Farmington and Hartford, Conn.; Boston, Cambridge, Brighton, and Worcester, Mass.; Philadelphia, Pa.; and Durham, N.C. From the Departments of Surgery and Orthopedic Surgery, University of Connecticut School of Medicine; the Department of Plastic and Oral Surgery, Children's Hospital Boston, Harvard Medical School; the Program in Global Surgery and Social Change, Department of Global Health and Social Medicine, Harvard Medical School; the Division of Plastic and Reconstructive Surgery, Hartford Hospital and Connecticut Children's Medical Center; The Children's Hospital of Philadelphia; the Massachusetts Eye and Ear Infirmary; the Division of Plastic and Reconstructive Surgery, Mt. Auburn Hospital, Harvard Medical School; the Nicholas School of the Environment and Sanford School of Public Policy, Duke University; the Division of Plastic and Reconstructive Surgery, St. Elizabeth's Medical Center; and the Division of Plastic and Reconstructive Surgery, University of Massachusetts School of Medicine.
Plast Reconstr Surg. 2012 Jul;130(1):87e-94e. doi: 10.1097/PRS.0b013e318254b2a2.
The development of surgery in low- and middle-income countries has been limited by a belief that it is too expensive to be sustainable. However, subspecialist surgical care can provide substantial clinical and economic benefits in low-resource settings. The goal of this study is to describe the clinical and economic impact of recurrent short-term plastic surgical trips in low- and middle-income countries.
The authors conducted a retrospective review of clinic and operative logbooks from Hands Across the World's surgical experience in Ecuador. The authors calculated the disability-adjusted life-years averted to estimate the clinical impact of cleft repair and then calculated the economic impact of surgical intervention for cleft disease.
One thousand one hundred forty-two reconstructive surgical cases were performed over 15 years. Surgery was most commonly performed for scar contractures [449 cases (39.3 percent)], of which burn scars comprised a substantial amount [215 cases (18.8 percent)]. There were 40 postoperative complications within 7 days of operation (3.5 percent), and partial wound dehiscence was the most common complication [16 of 40 (40 percent)]. Cleft disorders constituted 277 cases (24.3 percent), and 102 cases were primary cleft lip and/or palate cases. Between 396 and 1042 total disability-adjusted life-years were averted through surgery for these 102 cases of primary cleft repair. This translates to an economic benefit between $4.7 million (human capital approach) and $27.5 million (value of a statistical life approach).
Plastic surgical disease is a significant source of morbidity for patients in resource-limited regions. Dedicated programs that provide essential reconstructive surgery can produce substantial clinical and economic benefits to host countries.
发展中低收入国家的外科手术受到一种观念的限制，即认为手术成本太高，无法持续。然而，在资源匮乏的环境中，专科外科护理可以提供显著的临床和经济效益。本研究旨在描述中低收入国家中反复短期整形外科研修旅行的临床和经济影响。
作者对 Hands Across the World 在厄瓜多尔的外科手术经验的临床和手术日志进行了回顾性研究。作者计算了通过修复腭裂避免的残疾调整生命年来估计腭裂修复的临床影响，然后计算了外科手术干预治疗腭裂疾病的经济影响。
在 15 年期间，进行了 1142 例重建手术。手术最常用于治疗瘢痕挛缩[449 例（39.3％）]，其中烧伤瘢痕占很大比例[215 例（18.8％）]。术后 7 天内发生了 40 例并发症（3.5％），最常见的并发症是部分伤口裂开[40 例中的 16 例（40％）]。唇腭裂畸形占 277 例（24.3％），其中 102 例为原发性唇裂和/或腭裂。通过对这 102 例原发性唇腭裂修复手术，避免了 396 至 1042 个总残疾调整生命年。这相当于 470 万美元（人力资本法）至 2750 万美元（生命价值统计法）的经济效益。
在资源有限的地区，整形手术相关疾病是患者发病率的一个重要来源。专门提供基本重建手术的项目可以为主办国带来显著的临床和经济效益。
