Surgical Mission Trips Research Articles

IPA Analysis: Exploring the Postsurgical Needs of Guatemalan Children & Their Families From Low-SES Communities Using an OT Lens

Abstract Date Presented 03/22/24 This study explores the experiences of children and families from low-socioeconomic status (SES) communities after short-term surgical mission trips in Guatemala. The findings highlight the occupational injustices that challenge recovery experienced by this population. Primary Author and Speaker: Diana Del Carmen Tojin Additional Authors and Speakers: Karen Aranha Contributing Authors: Karen Aranha, Angela Labrie Blackwell

Cleft Lip and Palate Surgery at a Rural African Hospital: A 13-Year Experience From Western Kenya.

Most studies on the treatment of cleft lip and palate (CLP) in low-income and middle-income countries have reported on the experience of urban centers or surgical mission trips to rural locations. There is a paucity of literature on the experience of local teams providing orofacial cleft surgery in rural Sub-Saharan Africa. This study reports the efficacy and cost-effectiveness of cleft surgery performed by an all-local team in rural Kenya. A retrospective chart review was performed on all patients who received CLP repair at Kapsowar Hospital between 2011 and 2023. Information regarding patient age, sex, cleft etiology, surgical management, and home location was retrieved. For the most recent year of study (2023), the authors performed a financial audit of all costs related to the performance of unilateral cleft lip surgery. Descriptive statistics were performed. The authors identified 381 CLP surgeries performed on 311 patients (197 male, 63.3%). The most common etiology of the cleft was left unilateral (28.3%). The average age of primary lip repair decreased from 46.3 months in 2008 to 2009 to 20.2 months in 2022 to 2023 ( P <0.001). The average age of primary cleft palate repair decreased from 38.0 months in 2008 to 2009 to 25.3 months in 2022 to 2023 ( P <0.001). Patients traveled from 23 districts to receive treatment. Age of treatment was not different when distinguished by sex, county poverty level, or travel time from the hospital. The total costs associated with cleft lip repair was $201.6. Adequately staffed hospitals in rural locations can meaningfully address a regional CLP backlog more cost-effectively than surgical mission trips.

Three-stage correction of severe idiopathic scoliosis with limited skeletal traction during a humanitarian surgical mission: illustrative case.

Underprivileged and underserved patients from developing countries often present late with advanced, untreated spinal deformities. We report a three-stage all-posterior approach using limited skeletal traction with Gardner-Wells tongs (GWTs) for the management of severe idiopathic scoliosis during a humanitarian surgical mission trip. A 17-year-old high-school female was previously diagnosed with juvenile idiopathic scoliosis (diagnosed at age 8) and progressed to a severe 135° kyphoscoliosis. Procedural stage 1 involved spinal instrumentation and posterior releases via posterior column osteotomies from T3 to L4. She then underwent 7 days of skeletal traction with GWTs in the intensive care unit as stage 2. In stage 3, rod engagement, posterior spinal fusion, and partial T10 vertebral column resection were performed. There were no changes in intraoperative neuromonitoring during either surgery and she woke up neurologically intact after both stages of the surgical procedure. Skeletal traction with GWTs is a viable alternative to traditional halo-gravity traction in settings with limited resources. Three-stage spinal deformity correction using limited skeletal traction is a feasible and effective approach for managing severe scoliosis during humanitarian surgical mission trips.

Pediatric Otolaryngology Short-Term Mission Outcomes at a Surgical Mission Hospital in Guatemala.

