A Cost-Benefit Analysis of an Overseas Volunteer Mission to the Local Healthcare System.

BACKGROUND: The aim of this study was to comparatively evaluate the sustainability and cost-benefit of the Operation Giving Back Bohol surgical volunteerism mission (SVM) carried out in Bohol Province, Philippines, over twelve consecutive missions. METHODS: This was a cost-benefit analysis of prospectively collected financial data from twelve consecutive surgical volunteerism missions held between 2006 and 2018. The overall cost of an SVM and cost per patient were the endpoints of interest. Disability-adjusted life years (DALYs) and costs thereof were calculated for each patient undergoing surgery in the twelve SVMs. RESULTS: A mean of 112 ± 22 patients were included per year of the SVM. A statistically significant increasing trend in the overall cost of SVMs over time was found (R2 = .469; P = .014). A nonsignificant decreasing trend in the cost per patient over time was found (R2 = .007; P = .795). A total of 8811.71 DALYs were averted in the twelve SVMs. DALYs averted per year ranged between 474.02 (2009) and 969.16 (2012). Cost per a DALY averted ranged between $466.9 (2006) and $865.6 (2009). Comparison of the latter with GDP per capita showed that this SVM was "very cost-effective." CONCLUSION: The SVM contributes substantially to the health care system both clinically and financially. A total of 8812 DALYs were averted in these twelve SVMs. Costs per a DALY averted did not significantly change over the mission years. Increasing the number of patients served has increased the total cost of the mission with no impact on the cost per patient.

Thyroidectomy in a Surgical Volunteerism Mission: Analysis of 464 Consecutive Cases.

Although surgical volunteer missions (SVMs) have become a popular approach for reducing the burden of surgical disease worldwide, the outcomes of specific procedures in the context of a mission are underreported. The aim of this study was to evaluate outcomes and efficiency of thyroid surgery within a surgical mission. This was a retrospective analysis of medical records of all patients who underwent thyroid surgery within a SVM from 2006 to 2019. Postoperative complication rate was the safety endpoint, whereas length of hospital stay (LOS) was the efficiency endpoint. Serious complications were defined as Clavien-Dindo class 3-5 complications. Expected safety and efficiency outcomes were calculated using the American College of Surgeons National Surgical Quality Improvement Program (NSQIP) surgical risk calculator and compared to their observed counterparts. A total of 464 thyroidectomies were performed during the study period. Mean age of the patients was 40.3 ± 10.8 years, and male-to-female ratio was 72 : 392. Expected overall (p=0.127) and serious complication rates (p=0.738) were not significantly different from their observed counterparts. Expected LOS was found to be significantly shorter as compared to its observed counterpart (0.6 ± 0.2 vs. 2.5 ± 1.0 days; p < 0.001). This study found thyroid surgery performed within a surgical mission to be safe. NSQIP surgical risk calculator underestimates the LOS following thyroidectomy in surgical missions.

Outcomes of 1,327 patients operated on through twelve multispecialty surgical volunteerism missions: A retrospective cohort study.

BACKGROUND: Surgical volunteer missions (SVMs) have become a popular approach for reducing the burden of surgical disease worldwide. The aim of this study was to evaluate the outcomes of 12 surgical missions between 2006 and 2018 from the mission entitled "Operation Giving Back Bohol" Tagbilaran, Philippines and discuss the lessons learned during these missions in particular seven challenges that every volunteer surgeon should be familiar with. METHODS: This was a retrospective descriptive study of prospectively collected data on all patients treated during one SVM. The data collected included gender, age, diagnosis, types of surgeries performed, and perioperative adverse events. RESULTS: During the study period 1327 operations were performed (842 females (63.4%) and 485 males (36.6%); (male-to-female ratio 0.59); mean age 37 ±â€¯18 years. The majority of operations were for thyroid disease (31.6%), followed by hernia (17.3%), hysterectomies/salpingo-oophorectomies (12.2%), soft tissue tumors (9.9%), cleft lip/palate repairs (7.2%), breast (6.4%), gallbladder disease (4.7%), cataract (2.9%), parotid masses (1.4%) and others (6.4%). For each mission, there were an average 5.5 days of operating, performing a median of 105.5 (80-148) cases per mission. There were 27 complications (2%), of which, 22 were postoperative bleeding and two temporary tracheostomies. The mortality rate was 0.15% (2/1327). In one patient, the family withdrew care following compassionate last ditch effort thyroidectomy for advanced cancer and one patient died as a result of intracranial bleeding from a brain tumor, which was unrecognized before mastectomy. CONCLUSIONS: Surgical volunteerism missions are safe and valuable in lessening the burden of surgical disease globally when performed in an organized fashion and with continuity of care. However, there is need for standardization of surgical care provided during SVMs and creation of a world-wide database of all SVMs, and each surgeon and others who participate in these mission should be familiar with critical elements and challenges for the successful mission.

