The Impact of Short-Term Reconstructive Surgical Missions: A Systematic Review and Analysis

Background Short-term missions providing reconstructive surgery to patients in low-income countries are often criticized because evidence of their value is lacking. This study aims to assess the effectiveness of short-term reconstructive surgical missions in low- and middle-income countries. Methods A systematic review was conducted according to PRISMA guidelines. We searched 5 medical databases from inception up to July 2, 2018. Included were original studies on short-term reconstructive surgical missions, that reported on basic characteristics of missions and patient safety measurements, health gains of individual patients or sustainability. Data were combined to generate overall outcomes, including overall complication rates. PROSPERO registration: CRD42018099285. Findings Of 1662 identified studies, 41 met full inclusion criteria, including 48,546 patients. The overall study quality according to Oxford CEBM and GRADE was low. Ten studies reported a minimum of 6 months follow-up, showing a follow-up rate of 56.0% and a complication rate of 22.3%. Twelve studies that did not report on duration or rate of follow-up, reported a complication rate of 1.2%. Fifteen out of 20 studies (75%) that reported on follow-up, also reported on sustainable characteristics. Interpretation Evidence on the patient outcomes of reconstructive surgical missions is scarce and of limited quality. Higher complication rates were reported in studies which explicitly mentioned the duration and rate of follow-up. Studies with a low quality of follow-up, might under-report on complication rates and overestimate the positive impact of missions. This review indicates that missions should develop towards sustainable partnerships, which are able to provide quality aftercare, follow-up and build surgical capacity of local healthcare systems. Funding: None Declaration of Interest: All authors declare no competing interests.