The frequency of humanitarian surgical mission trips has grown over recent decades. Unfortunately, research on patient outcomes from these trips has not increased proportionately. We aim to analyze the safety and efficacy of surgeries in a low- and middle-income country missions-based surgery center in Guatemala City, Guatemala,and identify factors that influence surgical outcomes. Retrospective cohort study. Guatemalan surgery center is called the Moore Center. Pediatric patients underwent otolaryngology surgery between 2017 and 2019. All patients required follow up. We analyzed the effect of patient, surgical, and geographic factors on follow up and complications with univariate and multivariate analyses. A total of 1094 otolaryngologic surgeries were performed between 2017 to 2019, which comprised 37.4% adenotonsillectomies, 26.8% cleft lip (CL)/cleft palate (CP) repairs, 13.6% otologic, and 20% "other" surgeries. Patients traveled on average 88 km to the center (±164 km). Eighty-nine percent attended their first follow up and 55% attended their second. The 11% who missed their first follow up lived farther from the center (p < .001) and had a higher ASA classification (p < .001) than the 89% who did attend. Sixty-nine (6.3%) patients had 1 or more complications. CL/CP surgery was associated with more complications than other procedures (p < .001). Of 416 tonsillectomies, 4 patients (1%) had a bleeding episode with 2 requiring reoperation. This surgical center models effective surgical care in low-resource areas. Complications and follow-up length vary by diagnosis. Areas to improve include retaining complex patients for follow up and reducing complications for CL/CP repair.

A Retrospective and Prospective Cohort Study Comparing Pediatric Patients With Cleft Lip and Palate From the United States and Guatemala.

Orofacial clefts (OFC) remain among the most prevalent congenital abnormalities worldwide. In the United States in 2010 to 2014, 16.2 of 10,000 live births are born with OFC compared with 23.6 of 10,000 in Alta Verapaz, Guatemala in 2012. Demographics and cleft severity scores were retrospectively gathered from 514 patients with isolated OFC at the Children's Hospital of Philadelphia scheduled for surgery from 2012 to 2019 and from 115 patients seen during surgical mission trips to Guatemala City from 2017 to 2020. Risk factors were also gathered prospectively from Guatemalan families. The Guatemalan cohort had a significantly lower prevalence of cleft palate only compared with the US cohort, which may be a result of greater cleft severity in the population or poor screening and subsequent increased mortality of untreated cleft palate. Of those with lip involvement, Guatemalan patients were significantly more likely to have complete cleft lip, associated cleft palate, and right-sided and bilateral clefts, demonstrating an increased severity of Guatemalan cleft phenotype. Primary palate and lip repair for the Guatemalan cohort occurred at a significantly older age than that of the US cohort, placing Guatemalan patients at increased risk for long-term complications such as communication difficulties. Potential OFC risk factors identified in the Guatemalan cohort included maternal cooking-fire and agricultural chemical exposure, poor prenatal vitamin intake, poverty, and risk factors related to primarily corn-based diets. OFC patients who primarily rely on surgical missions for cleft care would likely benefit from more comprehensive screening and investigation into risk factors for more severe OFC phenotypes.

Prevalence of Critical Congenital Heart Disease During Surgical Mission Trips to Low-Middle Income Countries. What to Expect

Background&#x0D; The incidence of congenital heart disease (CHD) is about 8 per 1000 live births. About 20% of those patients diagnosed with CHD will present early after birth with Critical Congenital Heart Disease (CCHD) necessitating a catheter or surgical intervention during the neonatal period. This is based on Western literature and Western countries. Little is known about the actual prevalence of CCHD at the time of clinical assessment and treatment during surgical missions in low and middle income countries (LMICs).&#x0D; Methods&#x0D; This is a retrospective study and it compares prevalence of CCHD at time of presentation for surgery in LMICs&#x0D; to published data for similar cohorts in the USA. We discuss potential causes for epidemiological discrepancies&#x0D; Proportions were compared using OR and 95% CI. Significance was set at p&lt;0.01. We chose to classify our patients considering the number of ventricles (1or 2) combined with the existence of Aortic Arch obstruction (Yes/No) resulting in a CCHD classification with 4 categories&#x0D; Results&#x0D; Between Feb 2008 - June 2019 we operated 6115 patients in 27 countries. Of those, 243 Neonates were presented to our cardiologists&#x0D; after excluding simple PDA ligations in Preterm newborns and 239 neonates were surgically treated for their CCHD&#x0D; (4% of the total). overall surgical mortality among the 243 neonates operated in LMIC for their CCHD was 19.7% (n=48). Main discrepancies were in Classes 1 represented by 63% of our treated CCHD (p&lt;.0001) while Class 4 neonates represented only 4.2% of our total (p&lt;.0001). When compared to Western prevalence, Transposition of the Great Arteries was over-represented while some cyanotic (ToF) and non-cyanotic diagnosis (Critical Aortic Stenosis) were under-represented.&#x0D; Conclusions&#x0D; Patients diagnosed and treated for CCHD in LMICs during humanitarian missions represent but a very small fraction of the total number of patients born with CCHD in those countries. &#x0D; Discrepancies in specific diagnoses and prevalence between LMIC and their high-income counterparts are likely multifactorial, and management should be adapted to the conditions of each country and health system.&#x0D; Proper prenatal diagnosis, specialized critical neonatal transportation systems, countrywide availability of Prostaglandins and at least one highly functioning heart center are some of the most basic needs required in order to revert the current natural history of CCHD in countries with limited resources settings.

