Improved Early Cleft Lip and Palate Complications at a Surgery Specialty Center in the Developing World

Abstract

Objective: To evaluate complication rates following cleft lip and cleft palate repairs during the transition from mission-based care to center-based care in a developing region. Patients and Design: We performed a retrospective review of 3419 patients who underwent cleft lip repair and 1728 patients who underwent cleft palate repair in Guwahati, India between December 2010 and February 2014. Of those who underwent cleft lip repair, 654 were treated during a surgical mission and 2765 were treated at a permanent center. Of those who underwent cleft palate repair, 236 were treated during a surgical mission and 1491 were treated at a permanent center. Setting: Two large surgical missions to Guwahati, India, and the Guwahati Comprehensive Cleft Care Center (GCCCC) in Assam, India. Main Outcome Measure: Overall complication rates following cleft lip and cleft palate repair. Results: Overall complication rates following cleft lip repair were 13.2% for the first mission, 6.7% for the second mission, and 4.0% at GCCCC. Overall complication rates following cleft palate repair were 28.0% for the first mission, 30.0% for the second mission, and 15.8% at GCCCC. Complication rates following cleft palate repair by the subset of surgeons permanently based at GCCCC (7.2%) were lower than visiting surgeons (P < .05). Conclusions: Our findings support the notion that transitioning from a mission-based model to a permanent facility-based model of cleft care delivery in the developing world can lead to decreased complication rates.

Impact of short-term reconstructive surgical missions: a systematic review

“…Some authors argue that longer-term specialty surgical hospitals may be provide more effective care than short-term missions 9 12 39. Specialty hospitals provide continuous care all year round in a LMIC.…”

“…Specialty hospitals provide continuous care all year round in a LMIC. The cleft care centre of Operation Smile in India,39 or Smile Train’s model are examples of this approach 69–78…”

Optimizing Outcomes in Cleft Surgery

“…Two large missions were held in Guwahati prior to the opening of GCCCC, and this period of transition provides a unique opportunity to compare outcomes between a mission-based model of care delivery and a center-based model. In order to evaluate differences in complications, we performed a retrospective review of 3419 consecutive patients who underwent cleft lip repair and 1728 consecutive patients who underwent cleft palate repair with OS over a 4-year period (2010-2014) [13]. Our results show that early complication rates decreased for both cleft lip and cleft palate repairs with the transition to center-based care at GCCCC (p < 0.05) ( Table 1).…”

“…What little data that exists indicates that cleft mission work in low and middleincome countries (LMICs) has at times been associated with poor outcomes [8]. Complication rates following cleft palate repair in these settings often approach 30% and follow up rates are understandably much lower than at tertiary care centers in developed nations [13,14]. In order to bridge this gap, thoughtfully designed quality improvement measures must be implemented, and outcomes must be tracked over time to prove the efficacy of these interventions.…”

“…In order to bridge this gap, thoughtfully designed quality improvement measures must be implemented, and outcomes must be tracked over time to prove the efficacy of these interventions. Recently, various groups have contributed to a growing body of literature related to such efforts, and some substantial improvements have been reported [13,15,16].…”