The Gift of a Fresh Start: Results From A Single-Center Surgical Gift Program

Abstract

Introduction:

Since 1991, the Fresh Start Surgical Gifts Program (FSSGP) has provided surgical care to underserved patients at no direct cost. In 2009, the program transitioned from an outpatient center to a tertiary care hospital, offering complex surgical care 6 times per year with dedicated multidisciplinary teams. We describe a hybrid model for sustainable surgical care to low-income patients with unmet surgical needs.

Methods:

A retrospective chart review was conducted of all FSSGP patients at our children’s hospital from January 2009 to January 2023. Patient demographics and medical history were collected. Financial information captured total charges for housing, transportation, hospital, surgical costs, and gift-in-kind (GIK) donations, defined as the estimated market value of professional fees donated by all-volunteer clinical teams. Cost calculations used Medicare reimbursement rates tied to CPT codes, along with annually updated conversion factors and relative value units to account for inflation.

Results:

During the 14-year study period, 318 patients were treated: 44% from North America, 47% Central America, 3% South America, 3% Africa, and 3% Eastern Europe, South Asia, East Asia, and the Middle East combined. Of these 318 patients, 247 (78%) were treated by plastic surgery: 81% were treated for craniofacial conditions, 7% congenital hand conditions, 4% burn reconstruction, 5% breast conditions, 3% other congenital abnormalities, 2% oncologic reconstruction, and 2% trauma. Patients underwent an average of 3.0 surgeries (SD = 2.4; range = [1,16 surgeries]). The average total cost per patient was $110,837 (SD = $156,259; range = [$771, $1,212,044]). The average cost per surgical weekend was $179,586 and the average GIK per surgical weekend was $680,326.

Conclusions:

Our surgical gift model represents a sustainable, community-focused alternative to surgical mission trips.