15. Utilization of Augmented Reality Smart Glasses for the Provision of Remote Surgical Training in the Resource-Constrained Setting

Background: Surgical mission trips constitute an important strategy by which the global surgery campaign addresses inequities in surgical disease worldwide. Travel restrictions related to the COVID-19 pandemic, however, impose a challenging limit on the reach and impact of surgical mission work. In this study, we demonstrate the utility of a remote surgical mentorship program equipped with cutting-edge augmented reality (AR) technology for sustaining global surgery capacity building efforts within the constraints of the COVID-19 pandemic. Methods: Our remote surgical training program connects mentor and mentee surgeons via an AR-enabled digital headset and integrated smartphone application. The Vuzix® Smart Glasses system allows mentee surgeons to transmit a point-of-view livestream of activity in the operating room while receiving direct audio and visual feedback from their remote mentor in realtime. To facilitate their engagement, mentor and mentee surgeons interact using an integrated smartphone application that enables case scheduling, clinical documentation, and performance evaluation. Performance is assessed on the basis of three validated assessment tools that are well-established in the surgical education literature: the Objective Structured Assessment of Technical Skills, the Self-Confidence Scale, and the Student Evaluation of Educational Quality Survey. This survey is administered via the mobile application to both mentor and mentee surgeons at the time of their onboarding as well as after every subsequent three-month training quarter for the duration of the year-long program. Results: To date, 83 mentor and mentee surgeons across 33 countries and 6 continents are enrolled and actively participating in our remote training program. Baseline survey data suggest a mentee surgeon cohort that stands to benefit greatly from inclusion in our training program. A majority of mentee surgeons report incomplete knowledge and anxiety in association with their specialty prior to initiating training. Conclusion: The COVID-19 pandemic has created an urgent need for sustainable remote surgical capacity building strategies. Our remote surgical training program powered by AR-enabled telecommunication and smartphone technology constitutes a promising solution towards this end.

Resumption of Short-term Burn Reconstruction Missions to Ukraine in Light of COVID-19: A Paradigm Shift.

The COVID-19 pandemic has disrupted the lives of billions of people globally. Some medical systems continue to be overburdened due to the viral illness leading to incredible public health challenges domestically as well as abroad. However, with vaccination distribution increasing globally, many are pushing for a return to some form of normalcy. In the medical community, some are weighing the risks of returning to global health missions and considering protective strategies to minimize risk of viral spread. Here we describe our experience in returning to an annual burn reconstruction mission in a low- and middle-income country. We have successfully carried out a return surgical mission trip. Our team of ten individuals was able to perform over 75 procedures on 25 pediatric patients in four operative days. We applied a variety of protective strategies and altered mission protocol to limit exposure and transmission risk while focusing heavily on education and training Additionally, we increased the use of telemedicine and eliminated typical in person clinic visits. We increased operative complexity to increase impact while limiting patient exposure. Rigorous perioperative safety and follow-up protocols were implemented. The increased use of telemedicine, reduction of in person visits, emphasis on education, and implementation of safety and follow-up protocols have led to an improvement in efficiency, safety, and accountability. Our adaptations have provided guidance on responsibly resuming surgical outreach missions, with changes that are likely to endure beyond the COVID-19 pandemic.

