Clinical Outcome, Social Impact and Patient Expectation: a Purposive Sampling Pilot Evaluation of Patients in Benin Seven Years After Surgery
Access to affordable and timely surgery is not equitable around the world. Five billion people lack access, and while non-governmental organizations (NGOs) help to meet this need, long-term surgical outcomes, social impact or patient experience is rarely reported.
In 2016, Mercy Ships, a surgical NGO, undertook an evaluation of patients who had received surgery seven years earlier with Mercy Ships in 2009 in Benin. Using purposive sampling, patients who had received maxillofacial, plastics or orthopedic surgery were invited to attend a surgical evaluation day. In this pilot study, we used semi-structured interviews and questionnaire responses to assess patient expectation, surgical and social outcome.
Our results show that seven years after surgery 35% of patients report surgery-related pain and 18% had sought further care for a clinical complication of their condition. However, 73% of patients report gaining social benefit from surgery, and overall patient satisfaction was 89%, despite 35% of patients saying that they were unclear what to expect after surgery indicating a mismatch of doctor/patient expectations and failure of the consent process.
In conclusion, our pilot study shows that NGO surgery in Benin provided positive social impact associated with complication rates comparable to high-income countries when assessed seven years later. Key areas for further study in LMICs are: evaluation and treatment of chronic pain, consent and access to further care.
MW and KR conceived and designed the study. EA, JM and GP acquired the data. MW, KR and MGS contributed to data interpretation and analysis. MW wrote the first draft of the manuscript, and all authors were involved in critical revision of the article and approved the final version for publication.
Compliance with ethical standards
Conflict of interests
Mark G. Shrime receives funds from the Damon Runyon Cancer Research Foundation and from the GE Safe Surgery 2020 project. The other authors have no conflicts of interest to declare.
- 4.Uribe-Leitz T, Jaramillo J, Maurer L et al (2016) Variability in mortality following caesarean delivery, appendectomy, and groin hernia repair in low-income and middle-income countries: a systematic review and analysis of published data. The Lancet Glob Health 4(3):e165–e174CrossRefPubMedGoogle Scholar
- 13.Henerson ME, Morris LL, Fitz CT (1987) How to measure attitudes. Sage Publications, Newsbury ParkGoogle Scholar
- 20.Lerman BJ, Alsan M, Chia NJ, Brown JA, Wren SM (2016) Beyond infrastructure: understanding why patients decline surgery in the developing world: an observational study in Cameroon. Ann SurgGoogle Scholar
- 28.Maine RG, Hoffman WY, Palacios-Martinez JH, Corlew DS, Gregory GA (2012) Comparison of fistula rates after palatoplasty for international and local surgeons on surgical missions in Ecuador with rates at a craniofacial center in the United States. Plast Reconstr Surg 129(2):319e–326eCrossRefPubMedGoogle Scholar
- 29.Kim FS, Tran HH, Sinha I et al (2012) Experience with corrective surgery for postburn contractures in Mumbai, India. J Burn Care Res Off Publ Am Burn Assoc 33(3):e120–e126Google Scholar