The clinical and economic impact of a sustained program in global plastic surgery: valuing cleft care in resource-poor settings.

Journal Article (Multicenter Study;Journal Article)


The development of surgery in low- and middle-income countries has been limited by a belief that it is too expensive to be sustainable. However, subspecialist surgical care can provide substantial clinical and economic benefits in low-resource settings. The goal of this study is to describe the clinical and economic impact of recurrent short-term plastic surgical trips in low- and middle-income countries.


The authors conducted a retrospective review of clinic and operative logbooks from Hands Across the World's surgical experience in Ecuador. The authors calculated the disability-adjusted life-years averted to estimate the clinical impact of cleft repair and then calculated the economic impact of surgical intervention for cleft disease.


One thousand one hundred forty-two reconstructive surgical cases were performed over 15 years. Surgery was most commonly performed for scar contractures [449 cases (39.3 percent)], of which burn scars comprised a substantial amount [215 cases (18.8 percent)]. There were 40 postoperative complications within 7 days of operation (3.5 percent), and partial wound dehiscence was the most common complication [16 of 40 (40 percent)]. Cleft disorders constituted 277 cases (24.3 percent), and 102 cases were primary cleft lip and/or palate cases. Between 396 and 1042 total disability-adjusted life-years were averted through surgery for these 102 cases of primary cleft repair. This translates to an economic benefit between $4.7 million (human capital approach) and $27.5 million (value of a statistical life approach).


Plastic surgical disease is a significant source of morbidity for patients in resource-limited regions. Dedicated programs that provide essential reconstructive surgery can produce substantial clinical and economic benefits to host countries.

Full Text

Duke Authors

Cited Authors

  • Hughes, CD; Babigian, A; McCormack, S; Alkire, BC; Wong, A; Pap, SA; Vincent, JR; Meara, JG; Castiglione, C; Silverman, R

Published Date

  • July 2012

Published In

Volume / Issue

  • 130 / 1

Start / End Page

  • 87e - 94e

PubMed ID

  • 22743958

Electronic International Standard Serial Number (EISSN)

  • 1529-4242

International Standard Serial Number (ISSN)

  • 0032-1052

Digital Object Identifier (DOI)

  • 10.1097/prs.0b013e318254b2a2


  • eng