Cost-Effectiveness of Pediatric Hand International Medical Missions

Limited access and resources in low- and middle-income countries leave many individuals deprived of medical care. Surgical mission trips offer a solution to provide sound surgical care to underserved areas but require a sizable financial support. Previous analyses of such trips have not included values of donated supplies and costs borne by the host country. We hypothesized that the orthopedic mission trips, utilizing the World Pediatric Project (WPP) model, can be executed in a cost-effective manner according to the World Health Organization thresholds even when considering cost to the organizations and host country. World Pediatric Project records for the most recent pediatric upper extremity orthopedic mission trips of 2016, 2018, and 2019 were obtained. Cost estimates were based on documentation from each of the mission trips. Total costs included the costs borne by the WPP, estimates of the value of donated supplies, and costs borne by the host country. The cost-effectiveness of the surgical mission trips was determined by the total cost and potential benefit of performing the orthopedic surgeries using disability-adjusted life years averted. Three separate mission trips to St. Vincent and the Grenadines were analyzed. Forty-five pediatric patients had received surgical care. The cost was calculated to be $431.50 per disability-adjusted life years averted when only the WPP costs are considered; including donated supplies and cost borne by the host country in the total cost, the cost was $6898.10 per disability-adjusted life years averted. After comparing the cost values to the per capita gross domestic product of St. Vincent and the Grenadines, $7,463.54, the WPP mission trips were determined to be cost-effective according to the WHO-CHOICE thresholds in all 5 categories. Orthopedic medical mission trips can provide cost-effective surgical treatments for the upper extremity even when the costs to the organization and host country and trip donations are considered. Economic/Decision Analysis III.

MP67-10 REDIRECTING A GLOBAL HEALTH SURGICAL PROGRAM TO REMOTE SUPPORT DURING A PANDEMIC: THE IVU VIRTUAL VISITING PROFESSORSHIP PROGRAM

You have accessJournal of UrologyGlobal Health/Humanitarian (MP67)1 Sep 2021MP67-10 REDIRECTING A GLOBAL HEALTH SURGICAL PROGRAM TO REMOTE SUPPORT DURING A PANDEMIC: THE IVU VIRTUAL VISITING PROFESSORSHIP PROGRAM Sanjay Das, Frank Burks, Patricia Christensen, Joseph Costa, Katherine Crawford, Benjamin Davies, Scott Eggener, Janelle Fox, Maahum Haider, Susan Kalota, Kurt McCammon, Ian Metzler, Eric Richter, Francis X Schneck, Joseph Smith, Heidi Stephany, Danielle D Sweeney, and Christina B. Ching Sanjay DasSanjay Das More articles by this author , Frank BurksFrank Burks More articles by this author , Patricia ChristensenPatricia Christensen More articles by this author , Joseph CostaJoseph Costa More articles by this author , Katherine CrawfordKatherine Crawford More articles by this author , Benjamin DaviesBenjamin Davies More articles by this author , Scott EggenerScott Eggener More articles by this author , Janelle FoxJanelle Fox More articles by this author , Maahum HaiderMaahum Haider More articles by this author , Susan KalotaSusan Kalota More articles by this author , Kurt McCammonKurt McCammon More articles by this author , Ian MetzlerIan Metzler More articles by this author , Eric RichterEric Richter More articles by this author , Francis X SchneckFrancis X Schneck More articles by this author , Joseph SmithJoseph Smith More articles by this author , Heidi StephanyHeidi Stephany More articles by this author , Danielle D SweeneyDanielle D Sweeney More articles by this author , and Christina B. ChingChristina B. Ching More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002028.10AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Global health surgical programs generally provide support through hands on surgical workshops. The COVID-19 pandemic has significantly impacted domestic and international travel, virtually eliminating the ability of such programs to provide in person care. International Volunteers in Urology (IVU) has developed a virtual visiting professorship (VVP) program out of necessity to redirect in person support to virtual support. METHODS: The VVP program was established in February 2020 when the decision was being made to suspend surgical mission trips. The program consists of hour long lectures provided to established international sites at which IVU has previously held global health surgical workshops on topics requested by those sites after solicitation by IVU. Lecturers are IVU volunteers. We report the experience of the IVU VVP program from February 2020 through January 2021. We evaluated the number and timing of VVPs, as well as topics, locations served, and volunteers engaged. We also report the results of a basic survey from participants evaluating the program. RESULTS: 42 lectures have been given over 12 months. Topics included those in General Urology (n=9), Oncology (n=20), Female Urology (n=2), Reconstruction (n=2), and Pediatrics (n=9). Lectures have been given to sites in 11 countries outside of the US, mainly in Africa, with 10 lectures given to the Pan-African Urological Surgeon’s Association. A total of 2,149 persons registered for the VVPs; 1,094 (51%) participated. While participation initially was proportionate to the number lectures given, there has been some decrease since September 2020 (Figure 1). The lectures have been given by 31 IVU volunteers, of which for 12 (39%), the VVP was their first experience with IVU. Participants ranked presentations on Likert Scale (0 poor-100 excellent) a median of 98. CONCLUSIONS: The COVID-19 pandemic has required global health surgical programs to significantly rethink their support of others. IVU has created a well-received VVP program that enables remote education during a time when it has been necessary for more self-isolation. Such a program enables maintained connectivity in this altered landscape of global health programs and has increased IVU participation. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e513-e513 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Sanjay Das More articles by this author Frank Burks More articles by this author Patricia Christensen More articles by this author Joseph Costa More articles by this author Katherine Crawford More articles by this author Benjamin Davies More articles by this author Scott Eggener More articles by this author Janelle Fox More articles by this author Maahum Haider More articles by this author Susan Kalota More articles by this author Kurt McCammon More articles by this author Ian Metzler More articles by this author Eric Richter More articles by this author Francis X Schneck More articles by this author Joseph Smith More articles by this author Heidi Stephany More articles by this author Danielle D Sweeney More articles by this author Christina B. Ching More articles by this author Expand All Advertisement Loading ...

