The Morbidity and Mortality of Plastic Surgery Disease in Canada: A Perspective Based on the Global Burden of Disease Study

Abstract

PURPOSE: Identifying the burden of disease related to plastic and reconstructive surgery in Canada will provide timely population-based data, will inform policy, and will generate important research funding. Using the most current Global Burden of Disease (GBD) data, we present results on the years of life lost (YLLs), years lived with disability (YLDs), and disability-adjusted life years (DALYs) for diseases relevant to our field. METHODS AND PATIENTS: Data were extracted through the GBD 2017 results tool for all available and relevant plastic surgery diseases. Incidence, prevalence, mortality, and cost were calculated for each disease. The data were analyzed using a Bayesian meta-regression modelling tool to provide epidemiological estimates of YLLs, YLDs and DALYs by combining other available parameters. To quantify and compare the costs of adverse health end points, the monetary value (CAD) of a DALY was ascertained based on previous analysis. RESULTS: In 2017, plastic surgery-related conditions in Canada had an overall age-standardized DALY rate of 481 per 100,000 (95% UI, 409–562). Of these conditions, breast cancer was responsible for over 50% of the overall burden of disease, with an age-standardized DALY rate of 247 per 100,000 (95% UI, 222–274), followed by thermal burns (64 per 100,000 [95% UI, 51–82]) and malignant skin melanoma (54 per 100,000 [95% UI, 39–68]). Age-standardized incidence rates were highest for cellulitis (3,008 per 100,000 [95% UI, 2,814–3,192]) followed by pyoderma (1,432 per 100,000 [95% UI, 1,391–1,478]). Breast cancer had the highest age-standardized cost of care of all plastic surgery-related diseases, at $4.6 billion. Summed values for all 13-plastic surgery-related diseases demonstrate a total age-standardized cost of $9.2 billion. CONCLUSION: Plastic and reconstructive surgery-related diseases are responsible for a high burden of disease and significant cost to the Canadian healthcare system. Unsurprisingly, breast cancer is the leading cause of morbidity and mortality of these diseases, followed by thermal burns and malignant melanoma. These results will help guide national policy on healthcare and research funding for plastic surgery-related diseases and will direct current efforts toward the highest impact diseases facing the Canadian healthcare system.