Total thyroidectomy for giant goiter under local anesthesia and Ketamine in a surgical mission.

BACKGROUND: Operation Giving Back (OGB) of the American College of Surgeons (ACS) and various other surgical missions in the developing world have become more popular and provide a valuable way of reducing the surgical burden worldwide. While most cases are "bread and butter" general surgery, difficult surgeries are often encountered. MATERIALS AND METHODS: Description of a total thyroidectomy for super giant goiter extending to chest inferiorly, lateral neck and behind both ears, compressing the trachea and causing chronic difficulties breathing. The surgical team was unable to intubate, but performed surgery under local anesthesia and sedation with Ketamine injection. RESULTS: Total thyroidectomy, as a life-saving procedure, was performed under local anesthesia and Ketamine with mild sedation. Once thyroid was removed, the outside diameter of trachea was assessed to be 4mm. Patient tolerated the procedure well and had no postoperative complication. Her breathing improved significantly post-operatively. Five years later, she is doing well. CONCLUSION: Total thyroidectomy for giant goiters can be done under local anesthesia with Ketamine and proper sedation. Surgeons and anesthesiologists participating in surgical missions may have to perform major surgery under local anesthesia.

Preoperative telemedicine evaluation of surgical mission patients: should we use it routinely?

Low-cost telemedicine is a viable and secure tool for preoperative evaluation of surgical mission patients. It increases efficiency and optimizes the use of existing resources. More specifically, it helps ensure an accurate assessment of patients before the surgical team arrives, reduces on-site prescreening time, and decreases the number of surgical candidates on the waiting list. Routine use of telemedicine in surgical missions most likely would reduce preoperative times and the number of operations canceled at the last minute. Moreover, it may be effectively used for long-term follow-up care, including the management of any postoperative complications.

Round pneumonia in a child

Un niño de 8 años de edad presentó un cuadro clínico de neumonía aguda; hemocultivo positivo para Streptococcus pneumoniae, una densidad redonda en el lóbulo superior izquierdo y mejoría rápida con ampicilina. Este cuadro clínico se denomina neumonía redonda o esférica; no es común y se confunde con otras infeccions y con procesos malignos. Es importante establecer un diagnóstico precoz para instaurar la antibioticoterapia curativa y evitar realizar pruebas de diagnóstico costosas, invasoras e innecesarias

Tracheal papilloma simulating asthma in a child

Las tumefacciones de la traquea son raras en los niños; es poco probable que el pediatra general tenga que enfrentarse con este diagnóstico y podría encontrar dificuldades para establecerlo. La presentación es solapada y se confunde con otras afecciones obstructivas de las vías aéreas. Se presenta el caso de un niño de tres años de edad con un papiloma de la traquea cuyos síntomas se confundieron con los de asma bronquial y fue tratado con broncodilatadores durante varios meses antes de que se estableciera el diagnóstico correcto

Congenital cystic adenomatoid malformation of the lung

La malformación adenomatoide quística congénita es una anomalía poco común, la cual debe considerarse entre las posibilidades ante el diagnóstico diferencial de la dificuldad respiratoria del neonato y de las lesiones quísticas pulmonares que se descubran en el mismo. Una vez que se establece el diagnóstico de la malformación adenomatoide, el tratamiento definitivo es quirúrgico. Se presenta el caso de una recién nacida con la malformación adenomatoide quística en el pulmón izquierdo. Tomando en consideración la posibilidad de hipoplasia del pulmón derecho, se practicó la lobectomía del lóbulo inferior izquierdo y cistectomía en el lóbulo superior izquierdo. La recuperación fue incompleta por motivo de la enfermedad residual del lóbulo superior izquierdo. Se practicó la resección del mismo y la paciente recuperó totalmente. Hemos llegado a la conclusión de que, después de valorar la función del pulmón contralateral, todo el pulmón afectado por la malformación debe ser resecado, aun cuando durante la operación un lóbulo parezca estar afectado en forma mínima

Foreign body aspiration in Puerto Rican children: report of 83 cases

Ochenta y tres niños que habían inhalado cuerpos extraños fueron admitidos al Hospital Pediátrico Universitario de Puerto Rico entre 1972 y 1986. La mortalidad fue de 3.6% (3/83) y la mayoría de los supervivientes no presentó secuelas. Las características clínicas y epidemiológicas fueron comparables a las de series publicadas en otros países. Pero en nuestros casos encontramos una mayor proporción de aspiración de objetos metálicos como, por ejemplo, alfileres y agujas. Esto permitió detectar los mismos por medio de la radiografía del tórax en una cuarta parte de los casos. Las características epidemiológicas de nuestros casos podríam ser útiles para desarrollar programas educativos de intervención temprana a fin de evitar estos accidentes en los niños puertorriqueños