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Abstract

Objective:

To evaluate complication rates following cleft lip and cleft palate repairs during the transition from mission-based care to center-based care in a developing region.

Patients and Design:

We performed a retrospective review of 3419 patients who underwent cleft lip repair and 1728 patients who underwent cleft palate repair in Guwahati, India between December 2010 and February 2014. Of those who underwent cleft lip repair, 654 were treated during a surgical mission and 2765 were treated at a permanent center. Of those who underwent cleft palate repair, 236 were treated during a surgical mission and 1491 were treated at a permanent center.

Setting:

Two large surgical missions to Guwahati, India, and the Guwahati Comprehensive Cleft Care Center (GCCCC) in Assam, India.

Main Outcome Measure:

Overall complication rates following cleft lip and cleft palate repair.

Results:

Overall complication rates following cleft lip repair were 13.2% for the first mission, 6.7% for the second mission, and 4.0% at GCCCC. Overall complication rates following cleft palate repair were 28.0% for the first mission, 30.0% for the second mission, and 15.8% at GCCCC. Complication rates following cleft palate repair by the subset of surgeons permanently based at GCCCC (7.2%) were lower than visiting surgeons (P < .05).

Conclusions:

Our findings support the notion that transitioning from a mission-based model to a permanent facility-based model of cleft care delivery in the developing world can lead to decreased complication rates.

Keywords

surgical complications soft palate lip form

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References

Adetayo

Ford

Martin

. Africa has unique and urgent barriers to cleft care: lessons from practitioners at the Pan-African Congress on cleft lip and palate. Pan Afr Med J. 2012;12:15.

Aznar

Schonmeyr

Echaniz

Nebeker

Wendby

Campbell

. Role of postoperative antimicrobials in cleft palate surgery: prospective, double-blind, randomized, placebo-controlled clinical study in India. Plast Reconstr Surg. 2015;136(1):59e–66e. doi:10.1097/PRS.0000000000001324.

Baran

Tiftikcioglu

. Physicians for peace and interplast Turkiye: combined humanitarian surgical activities and conferences. Plast Reconstr Surg. 2007;119(3):1077–1090. doi:10.1097/01.prs.0000242496.26367.10.

Bermudez

Carter

Magee

Jr Sherman

Ayala

. Surgical outcomes auditing systems in humanitarian organizations. World J Surg. 2010;34(3):403–410. doi:10.1007/s00268-009-0253-6.

Bermudez

. Operation smile: plastic surgery with few resources. Lancet. 2000;356(suppl):s45.

Bermudez

Lizarraga

. Operation smile: how to measure its success. Ann Plast Surg. 2011;67(3):205–208. doi:10.1097/SAP.0b013e318212f1b7.

Bickler

Spiegel

. Global surgery—defining a research agenda. Lancet. 2008;372(9633):90–92. doi:10.1016/S0140-6736(08)60924-1.

Birkmeyer

Siewers

Finlayson

Stukel

Lucas

Batista

Welch

Wennberg

. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346(15):1128–1137. doi:10.1056/NEJMsa012337.

Butler

Samman

Gollogly

. A multidisciplinary cleft palate team in the developing world: performance and challenges. J Plast Reconstr Aesthet Surg. 2011;64(11):1540–1541. doi:10.1016/j.bjps.2011.06.003.

10.

Campbell

Restrepo

Mackay

Sherman

Varma

Ayala

Sarma

Deshpande

Magee

. Scalable, sustainable cost-effective surgical care: a model for safety and quality in the developing world, part I: challenge and commitment. J Craniofac Surg. 2014;25(5):1674–1679. doi:10.1097/SCS.0000000000001209.

11.

Deshpande

Campbell

Jagtap

Restrepo

Dobie

Keenan

Sarma

. Early complications after cleft palate repair: a multivariate statistical analysis of 709 patients. J Craniofac Surg. 2014;25(5):1614–1618. doi:10.1097/SCS.0000000000001113.

12.

Farmer

Kim

. Surgery and global health: a view from beyond the OR. World J Surg. 2008;32(4):533–536. doi:10.1007/s00268-008-9525-9.

13.

GC4 Facilities. http://www.youtube.com/watch?v=lOh1ba2LMYk Published 2011. Accessed February 15, 2017.

14.

Global Burden of Surgical Disease Working Group 2008 Meeting. http://www.gsd2008.org/.

15.

Jansen

Carillo

Wendby

Dobie

Das

Restrepo

Campbell

. Improving patient follow-up in developing regions. J Craniofac Surg. 2014;25(5):1640–1644. doi:10.1097/SCS.0000000000001147.

16.

Luft

Bunker

Enthoven

. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979;301(25):1364–1369. doi:10.1056/NEJM197912203012503.

17.

Magee

Jr . Evolution of a sustainable surgical delivery model. J Craniofac Surg. 2010;21(5):1321–1326. doi:10.1097/SCS.0b013e3181ef2a6c.

