title: Surgical mission planning in the developing world.
abstract: Surgical missions to the developing world have been criticized for their lack of outcome analysis. Reported studies indicate a high rate of postoperative complications. An integrated pathway developed for surgical missions and a report of its performance in action is presented herein. Patients were optimized for surgery by a medical team from the UK for a minimum of 14 days preoperatively. They were then transferred to hospital for surgery and returned when stable. At the completion of the mission a junior doctor remained behind for 3 weeks to chart the patients' progress. Thirty case patients were treated over a 2-week period. The complication rate at 3 weeks postoperatively was 7/30. Twenty-two operations were classified as complex (over 1h with more than one flap) and eight as simple (under 1h with minimal flaps). Of those undergoing the simple operations, 2/8 encountered complications at an average of 5 days postoperatively (range 3-7 days). Many medical teams depart in an elevated atmosphere of accomplishment, which without an outcome analysis gives a false impression of their positive impact. Outcome analysis is essential to honestly appraise the effect of surgical missions.
authors.affiliation: The Royal London Hospital, London, UK. Electronic address: fiona.mcclenaghan@gmail.com.
authors.forename: F
authors.initials: F
authors.lastname: McClenaghan
authors.forename: M
authors.initials: M
authors.lastname: Fell
authors.forename: D
authors.initials: D
authors.lastname: Martin
authors.forename: G
authors.initials: G
authors.lastname: Smith
authors.forename: M
authors.initials: M
authors.lastname: McGurk
mesh_terms: D002608:Charities / Q000379:methods / Q000458:organization & administration; D002971:Cleft Lip / Q000601:surgery*; D002972:Cleft Palate / Q000601:surgery*; D003906:Developing Countries; D005002:Ethiopia; D005145:Face / Q000002:abnormalities* / Q000601:surgery; D006801:Humans; D008493:Medical Missions / Q000458:organization & administration* / Q000592:standards; D017063:Outcome Assessment, Health Care; D010347:Patient Care Planning / Q000458:organization & administration; D011183:Postoperative Complications / Q000517:prevention & control*; D019651:Plastic Surgery Procedures / Q000706:statistics & numerical data
keywords: complex facial reconstruction; developing world; head and neck reconstruction; surgical missions