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Surgical Outcomes Auditing Systems in Humanitarian Organizations

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Abstract

Background

Operation Smile is a humanitarian volunteer-based organization that provides cleft care around the world. Successful primary surgery is the key to improving the quality of life of patients with oral clefts. A cleft surgery outcomes database and evaluation system has been developed and implemented.

Methods

During Operation Smile’s “World Journey of Smiles” in November 2007, a total of 4100 patients were operated on during a 10-day period at 40 simultaneous missions in 25 countries. Photographs taken before surgery, right after surgery, and at the follow-up consultations were entered in a database and used as media to evaluate surgical outcomes objectively by independent unbiased evaluators. Data about complications collected during the postoperative consultations were also entered.

Results

A postoperative consultation, 6 months to 1 year after surgery was conducted at 24 sites, 19 of which sent back postoperative images; and most returned postoperative examination forms. At those 19 sites, 703 of 1917 patients returned for a 6- to 9-month postoperative visit, for a 36.67% return rate. After matching before and after pictures, 562 patients were able to be entered into the database, allowing 580 procedures to be evaluated. Feedback reports have been sent to 134 volunteer surgeons around the world. Results were compared among sites and locations; and the places where future actions were needed to improve the quality of surgery were identified.

Conclusions

The current outcomes evaluation system has proven beneficial in tracking patient outcomes, auditing surgical performance, and providing feedback to surgeons and other team members. Challenges are discussed.

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References

  1. Vanderas AP (1987) Incidence of cleft lip, cleft palate, and cleft lip and palate among races: a review. Cleft Palate J 24:216–225

    CAS  PubMed  Google Scholar 

  2. Lee ST (2002) International surgical missions. In: Wyszynski DF (ed) Cleft lip & palate: from origin to treatment. Oxford University Press, New York, pp 424–427

    Google Scholar 

  3. Bermudez L (2004) Humanitarian missions in the Third World [letter]. Plast Reconstr Surg J 114:1687–1689

    Google Scholar 

  4. Shaw WC, Williams AC, Sandy JR et al (1996) Minimum standards for the management of cleft lip and palate: efforts to close the audit loop. Ann R Coll Surg Engl 78:110–114

    CAS  PubMed  Google Scholar 

  5. Hathorn IS, Atack NE, Butcher G et al (2006) Centralization of services: standard setting and outcomes. Cleft Palate Craniofac J 43:401–405

    CAS  PubMed  Google Scholar 

  6. Shaw WC, Semb G, Nelson PA et al (2000) The eurocleft project 1996–2000. IOS Press, Amsterdam

    Google Scholar 

  7. Shaw WC, Asher-McDade C, Brattström V et al (1992) A six-center international study of treatment outcome in patients with clefts of the lip and palate. Part 5. General discussion and conclusions. Cleft Palate Craniofac J 29:413–418

    Article  CAS  PubMed  Google Scholar 

  8. Shaw WC, Dahl E, Asher-McDade C et al (1992) A six-center international study of treatment outcome in patients with clefts of the lip and palate. Part 1. Principles and study design. Cleft Palate Craniofac J 29:393–397

    Article  CAS  PubMed  Google Scholar 

  9. Flinn W, Long R, Garattini G et al (2006) A multicenter outcomes assessment of five-year-old patients with unilateral cleft lip and palate. Cleft Palate Craniofac J 43:253–258

    PubMed  Google Scholar 

  10. Atack N, Hathorn I, Mars M et al (1997) Study models of 5-year-old children as predictors of surgical outcome in unilateral cleft lip and palate. Eur J Orthod 19:165–170

    Article  CAS  PubMed  Google Scholar 

  11. Atack NE, Hathorn I, Dowell T et al (1998) Early detection of differences in surgical outcome for cleft lip and palate. Br J Orthod 25:181–185

    Article  CAS  PubMed  Google Scholar 

  12. Asher-McDade C, Roberts C, Shaw WC et al (1991) Development of a method for rating nasolabial appearance in patients with clefts of the lip and palate. Cleft Palate Craniofac J 28:385–390

    Article  CAS  PubMed  Google Scholar 

  13. Brattstrom V, Molsted K, Phral-Andersen B et al (2005) The Euroclef study: intercenter study of treatment outcome in patients with complete cleft lip and palate. Part 2. Craniofacial form and nasolabial appearance. Cleft Palate Craniofac J 42:69–77

    Article  PubMed  Google Scholar 

  14. Coghlan BA, Matthews B, Pigott RW (1987) A computer-based method of measuring facial asymmetry: results from an assessment of the repair of cleft lip deformities. Br J Plast Surg 40:371–376

