Lessons Learned From Two Consecutive Cleft Lip and Palate Missions and the Impact of Patient Education

Abstract

Two consecutive cleft missions were conducted in Guwahati, northeastern India in December 2010 and January 2011. In the later mission, a standardized patient education program for postoperative care was introduced. The objective of this study was to retrospectively evaluate the impact of the patient education program on cleft lip complications in terms of wound infection and dehiscence. Two hundred ninety-eight cleft lip repairs were performed in the first mission and 220 (74%) returned for early follow-up. In the second mission, 356 patients were operated on and 252 (71%) returned for follow-up. From the first mission, 8 patients (3.7%) were diagnosed with lip wound infection and 21 patients (9.6%) with lip dehiscence. After the second mission, only 1 patient (0.4%) returned with a wound infection and 16 (6.4%) were diagnosed with dehiscence.Using binary logistic regression including age, cleft type, postoperative antibiotics, surgeon, and patient education program as covariates, the patient education program stood out as the only variable with a statistically significant impact on the incidence of postoperative wound infections. Even though the incidence of lip dehiscence was reduced by one third when the patient education program was utilized, our regression model singled out the surgeons as the only factor significantly related to this type of complication. Moreover, no benefits of postoperative antibiotic prophylaxis were found. Further analysis of the data also implied that the use of tissue adhesive as a compliment to sutures does not reduce the risk of dehiscence.

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

“…For example, implementation of a standardized patient education program combining pictographs with instructions in the local language lowered postoperative infection rates during a cleft palate surgical brigade in India. 56 Additional research is needed to determine optimal modes of patient education and the effect of patient education on outcomes in these unique settings. Future efforts may even include electronic versions of materials for regions where patients have cell phone service.…”

Optimizing Outcomes in Cleft Surgery

“…Of the 220 patients who presented for early follow-up after the first mission, 3.7% had developed lip wound infection and 9.6% developed lip dehiscence. Of the 252 patients who presented for follow up after the second mission, 0.4% had infections and 6.4% developed dehiscence [26]. Logistic regression revealed that patient education was the only covariate that contributed significantly to the decrease in wound infection rates.…”

“…Cleft Lip [27] • 1 dose pre-operative intravenous antibiotic before incision Cleft Palate [28] • 1 dose pre-operative intravenous antibiotic before incision • 5 days of oral antibiotics post-operatively [30] • May breastfeed immediately; liquid diet by syringe / spoon for 1 week; soft diet for three weeks • Oral hygiene including washing mouth after eating and brushing teeth twice a day • Nothing in mouth 2. Implement standardized patient education program that is taught to nurses then to patients and families [26].…”

The Expanding Role of Education and Research in International Healthcare

“…Standardized, simple, and culturally based postoperative instructions were developed to improve the understanding of postoperative care and reduce the rate of complications. 29 Novel methods were developed to help reduce cost of follow-up care to the families. For those able to return to GC4, free local housing was provided, patients received multidisciplinary care, and travel costs were reimbursed.…”

“…As this model carefully ties high clinical volume with academic interests, research done through Operation Smile local centers has resulted in over 25 publications, [16][17][18][19][20][21][22][23][24][25][26] with almost 20 coming from GC4 alone. 10,[13][14][15][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41] Operation Smile India spent 2 preliminary years studying the government, culture, and infrastructure of Assam to develop the successful model for sustainable care that is GC4. 14,15,27 Unique methods were developed to recruit patients through nonmedical screening personnel in the community, because 87% of the population of Assam lives in rural and isolated areas.…”