Evaluation of Patient Satisfaction, Impact and Disability-Free Survival After a Surgical Mission in Madagascar: A Pilot Survey.

Abstract

Billions of people worldwide lack access to safe affordable surgery. Surgical missions and non-governmental organisations (NGO) are vital in meeting this need, but long-term outcomes are rarely reported. Mercy Ships is a surgical NGO, and we aimed to measure disability-free survival, impact and patient satisfaction in Madagascar after a 7-month mission. We aimed to evaluate 346 patients. Primary outcome measure was the World Health Organisation Disability Assessment Schedule 2.0 (WHODAS 2.0); secondary outcomes were residual pain; changes in perception of shame and acceptance by society; and overall satisfaction with surgery. Linear regression used to determine association between covariates and each outcome measure. One hundred patients were uncontactable and 98 failed to attend, leaving 148 for final evaluation at a median duration of 8months. Median WHODAS 2.0 was 2.1% (range 0-25%); 1 patient had a score of 25% defined as disability. 32/148 had residual pain; average pain score of 1.8/5. Overall patient satisfaction was 4.7/5 (94%). Median patient shame scores fell from 2.9/5 (58%) to 0.3/5 (6%) and median acceptance scores rose from 3.3/5 (66%) to 4.8/5 (96%) (both p≤0.001) postoperatively. WHODAS 2.0 significantly correlated with gender and postoperative pain (both p≤0.05). Surgical missions have a duty-of-care to evaluate outcomes, and WHODAS 2.0 is a quick, reliable method to ensure surgeries do no harm. Measurements of perception of shame, acceptance by society, patient expectation and satisfaction can also be reliably measured and should not be forgotten by surgical NGOs.