Ethical Dilemmas in Surgical Mission Trips During the COVID-19 Pandemic.

Otolaryngology–Head and Neck SurgeryVolume 166, Issue 5 p. 840-843 Ethics in Practice Ethical Dilemmas in Surgical Mission Trips During the COVID-19 Pandemic Brianne B. Roby MD, Brianne B. Roby MD ENT and Facial Plastic Surgery, Children’s Minnesota, Minneapolis, Minnesota, USASearch for more papers by this authorZahrah Taufique MD, MBA, Zahrah Taufique MD, MBA ENT and Facial Plastic Surgery, Children’s Minnesota, Minneapolis, Minnesota, USASearch for more papers by this authorAndrew Redmann MD, Andrew Redmann MD ENT and Facial Plastic Surgery, Children’s Minnesota, Minneapolis, Minnesota, USASearch for more papers by this authorAsitha D. L. Jayawardena MD, MPH, Asitha D. L. Jayawardena MD, MPH ENT and Facial Plastic Surgery, Children’s Minnesota, Minneapolis, Minnesota, USASearch for more papers by this authorSivakumar Chinnadurai MD, MPH, Corresponding Author Sivakumar Chinnadurai MD, MPH [email protected] ENT and Facial Plastic Surgery, Children’s Minnesota, Minneapolis, Minnesota, USASivakumar Chinnadurai, MD, MPH, Children’s Minnesota, 2525 Chicago Ave, Minneapolis, MN 55404, USA. Email: [email protected]Search for more papers by this author Brianne B. Roby MD, Brianne B. Roby MD ENT and Facial Plastic Surgery, Children’s Minnesota, Minneapolis, Minnesota, USASearch for more papers by this authorZahrah Taufique MD, MBA, Zahrah Taufique MD, MBA ENT and Facial Plastic Surgery, Children’s Minnesota, Minneapolis, Minnesota, USASearch for more papers by this authorAndrew Redmann MD, Andrew Redmann MD ENT and Facial Plastic Surgery, Children’s Minnesota, Minneapolis, Minnesota, USASearch for more papers by this authorAsitha D. L. Jayawardena MD, MPH, Asitha D. L. Jayawardena MD, MPH ENT and Facial Plastic Surgery, Children’s Minnesota, Minneapolis, Minnesota, USASearch for more papers by this authorSivakumar Chinnadurai MD, MPH, Corresponding Author Sivakumar Chinnadurai MD, MPH [email protected] ENT and Facial Plastic Surgery, Children’s Minnesota, Minneapolis, Minnesota, USASivakumar Chinnadurai, MD, MPH, Children’s Minnesota, 2525 Chicago Ave, Minneapolis, MN 55404, USA. Email: [email protected]Search for more papers by this author First published: 10 August 2021 https://doi.org/10.1177/01945998211038486Citations: 1Read the full textAboutPDF ToolsExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Citing Literature Volume166, Issue5May 2022Pages 840-843 RelatedInformation

Short-term general, gynecologic, orthopedic, and pediatric surgical mission trips in Nicaragua: A cost-effectiveness analysis.

