World Journal of Surgery

, Volume 42, Issue 5, pp 1254–1261 | Cite as

Clinical Outcome, Social Impact and Patient Expectation: a Purposive Sampling Pilot Evaluation of Patients in Benin Seven Years After Surgery

  • Michelle C. White
  • Kirsten Randall
  • Esther Avara
  • Jenny Mullis
  • Gary Parker
  • Mark G. Shrime
Original Scientific Report

Abstract

Background

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.

Method

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.

Results

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.

Conclusion

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.

Notes

Author contributions

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.

References

  1. 1.
    Alkire BC, Raykar NP, Shrime MG et al (2015) Global access to surgical care: a modelling study. The Lancet Glob Health 3(6):e316–e323CrossRefPubMedGoogle Scholar
  2. 2.
    Shrime MG, Dare A, Alkire BC, Meara JG (2016) A global country-level comparison of the financial burden of surgery. Br J Surg 103(11):1453–1461CrossRefPubMedGoogle Scholar
  3. 3.
    Shrime MG, Dare AJ, Alkire BC, O’Neill K, Meara JG (2015) Catastrophic expenditure to pay for surgery worldwide: a modelling study. The Lancet Glob Health 3(Suppl 2):S38–S44CrossRefPubMedGoogle Scholar
  4. 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
  5. 5.
    Bolkan HA, Von Schreeb J, Samai MM et al (2015) Met and unmet needs for surgery in Sierra Leone: a comprehensive, retrospective, countrywide survey from all health care facilities performing operations in 2012. Surgery 157(6):992–1001CrossRefPubMedGoogle Scholar
  6. 6.
    Ng-Kamstra JS, Riesel JN, Arya S et al (2016) Surgical non-governmental organizations: global surgery’s unknown nonprofit sector. World J Surg 40(8):1823–1841. doi: 10.1007/s00268-016-3486-1 CrossRefPubMedGoogle Scholar
  7. 7.
    Shrime MG, Sleemi A, Ravilla TD (2015) Charitable platforms in global surgery: a systematic review of their effectiveness, cost-effectiveness, sustainability, and role training. World J Surg 39(1):10–20. doi: 10.1007/s00268-014-2516-0 CrossRefPubMedGoogle Scholar
  8. 8.
    Gil J, Rodriguez JM, Hernandez Q, Gil E et al (2012) Do hernia operations in African international cooperation programmes provide good quality? World J Surg 36(12):2795–2801. doi: 10.1007/s00268-012-1768-9 CrossRefPubMedGoogle Scholar
  9. 9.
    Bermudez L, Carter V, Magee W Jr, Sherman R, Ayala R (2010) Surgical outcomes auditing systems in humanitarian organizations. World J Surg 34(3):403–410. doi: 10.1007/s00268-009-0253-6 CrossRefPubMedGoogle Scholar
  10. 10.
    White M, Alcorn D, Randall K et al (2017) Evaluation of patient satisfaction, impact and disability-free survival after a surgical mission in Madagascar: a pilot survey. World J Surg 41(2):364–367. doi: 10.1007/s00268-016-3745-1 CrossRefPubMedGoogle Scholar
  11. 11.
    Schonmeyr B, Wendby L, Sharma M et al (2015) Speech and speech-related quality of life after late palate repair: a patient’s perspective. The J Craniofac Surg 26(5):1513–1516CrossRefPubMedGoogle Scholar
  12. 12.
    Wong DL, Baker CM (1988) Pain in children: comparison of assessment scales. Pediatr Nurs 14(1):9–17PubMedGoogle Scholar
  13. 13.
    Henerson ME, Morris LL, Fitz CT (1987) How to measure attitudes. Sage Publications, Newsbury ParkGoogle Scholar
  14. 14.
    Macrae WA (2008) Chronic post-surgical pain: 10 years on. Br J Anaesth 101(1):77–86CrossRefPubMedGoogle Scholar
  15. 15.
    Reddi D, Curran N (2014) Chronic pain after surgery: pathophysiology, risk factors and prevention. Postgrad Med J 90(1062):222–227 quiz 6 CrossRefPubMedGoogle Scholar
  16. 16.
    Fuzier R, Puel F, Izard P, Sommet A, Pierre S (2017) Prospective cohort study assessing chronic pain in patients following minor surgery for breast cancer. J Anesth 31(2):246–254CrossRefPubMedGoogle Scholar
  17. 17.
    Bjornnes AK, Parry M, Lie I et al (2016) Pain experiences of men and women after cardiac surgery. J Clin Nurs 25(19–20):3058–3068CrossRefPubMedGoogle Scholar
  18. 18.
    Grimes CE, Bowman KG, Dodgion CM, Lavy CB (2011) Systematic review of barriers to surgical care in low-income and middle-income countries. World J Surg 35(5):941–950. doi: 10.1007/s00268-011-1010-1 CrossRefPubMedGoogle Scholar
  19. 19.
