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Impact of short-term reconstructive surgical missions: a systematic review
  1. Thom C.C. Hendriks1,2,
  2. Matthijs Botman1,2,
  3. Charissa N.S. Rahmee1,2,
  4. Johannes C.F. Ket3,
  5. Margriet G. Mullender1,
  6. Barend Gerretsen4,
  7. Emanuel Q. Nuwass5,
  8. Klaas W. Marck6,
  9. Henri A.H. Winters1,2
  1. 1 Plastic, Reconstructive and Hand Surgery, VU Medisch Centrum, Amsterdam, The Netherlands
  2. 2 Global Surgery Amsterdam, Amsterdam, The Netherlands
  3. 3 Medical library, Vrije Universiteit, Amsterdam, The Netherlands
  4. 4 Koninklijk Instituut voor de Tropen, Amsterdam, The Netherlands
  5. 5 Department of Surgery, Haydom Lutheran Hospital, Haydom, Tanzania
  6. 6 Department of Plastic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
  1. Correspondence to Drs. Thom C.C. Hendriks; thom.hendriks{at}gmail.com

Abstract

Introduction Short-term missions providing patients in low-income countries with reconstructive surgery are often criticised because evidence of their value is lacking. This study aims to assess the effectiveness of short-term reconstructive surgical missions in low-income and middle-income countries.

Methods A systematic review was conducted according to PRISMA guidelines. We searched five medical databases from inception up to 2 July 2018. Original studies of short-term reconstructive surgical missions were included, which reported data on patient safety measurements, health gains of individual patients and sustainability. Data were combined to generate overall outcomes, including overall complication rates.

Results Of 1662 identified studies, 41 met full inclusion criteria, which included 48 546 patients. The overall study quality according to Oxford CEBM and GRADE was low. Ten studies reported a minimum of 6 months’ follow-up, showing a follow-up rate of 56.0% and a complication rate of 22.3%. Twelve studies that did not report on duration or follow-up rate reported a complication rate of 1.2%. Fifteen out of 20 studies (75%) that reported on follow-up also reported on sustainable characteristics.

Conclusions Evidence on the patient outcomes of reconstructive surgical missions is scarce and of limited quality. Higher complication rates were reported in studies which explicitly mentioned the duration and rate of follow-up. Studies with a low follow-up quality might be under-reporting complication rates and overestimating the positive impact of missions. This review indicates that missions should develop towards sustainable partnerships. These partnerships should provide quality aftercare, perform outcome research and build the surgical capacity of local healthcare systems.

PROSPERO registration number CRD42018099285.

  • systematic review
  • surgery
  • treatment
  • burns
  • other infection
  • disease
  • disorder
  • injury
  • public health

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

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Footnotes

  • Handling editor Soumyadeep Bhaumik

  • Contributors The contributorship will be proceeded with the plastic surgery department at VU University Medical Center Amsterdam.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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