title: Thyroid Surgery in a Resource-Limited Setting.
abstract: Objective The present study reviews a series of patients who underwent thyroid surgery in Eldoret, Kenya, to demonstrate the feasibility of conducting long-term (>1 year) outcomes research in a resource-limited setting, impact on the quality of life of the recipient population, and inform future humanitarian collaborations. Study Design Case series with chart review. Setting Tertiary public referral hospital in Eldoret, Kenya. Subjects and Methods Twenty-one patients were enrolled during the study period. A retrospective chart review was performed for all adult patients who underwent thyroid surgery during humanitarian trips (2010-2015). Patients were contacted by mobile telephone. Medical history and physical examination, including laryngoscopy, were performed, and the SF-36 was administered (a quality-of-life questionnaire). Laboratory measurements of thyroid function and neck ultrasound were obtained. Results The mean follow-up was 33.6 ± 20.2 months after surgery: 37.5% of subtotal thyroidectomy patients and 15.4% of lobectomy patients were hypothyroid postoperatively according to serologic studies. There were no cases of goiter recurrence or malignancy. All patients reported postoperative symptomatic improvement and collectively showed positive pre- and postoperative score differences on the SF-36. Conclusion Although limited by a small sample size and the retrospective nature, our study demonstrates the feasibility of long-term surgical and quality-of-life outcomes research in a resource-limited setting. The low complication rates suggest minimal adverse effects of performing surgery in this context. Despite a considerable rate of postoperative hypothyroidism, it is in accordance with prior studies and emphasizes the need for individualized, longitudinal, and multidisciplinary care. Quality-of-life score improvements suggest benefit to the recipient population.
authors.affiliation: 1 Division of Otolaryngology-Head and Neck Surgery, Department of Surgery, University of California San Diego, San Diego, California, USA.
authors.forename: Aria
authors.initials: A
authors.lastname: Jafari
authors.affiliation: 2 Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: David
authors.initials: D
authors.lastname: Campbell
authors.affiliation: 3 Division of Head and Neck Oncology and Reconstruction, Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee, Wisconsin, USA.
authors.forename: Bruce H
authors.initials: BH
authors.lastname: Campbell
authors.affiliation: 4 Department of Otolaryngology-Head and Neck Surgery, Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Henry Nono
authors.initials: HN
authors.lastname: Ngoitsi
authors.affiliation: 4 Department of Otolaryngology-Head and Neck Surgery, Moi Teaching and Referral Hospital, Eldoret, Kenya.|5 School of Medicine, Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Titus M
authors.initials: TM
authors.lastname: Sisenda
authors.affiliation: 4 Department of Otolaryngology-Head and Neck Surgery, Moi Teaching and Referral Hospital, Eldoret, Kenya.
authors.forename: Makaya
authors.initials: M
authors.lastname: Denge
authors.affiliation: 6 Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.
authors.forename: Benjamin C
authors.initials: BC
authors.lastname: James
authors.affiliation: 6 Department of Surgery, Indiana University School of Medicine, Indianapolis, Indiana, USA.|7 Department of Otolaryngology-Head and Neck Surgery, Ukiah Valley Medical Center, Ukiah, California, USA.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Cordes
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006295:Health Resources; D006801:Humans; D007630:Kenya; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D012066:Relief Work; D012189:Retrospective Studies; D013965:Thyroidectomy; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: global health; humanitarian; quality of life; resource limited; thyroid; thyroidectomy