Rossell-Perry Percy, Segura Eddy, Salas-Bustinza Lorgio, Cotrina-Rabanal Omar
Faculty of Medicine, San Martin de Porres University, Lima, Peru,
World J Surg. 2015 Jan;39(1):47-53. doi: 10.1007/s00268-013-2395-9.
The Peruvian health system is limited in providing specialized care for patients with clefts because there are an insufficient number of hospitals and few specially trained doctors in rural areas of the country. The most common model of care in these areas is the surgical mission wherein experienced cleft surgeons perform surgeries and teach local doctors. The purpose of this research was to identify the differences in outcome between the surgical mission trip and the referral center model of care provided by the same team.
A retrospective analysis (2002-2012) was performed on data from surgical outcomes provided by the Outreach Surgical Center Lima that utilized both models of care (surgical mission and referral center). A total of 935 procedures were performed in 680 patients with clefts who were treated by the Outreach Surgical Center Program Lima since 2002. Patients in both groups were identified from our records (medical records and screening-day registries). All patients underwent a physical examination, had photographs taken, and any unfavorable results and complications were documented. Comparison of categorical variables (including outcomes) between care models was performed using Pearson's χ (2) test or Fisher's exact test when appropriate. In all cases a two-tailed test was performed and the p value for rejecting the null hypothesis (no difference or no association) was set at 0.05.
We found significant differences between the two models of care with respect to unilateral cleft lip and cleft palate dehiscence (p = 0.02 and p = 0.04, respectively), palate postoperative hemorrhage (p < 0.01), and palatal fistula (p < 0.01) outcomes.
Differences in observed surgical outcomes between the two models might be attributed to the surgeon's performance and/or the patient's age, and these factors are also considered with respect to the model of care. Limitations in long-term medical evaluation at each site should be identified and strategies to improve surgical outcomes must be developed to ensure that patients served by surgical missions obtain the same results achieved at a referral center.
秘鲁卫生系统在为腭裂患者提供专科护理方面存在局限，因为该国农村地区医院数量不足，且经过专门培训的医生很少。这些地区最常见的护理模式是外科医疗队模式，即经验丰富的腭裂外科医生进行手术并培训当地医生。本研究的目的是确定同一团队提供的外科医疗队模式和转诊中心护理模式在治疗结果上的差异。
对利马外展外科中心提供的采用两种护理模式（外科医疗队模式和转诊中心模式）的手术结果数据进行回顾性分析（2002 - 2012年）。自2002年以来，利马外展外科中心项目共为680例腭裂患者实施了935例手术。两组患者均从我们的记录（病历和筛查日登记册）中识别出来。所有患者均接受了体格检查、拍照，并记录了所有不良结果和并发症。护理模式之间分类变量（包括结果）的比较在适当情况下使用Pearson卡方检验或Fisher精确检验。在所有情况下均进行双侧检验，将拒绝零假设（无差异或无关联）的p值设定为0.05。
我们发现两种护理模式在单侧唇腭裂裂开（分别为p = 0.02和p = 0.04）、腭裂术后出血（p < 0.01）和腭瘘（p < 0.01）结果方面存在显著差异。
两种模式观察到的手术结果差异可能归因于外科医生的表现和/或患者的年龄，并且在护理模式方面也考虑了这些因素。应确定每个地点长期医学评估的局限性，并制定改善手术结果的策略，以确保接受外科医疗队治疗的患者能获得与转诊中心相同的治疗效果。