BackgroundShort-term surgical missions facilitated by non-governmental organizations (NGOs) may be a possible platform for cost-effective international global surgical efforts. The objective of this study is to determine if short-term surgical mission trips provided by the non-governmental organization (NGO) Esperança to Nicaragua from 2016 to 2020 are cost-effective.MethodsUsing a provider perspective, the costs of implementing the surgical trips were collected via Esperança’s previous trip reports. The reports and patient data were analyzed to determine disability-adjusted life years averted from each surgical procedure provided in Nicaragua from 2016-2020. Average cost-effectiveness ratios for each surgical trip specialty were calculated to determine the average cost of averting one disability-adjusted life year.ResultsEsperança’s surgical missions’ program in Nicaragua from 2016 to 2020 was found to be cost-effective, with pediatric and gynecology surgical specialties being highly cost-effective and general and orthopedic surgical specialties being moderately cost-effective. These results were echoed in both scenarios of the sensitivity analysis, except for the orthopedic specialty which was found to not be cost-effective when testing an increased discount rate.ConclusionsThe cost-effectiveness of short-term surgical missions provided by NGOs can be cost-effective, but limitations include inconsistent data from a societal perspective and lack of an appropriate counterfactual. Future studies should examine the capacity for NGOs to collect adequate data and conduct rigorous economic evaluations.

Development of Patient Education Materials for Total Joint Replacement During an International Surgical Brigade.

Background:Temporary brigade trips to deliver international surgical care are increasingly common. For the purposes of this work, we use the term brigade to describe self-contained short-term medical or surgical mission trips where healthcare professionals are brought in from foreign regions to provide care to an underserved population. Many brigade programs have begun to collect and publish data on outcomes and complications, but few have examined their own patient education practices.Methods:We used evidence-based readability and suitability analyses along with patient interviews to develop improved patient education materials for a total joint replacement surgical brigade in the Dominican Republic.Results:Existing patient education materials required an eighth grade reading level and lacked suitability based on the principles of educational theory. The redesigned materials required fifth grade reading skills or less and had superior suitability. Pilot testing with patients from the target population suggested that the materials were appealing and appropriate.Conclusions:Patient education may play an important role in optimizing outcomes in the setting of medical or surgical brigades where resources and access to follow-up care are limited. More research is needed to bring attention to the importance of patient education during brigades, and programs should work with patients to develop educational materials that are suitable and effective.

The Perceived Effectiveness of a Short-term Orthopaedic Foot and Ankle Mission Trip to Kenya

Category:OtherIntroduction/Purpose:Short-term surgical mission trips have become increasingly common, with many benefits seen by the hosts and the visitors when trips are done properly. However, few visitors ever attempt to measure the impact of their visit other than to list the surgeries that were performed. This study was performed to determine the perceived educational impact on orthopaedic attendings and residents of a Kenyan internationally accredited orthopaedic residency program and to determine the hosts’ opinions on the effectiveness of orthopaedic short-term trips.Methods:A survey was developed and distributed to four host attending surgeons and 9 host residents at the beginning of an orthopaedic mission trip. The visitors included four attending orthopaedic foot and ankle surgeons from various US sites, and two orthopaedic surgery residents from one US program. Using a scale from 1-10, with 1 meaning definitely No, and 10 meaning definitely Yes, hosts were asked if they felt there was a need for more foot and ankle training in Kenya. A post-trip survey was distributed to the host attendings and residents to determine perceived competency in five topics of foot and ankle pathology.Results:When hosts were asked if they felt there was a need for more foot and ankle training in Kenya, attendings responded an average 8.3, and residents 9.4. When asked if a short-term trip would improve foot and ankle care for the community, attendings responded 7.8, and residents 7.9. A post-trip survey was completed by one attending and 3 residents to determine their perceived competency in five topics of foot and ankle pathology. Overall, they averaged an increase of +2.0 on the scale in their competency for all topics. The highest increase was with ankle instability and hallux valgus at +3.0, and the lowest increase was with Achilles pathology at +0.75.Conclusion:The survey supported the hypothesis that short-term orthopaedic foot and ankle surgery trips to this program are helpful according to the hosts. Furthermore, understanding the competencies of the hosts can help the visitors develop more impactful teaching by focusing on the topics of need. Further studies such as this should be routinely performed with medical trips to help determine their effectiveness.

