterz, E: International aid and medical practice in the less-developed world: Doing it right. Lancet 2001;357:15241525.
26. Dupuis, CC: Humanitarian missions in the third world: A polite dissent. Plast Reconstr Surg 2004;113(1):433435.
27. Operation Smile International: Global Standards. Available at http://www.operationsmile.org. Accessed 10 August 2007.
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;45:232234.
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):336344.
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;61:263269.
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):576580.
32. Wilhelmsen, HR, Musgrave, RH: Complications of cleft lip surgery. Cleft Palate J 1966;3:223230.
33. Crysdal, WS, Russel, D: Complications of tonsillectomy and adenoidectomy in 9,404 children observed overnight. Can Med Assoc J 1986;135:11391141.
34. Fillies, T, Homann, C, Meyer, U, et al. : Perioperative complications in infant cleft repair. Head Face Med 2007;3:9.
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.
36. Hodges, SC, Mijumbi, C, Okello, M, et al. : Anaesthesia services in developing countries: Defining the problems. Anaesthesia 2007;62:441.

Keywords

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

  • K.A. Kelly McQueen (a1), William Magee (a2), Thomas Crabtree (a3), Christopher Romano (a4) and Frederick M. Burkle (a1)...

Metrics

Full text views

Total number of HTML views: 0
Total number of PDF views: 0 *
Loading metrics...

Abstract views

Total abstract views: 0 *
Loading metrics...

* Views captured on Cambridge Core between <date>. This data will be updated every 24 hours.

Usage data cannot currently be displayed