Plastic Surgery Research Council
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PSRC 60th Annual Meeting
Program and Abstracts

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Outcomes of a Hand Surgery Mission to Honduras
Carolyn Chuang, BS1, Jacob Azurdia, MD2, David Asuzu, PhD1, Kyle Ragins, BA1, Grant Thomson, MD1.
1Yale School of Medicine, New Haven, CT, USA, 2University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA.

PURPOSE:
The purpose of this study was to assess functional, quality-of-life, and satisfaction outcomes of a hand surgery mission to Honduras and whether certain patient demographics and surgery characteristics during a surgical mission are correlated with outcome measurements. There exists limited research about outcomes in surgical missions due to the complicated logistical task of follow-up in a foreign country.
METHODS:
The population studied included 63 patients who received upper extremity surgery at a week-long hand surgery mission to Honduras in March 2013. Before receiving surgery, participants completed the pre-operative Quality Improvement Survey, QuickDASH, and SF12. Three months post-operatively, participants completed the post-operative Satisfaction Survey, QuickDASH, and SF12. Linear correlations of patient characteristics with QuickDASH and SF12 outcome, along with linear correlations of additional outcome measurements with QuickDASH and SF12 outcome, were performed in Stata.


RESULTS:
Demographics measures of age, years of education, and family income did not significantly correlate with change in QuickDASH score. Preoperative QuickDASH scores showed statistically significant correlation with surgery type: syndactyly/polydactyly (p=0.01) and mass excision (p=0.003) patients had the lowest scores (best functioning), while carpal tunnel (p<0.001) patients had the highest scores (worst functioning). Postoperative QuickDASH scores also statistically significantly correlated with surgery type: syndactyly/polydactyly (p=0.05) and mass excision (p=0.002) patients had the lowest scores, while tendon transfer/repair (p=0.045) patients had the highest scores. Carpal tunnel patients had a significant higher magnitude of QuickDASH improvement (p=0.005) compared to other surgical interventions.
Increased satisfaction with hand movement and satisfaction with surgery results were correlated with better pre-surgical and post-surgical QuickDASH score. Increased self-reported understanding of surgery was statistically significant for correlation with better post-surgical QuickDASH score.
SF12 scores experienced modest changes from the pre-operative to post-operative time point with changes of less than ten points in all categories.




CONCLUSION:
In general, hand surgery performed during short-term surgical missions can result in significant functional improvement, regardless of socioeconomic status. Simple operations have higher functional improvement compared to more complex operations. However, barriers still exist to improvement of general health-related quality of life in Honduran surgical mission patients. Further research on outcomes of different types of surgical missions to various low and middle-income countries is necessary to enable broader conclusions to be made. Results of these outcomes studies could potentially support future guidelines regarding best practices in surgical missions.


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