3. Global Spine Outreach (GSO): how to safely establish a sustainable short-term spine deformity outreach program

Abstract

BACKGROUND CONTEXT Many nonprofit organizations exist with the purpose of providing medical care to patients in low and middle-income countries and the most common way to approach this is through short-term surgical mission trips (STSM). Within this matter, surgical voluntarism has become an increasingly popular means to exercise generosity, share knowledge and bridge cultural gaps. Global Spine Outreach (GSO) was created to provide a mechanism to safely execute an STSM. The critical elements to develop an STSM include a local surgeon, hospital partner, local nonprofit and an industry partner for implant support. There are presently no published reports that unify the safe delivery of pediatric spine care in low and middle-income countries. PURPOSE The aim of this study is to present a model that can be used by other organizations who desire to initiate, maintain and grow an STSM. We hypothesize that outlining a standardized and reproducible protocol can lead to other organizations who desire to initiate, maintain and grow an STSM. STUDY DESIGN/SETTING We retrospectively reviewed 30 consecutive STSM trips between 2013 and 2019. Our current STSM model is presented. OUTCOME MEASURES GSO evaluation was based on the reproducibility and sustainability of the STSM and re-engagement of our volunteers, local and US surgeons. METHODS We retrospectively reviewed 30 consecutive STSMs from 2013 to 2019. The protocol includes pre-work and data gathering prior to site visitation, initial site visitation prior to selection, pre-STSM clinic, initial STSM and recurring STSM. RESULTS The protocol was implemented in three countries to initiate five STSMs: Cali, Colombia; Chihuahua and Monterrey in Mexico; Poznan and Otwock in Poland. A total of 1,479 patients were screened, with 346 surgeries performed; GSO engaged 17 local surgeons, all serving on >1 STSM. One hundred and two different volunteers have served at least in one STSM, 32 in at least 2 trips and 17 in >2 trips. Five different industry partners have generously donated implants for the STSMs and four have partnered with GSO on ≥2 trips. One site was aborted and moved (including its patients) from Chihuahua to Monterrey as there was no local surgeon to maintain the site. In Colombia, at the time of site initiation, local surgeons had not performed pediatric deformity surgery independently. In 2018, the same local surgeon team performed 187 complex spine cases without GSO being present. CONCLUSIONS The demand for STSMs focused on pediatric deformity in low and middle income countries is high. GSO has developed a protocol that can be used to safely initiate and maintain a spine deformity STSM and have a lasting impact. Perhaps sharing this methodology will result in surgeons having a resource to safely pursue their philanthropic passions. By following this standardized and reproducible model, any organization who desire can initiate, maintain and grow a safe and sustainable short-term surgical mission trip in an outreach setting. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.