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

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.

Preoperative Patient Education Class During an Orthopedic Mission Trip: Effects on Knowledge, Anxiety, and Informed Consent

BackgroundPatient knowledge about arthritis and risks, benefits, and outcomes of joint arthroplasty in developing countries is unknown. We evaluated the effectiveness of a preoperative class on improving knowledge and decreasing anxiety during a surgical mission trip offering total joint arthroplasty. MethodsA team of US health care providers taught a preoperative class to 41 patients selected for total joint arthroplasty during a surgical mission trip to Guyana. Participants completed a 32-point survey about arthritis; indications, risks, and benefits of joint arthroplasty; and postoperative, in-patient rehabilitation expectations. The State-Trait Anxiety Inventory was used to measure participant anxiety. Participants completed identical surveys before and after class. Matched-pairs Student t tests were used to compare means between preclass and postclass surveys. Significance was accepted at P < .05. ResultsSeventy-eight percent of patients (31 of 41) scored less than 12 of 32 possible points (40%) on the preclass knowledge questionnaire. Mean ± standard deviation knowledge scores improved from 14.0 ± 4.5 before the class to 16.5 ± 6.5 after the class (P = .008). Anxiety scores (n = 33) improved from 35 ± 13 before the class to 33 ± 12 after the class (P = .047). ConclusionOn this surgical mission trip, underserved patients' knowledge about total joint arthroplasty increased only modestly after taking a preoperative class. Greater understanding of how to educate patients and reduce their anxiety on medical missions is needed.

Abstract 11: The Gender Disparity in Global Plastic Surgery Mission Participation

Background: Plastic surgery is integral to global surgery; however, not all plastic surgeons are equally represented in this effort, with women only representing 18.7% of plastic surgeons who participate in international mission trips.1 The present study aims to identify gender barriers to participating on surgical mission trips by surveying members of the American Cleft Palate Association. Methods: A validated survey methodology with neutral, fact-based questions was implemented through Google Forms. The google form link was distributed by an administrator in the American Cleft-Palate Association (ACPA). Questions included demographics, non-identifying surgeon-specific information, and potential barriers in participation. Responses were analyzed using GraphPad Prism 8.1.2. Results: One hundred-fifty-one plastic surgeons responded to the distributed survey, resulting in a 27.45% response rate. Respondents consisted of 118 (78%) males and 33 (22%) females, with 77 (51%) under the age of 55 years old. One hundred twenty-one (80.13%) were married, and 129 (85.4%) had children, with an average number of 2.5 children. All respondents were plastic surgery trained, with 6 (3.92%) having additional training in otolaryngology and 2 (1.3%) having additional training in oral surgery. One-hundred-seventeen (77.5%) of respondents were fellowship trained. One hundred-thirty-four (88.74%) respondents reported previously having been on mission trips, with 77 (51.0%) having previously been on more than 5 mission trips and 107 (70.4%) having been on a mission trip less than 5 years ago. More men reported prior experience on mission trips as compared to women (92.2% vs. 78.8%, p<0.05), with no significant difference in men vs. women reporting mission trip experience in the last 5 years (72.0% vs. 66.7%, p>0.05). Forty-three percent of respondents with prior mission experience reported no institutional support, and of those who did not receive institutional support, there were significantly more men than women with children (p<0.05). Eight women (24.24%) reported barriers surrounding pregnancy and lactation, with 4 of those participants reporting significant barriers due to Zika. Conclusion: The present study should provoke future initiatives to encourage female plastic surgeon participation through initiatives that aid female participation during reproductive years and initiatives that enhance institutional support.

