Surgical mission planning in the developing world

Surgical missions to the developing world have been criticized for their lack of outcome analysis. Reported studies indicate a high rate of postoperative complications. An integrated pathway developed for surgical missions and a report of its performance in action is presented herein. Patients were optimized for surgery by a medical team from the UK for a minimum of 14 days preoperatively. They were then transferred to hospital for surgery and returned when stable. At the completion of the mission a junior doctor remained behind for 3 weeks to chart the patients' progress. Thirty case patients were treated over a 2-week period. The complication rate at 3 weeks postoperatively was 7/30. Twenty-two operations were classified as complex (over 1 h with more than one flap) and eight as simple (under 1 h with minimal flaps). Of those undergoing the simple operations, 2/8 encountered complications at an average of 5 days postoperatively (range 3-7 days). Many medical teams depart in an elevated atmosphere of accomplishment, which without an outcome analysis gives a false impression of their positive impact. Outcome analysis is essential to honestly appraise the effect of surgical missions.