    Irfan FB, Irfan BB, Spiegel DA (2012) Barriers to accessing surgical care in Pakistan: healthcare barrier model and quantitative systematic review. The J Surg Res 176(1):84–94CrossRefPubMedGoogle Scholar
  20. 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
  21. 21.
    Massenburg BB, Jenny HE, Saluja S et al (2016) Barriers to cleft lip and palate repair around the world. The J Craniofac Surg 27(7):1741–1745CrossRefPubMedGoogle Scholar
  22. 22.
    Lin BM, White M, Glover A et al (2016) Barriers to surgical care and health outcomes: a prospective study on the relation between wealth, sex, and postoperative complications in the Republic of Congo. World J Surg 41(1):14–23. doi: 10.1007/s00268-016-3676-x CrossRefGoogle Scholar
  23. 23.
    Kadaluru UG, Kempraj VM, Muddaiah P (2012) Utilization of oral health care services among adults attending community outreach programs. Indian J Dent Res Off Publ Indian Soc Dent Res 23(6):841–842CrossRefGoogle Scholar
  24. 24.
    Nagarajan N, Gupta S, Shresthra S et al (2015) Unmet surgical needs in children: a household survey in Nepal. Pediatr Surg Int 31(4):389–395CrossRefPubMedGoogle Scholar
  25. 25.
    Zhang XJ, Jhanji V, Leung CK et al (2014) Barriers for poor cataract surgery uptake among patients with operable cataract in a program of outreach screening and low-cost surgery in rural China. Ophthalmic Epidemiol 21(3):153–160CrossRefPubMedGoogle Scholar
  26. 26.
    Nguyen K, Bhattacharya SD, Maloney MJ et al (2013) Self-reported barriers to pediatric surgical care in Guatemala. The Am Surg 79(9):885–888PubMedGoogle Scholar
  27. 27.
    Poilleux J, Lobry P (1991) Surgical humanitarian missions. An experience over 18 years. Chirurgie; memoires de l’Academie de chirurgie 117(8):602–606PubMedGoogle Scholar
  28. 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. 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
  30. 30.
    Cousins GR, Obolensky L, McAllen C, Acharya V, Beebeejaun A (2012) The Kenya orthopaedic project: surgical outcomes of a travelling multidisciplinary team. The J Bone and Joint Surg Br 94(12):1591–1594CrossRefGoogle Scholar
  31. 31.
    Taiwo AOAW, Braimah RO, Ibikunle AA (2016) A prospective, single center analysis of satisfaction following cleft lip and palate surgeries in Southwest Nigeria. J Cleft Lip Palate Craniofac Anom 3(1):9–13CrossRefGoogle Scholar
  32. 32.
    Baker DP, Leon J, Smith Greenaway EG, Collins J, Movit M (2011) The education effect on population health: a reassessment. Popul Dev Rev 37(2):307–332CrossRefPubMedPubMedCentralGoogle Scholar
  33. 33.
    Jourdan C, Poiraudeau S, Descamps S et al (2012) Comparison of patient and surgeon expectations of total hip arthroplasty. PLoS ONE 7(1):e30195CrossRefPubMedPubMedCentralGoogle Scholar
  34. 34.
    Bowling A, Rowe G, Lambert N et al (2012) The measurement of patients’ expectations for health care: a review and psychometric testing of a measure of patients’ expectations. Health Technol Assess 16(30):i-xii–1–509 (Winchester, England) CrossRefGoogle Scholar
  35. 35.
    Kane RL, Maciejewski M, Finch M (1997) The relationship of patient satisfaction with care and clinical outcomes. Med Care 35(7):714–730CrossRefPubMedGoogle Scholar
  36. 36.
    Thompson AG, Sunol R (1995) Expectations as determinants of patient satisfaction: concepts, theory and evidence. Int J Qual Health Care J Int Soc Qual Health Care 7(2):127–141CrossRefGoogle Scholar
  37. 37.
    de Buys Roessingh AS, Dolci M, Zbinden-Trichet C et al (2012) Success and failure for children born with facial clefts in Africa: a 15-year follow-up. World J Surg 36(8):1963–1969. doi: 10.1007/s00268-012-1607-z CrossRefPubMedGoogle Scholar
  38. 38.
    Riviello R, Scott JW (2016) Closing the data gaps for surgical care delivery in LMICs. The Lancet Glob Health 4(3):e138–e139CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2017

Authors and Affiliations

  • Michelle C. White
    • 1
    • 2
  • Kirsten Randall
    • 1
  • Esther Avara
    • 1
  • Jenny Mullis
    • 1
  • Gary Parker
    • 1
  • Mark G. Shrime
    • 1
    • 3
    • 4
  1. 1.M/V Africa Mercy, Mercy ShipsPort Au CotonouBenin
  2. 2.Great Ormond Street Children’s HospitalLondonUK
  3. 3.Program in Global Surgery and Social Change, Department of Global Health and Social MedicineHarvard Medical SchoolBostonUSA
  4. 4.Department of OtolaryngologyMassachusetts Eye and Ear InfirmaryBostonUSA

Personalised recommendations