S. R. Addington1, A. Matousek1,3, C. Exe2, R. R. Jean-Louis2, H. Sannon2, J. G. Meara3, R. Riviello1,3 1Brigham And Women’s Hospital,The Center Of Surgery And Public Health,Boston, MA, USA 2Hospital Albert Schweitzer,Surgery,Deschapelles, ARTIBONITE, Haiti 3Harvard Medical School,The Program In Global Surgery And Social Change, Department Of Global Health And Social Medicine,Boston, MA, USA
Introduction: Short-term surgical teams (STSTs) offer the potential to increase surgical capacity, provide specialty services and create educational opportunities for local staff. They also often gain exposure to advanced pathology, improved physical examination skills and practice patterns with limited resources from experienced local providers. In the absence of outcome data, STSTs often use productivity as a metric of impact. We set out to determine whether STSTs increase operative volume at an NGO hospital in rural Haiti.
Methods: We retrospectively reviewed the operative log at an NGO hospital in rural Haiti from Jan 1st, 2013 through July 1st, 2014. We compared the mean number of operations performed on weekdays when STSTs were present and absent. We also analyzed the relative contributions of STSTs and local staff surgeons to the operative volume.
Results: The sample included 1976 operations completed over 399 weekdays. During the study period, 53 individuals comprising 22 STSTs were present for 118 of the 399 weekdays (29.6%). STSTs were associated with a modest increase in operative volume (5.83 vs. 4.58 operations/day, p= 0.0024) that accounted for approximately 100 additional procedures per year. STSTs did not perform as many operations as the local staff did during their stays (2.11 vs. 3.72 operations/day, p=0.0001). STSTs were also associated with a decrease in local staff productivity (3.72 vs. 4.58 operations/day, p=0.025).
Conclusion: STSTs were associated with a modest increase in operative volume partially mitigated by a decrease in local staff productivity. STSTs offer many benefits to hospitals in LMICs, but must be well coordinated and integrated into existing systems to maximize potential benefits.