18.

Magee

Jr Vander Burg

Hatcher

. Cleft lip and palate as a cost-effective health care treatment in the developing world. World J Surg. 2010;34(3):420–427. doi:10.1007/s00268-009-0333-7.

19.

McQueen

Magee

Crabtree

Romano

Burkle

Jr . Application of outcome measures in international humanitarian aid: comparing indices through retrospective analysis of corrective surgical care cases. Prehosp Disaster Med. 2009a;24(1):39–46.

20.

McQueen

Parmar

Kene

Broaddus

Casey

Chu

Hyder

Mihailovic

Semer

Sullivan

. Burden of surgical disease: strategies to manage an existing public health emergency. Prehosp Disaster Med. 2009b;24(suppl 2):s228–s231.

21.

Moghe

Mauli

Thomas

Obed

. Bridging the gap: addressing challenges toward improvement of cleft teamwork in a tertiary care center in north India: a pilot study. Cleft Palate Craniofac J. 2013;50(4):473–480. doi:10.1597/11-079.

22.

Onah

Opara

Olaitan

Ogbonnaya

. Cleft lip and palate repair: the experience from two West African sub-regional centres. J Plast Reconstr Aesthet Surg. 2008;61(8):879–882. doi:10.1016/j.bjps.2007.06.002.

23.

Operation Smile. About Us. http://www.operationsmile.org/about_us/who-we-are Published 2017. Accessed February 15, 2017.

24.

Operation Smile Global Standards of Care. https://www.operationsmile.org/sites/default/files/OperationSmileGlobalStandardsofCare.pdf Published 2015. Accessed February 15, 2017.

25.

Pham

Tollefson

. Cleft deformities in Zimbabwe, Africa: socioeconomic factors, epidemiology, and surgical reconstruction. Arch Facial Plast Surg. 2007;9(6):385–391. doi:10.1001/archfaci.9.6.qsp70001.

26.

Schneider

Politis

Gosain

Migliori

Cullington

Peterson

Corlew

Wexler

Flick

Van Beek

. Volunteers in plastic surgery guidelines for providing surgical care for children in the less developed world. Plast Reconstr Surg. 2011;127(6):2477–2486. doi:10.1097/PRS.0b013e3182131d2a.

27.

Schonmeyr

Restrepo

Wendby

Gillenwater

Campbell

. Lessons learned from two consecutive cleft lip and palate missions and the impact of patient education. J Craniofac Surg. 2014;25(5):1610–1613. doi:10.1097/SCS.0000000000000999.

28.

Shaw

Dahl

Asher-McDade

Brattstrom

Mars

McWilliam

Mølsted

Plint

Prahl-Andersen

Roberts

. A six-center international study of treatment outcome in patients with clefts of the lip and palate: part 5. General discussion and conclusions. Cleft Palate Craniofac J. 1992;29(5):413–418. doi:10.1597/1545-1569(1992)029<0413: ASCISO>2.3.CO;2.

29.

Singh

. Smile train: the ascendancy of cleft care in India. Indian J Plast Surg. 2009;42(suppl):S192–S198. doi:10.4103/0970-0358.57186.

30.

Strauss

. Cleft palate and craniofacial teams in the United States and Canada: a national survey of team organization and standards of care. The American Cleft Palate-Craniofacial Association (ACPA) team standards committee. Cleft Palate Craniofac J. 1998;35(6):473–480. doi:10.1597/1545-1569-35.6.473.

31.

Tanna

Clayton

Roostaeian

Perry

Crisera

. The volume-outcome relationship for immediate breast reconstruction. Plast Reconstr Surg. 2012;129(1):19–24. doi:10.1097/PRS.0b013e31821e70ff.

32.

Uetani

Jimba

Niimi

Natsume

Katsuki

Xuan le

Wakai

. Effects of a long-term volunteer surgical program in a developing country: the case in Vietnam from 1993 to 2003. Cleft Palate Craniofac J. 2006;43(5):616–619. doi:10.1597/05-120.

33.

World Health Organization. Global Strategies to Reduce the Burden of Craniofacial Anomalies: Report of WHO Meetings on International Collaborative Research on Craniofacial Anomalies. Geneva, Switzerland: World Health Organization; 2001.

34.

Yeow

Lee

Lambrecht

Barnett

Gorney

Hardjowasito

Lemperle

McComb

Natsume

Stranc

. International task force on volunteer cleft missions. J Craniofac Surg. 2002;13(1):18–25.

35.

Zbar

Rai

Dingman

. Establishing cleft malformation surgery in developing nations: a model for the new millennium. Plast Reconstr Surg. 2000;106(4):886–889; discussion 890-881.

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Improved Early Cleft Lip and Palate Complications at a Surgery Specialty Center in the Developing World

Abstract

Objective:

Patients and Design:

Setting:

Main Outcome Measure:

Results:

Conclusions:

Keywords

Get full access to this article

References

Supplementary Material