Abstract 4: Global Health Involvement of Plastic Surgeons While In Residency and In Practice: Is There a Correlation?

Background: It is generally assumed that global health involvement during training increases the likelihood that surgeons will participate in missions in practice. However, little data exists on the proportion of current practicing plastic surgeons who have participated in surgical missions prior to starting practice (before or during residency), and if this correlates with global health involvement while in practice. Methods: We conducted a survey of American Council of Academic Plastic Surgeons membership to ascertain the impact of mission experiences and volunteerism in training on future involvement as a practicing physician. Surgeons were surveyed regarding the number of surgical missions attended at different phases of their education prior to starting practice (i.e., prior to medical school, during medical school, and during residency), and while in practice. Respondents were stratified by the number of years they had been in practice. Statistical analysis was performed via Fisher’s exact test, chi-square test, and correlation matrix, where appropriate. Results: 60 surgeons returned the survey (response rate 16.5%). 18 (30%) had been practicing for less than 10 years, 16 (26.7%) for 10-20 years, and 26 (43.3%) for more than 20 years. 18.3% of surgeons participated in surgical missions prior to medical school, 1.7% during medical school, 48.3% in residency, and 80% in practice. No significant difference in the number of surgeons participating in international surgical mission trips was found between those who had attended their first mission prior to starting practice and while in practice, regardless of their educational status during the initial global health experience (p = 0.3275). Involvement in international surgical missions during residency specifically was weakly correlated with later involvement during practice (r = 0.003, p = 0.981). Conclusion: This study provides a national survey of trends in global health involvement by plastic surgeons in the United States. Although early involvement in surgical missions is weakly correlated with global health involvement later in life, overall participation in missions was high in the sample of academic plastic surgeons who completed this survey.

Abstract 16: Characterizing the Global Need for Plastic Surgery Service

Background: Nearly 5 billion people worldwide do not have access to surgical care. Access to plastic surgery for trauma-related injuries, congenital anomalies, and malignancies is equally limited. The current global surgery model relies heavily on short-term international surgical mission trips, yet little information is available to guide their development. Methods: To assess global plastic surgery service needs, a 16-item survey was designed and electronically distributed to 4550 members of the International Society for Aesthetic Plastic Surgeons (ISAPS). Members are required to maintain active membership in their respective national society of plastic surgery. Three rounds of surveys were distributed. Countries with fewer than 3 responses were excluded from individual analysis. Results: A total of 906 responses (20%) were obtained. 91% of respondents practice in an urban setting, and the majority are in private practice. More than 80% of respondents from Bangladesh (n=12), China (n=3), Colombia (n=20), Ecuador (n=10), Iraq (n=5), Panama (n=10), Philippines (n=11), Saudi Arabia (n=7) and Vietnam (n=5) indicated a need for volunteer plastic surgeons. 80% of respondents in Southeast Asia (n=40) and 79% of respondents in Central America (n=29) indicated a need for volunteers. Respondents from India (n=26) and Bangladesh (n=12) indicated a particular need for burn and trauma reconstruction, while craniofacial anomaly repair is needed globally. “Operating together with local surgeons” and “offering educational opportunities to local surgeons” were rated as the “most helpful” service modalities overall. A majority of respondents in each country indicated that plastic surgeons, operating room staff, anesthesia, physical therapists, and speech therapists are at least “somewhat accessible” in their local community. Conclusion: To maximize the impact of global plastic surgery outreach, organizers should know which service modalities are most needed and where. Our study suggests partnering with local surgeons may provide the greatest local impact, and that much of the global need for plastic surgeons is concentrated in Southeast Asia and Central America.

My Introduction to Mission Surgery: A Diary.

I experienced my first international surgical mission trip in 1993. It was a turning point in my surgical career and has been followed by many missions in many countries over 25 years. Often I am asked by young surgeons what is it like to work on an international mission and what one should expect. Although each mission is different, the sense of accomplishment is always the same and the emotional high one gets from performing the work is always present. Different organizations have different team models. The description here is based on my first mission with Operation Smile, a global nonprofit medical service organization.