    Article  CAS  PubMed  Google Scholar 

  15. Kyrkanides S, Bellohusen R, Subtelny JD (1996) Asymmetries of the upper lip and nose in noncleft and postsurgical unilateral cleft lip and palate individuals. Cleft Palate Craniofac J 33:306–311

    Article  CAS  PubMed  Google Scholar 

  16. Feragen KJ, Semb G, Magnussen S (1999) Asymmetry of left versus right unilateral cleft impairments: an experimental study of face perception. Cleft Palate Craniofac J 36:527–532

    Article  CAS  PubMed  Google Scholar 

  17. Cleves M, Arboleda C, Bermudez B, et al (2009) Reliability of the perceptual evaluation of MP# speech samples. In: Proceedings of the 63rd meeting of the American Cleft Palate-Craniofacial Association, p 104

  18. PAHO/WHO (2008) Technical information system: regional mortality database; PAHO, 2008. Health situation in the Americas. http://www.who.int/pmnch/topics/americas_2008indicators/en/index.html

  19. English M, Lanata C F, Ngugi I, et al (2006) Priorities: disease control priorities in developing countries. DCPP publications, 2nd edn. Oxford University Press. New York, pp 1211–1228, www.dcp2.org

  20. Anastassov GE, Joos U, Zollner B (1998) Evaluation of the results of delayed rhinoplasty in cleft lip and palate patients: functional and aesthetic implications and factors that affect successful nasal repair. Br J Oral Maxillofac Surg 36:416–424

    Article  CAS  PubMed  Google Scholar 

  21. Asher-McDade C, Brattstrom V, Dahl E et al (1992) The RP: a six-center international study of treatment outcome in patients with clefts of the lip and palate. Part 4. Assessment of nasolabial appearance. Cleft Palate Craniofac J 29:409–412

    Article  CAS  PubMed  Google Scholar 

  22. Becker M, Svensson H, Jacobsson S (1998) Clinical examination compared with morphometry of digital photographs for evaluation of repaired cleft lips. Scand J Plast Reconstr Surg Hand Surg 32:301–306

    Article  CAS  PubMed  Google Scholar 

  23. Glass L, Starr CD (1979) A study of relationships between judgments of speech and appearance of patients with orofacial clefts. Cleft Palate J 16:436–440

    CAS  PubMed  Google Scholar 

  24. Schneiderman CR, Harding JB (1984) Social ratings of children with cleft lip by school peers. Cleft Palate J 21:219–223

    CAS  PubMed  Google Scholar 

  25. Tobiasen JM (1987) Social judgments of facial deformity. Cleft Palate J 24:323–327

    CAS  PubMed  Google Scholar 

  26. Tobiasen JM, Hiebert JM (1993) Combined effects of severity of cleft impairment and facial attractiveness on social perception: an experimental study. Cleft Palate Craniofac J 30:82–86

    Article  CAS  PubMed  Google Scholar 

  27. Tobiasen JM, Hiebert JM (1993) Clefting and psychosocial adjustment: influence of facial aesthetics. Clin Plast Surg 20:623–631

    CAS  PubMed  Google Scholar 

  28. Vegter F, Mulder JW, Hage JJ (1997) Major residual deformities in cleft patients: a new anthropometric approach. Cleft Palate Craniofac J 34:106

    Article  CAS  PubMed  Google Scholar 

  29. Al-Omari I, Millett DT, Ayoub AF et al (2003) An appraisal of three methods of rating facial deformity in patients with repaired complete unilateral cleft lip and palate. Cleft Palate Craniofac J 40:530–537

    Article  CAS  PubMed  Google Scholar 

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Acknowledgments

We thank all the volunteers involved in this process and Operation Smile’s regional and local offices for their support during the development and implementation of the Outcomes Program. Their efforts made patient follow-up and data collection possible. Additionally, we acknowledge the Operation Smile Board of Directors for their guidance throughout the process and assurance that the program was transparent and met the goals of the organization.

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Authors and Affiliations

  1. Operation Smile, Inc., 6435 Tidewater Drive, Norfolk, VA, 23509, USA

    Luis Bermudez, Victoria Carter, William Magee Jr., Randy Sherman & Ruben Ayala

Authors
  1. Luis Bermudez
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  2. Victoria Carter
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  3. William Magee Jr.
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  4. Randy Sherman
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  5. Ruben Ayala
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Corresponding author

Correspondence to Luis Bermudez.

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Bermudez, L., Carter, V., Magee, W. et al. Surgical Outcomes Auditing Systems in Humanitarian Organizations. World J Surg 34, 403–410 (2010). https://doi.org/10.1007/s00268-009-0253-6

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  • DOI: https://doi.org/10.1007/s00268-009-0253-6

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