Conference Coverage

Survey: Humanitarian surgical groups need best-practices guidelines

 

Key clinical point: The clinical practice of some humanitarian surgical organizations deviated from standard practice, suggesting a need for NGO-specific guidelines.

Major finding: The most common deviations from standard practice were in pain management (18%), preoperative workup (16%), and operative technique (16%).

Study details: 30 Responses from a survey of 83 organizations that provide general or subspecialty care through short-term surgical missions.

Disclosures: Study authors reported no conflicts.

Source: Johnston PF et al. Abstract SF121 presented at the American College of Surgeons Clinical Congress.


 

AT THE ACS CLINICAL CONGRESS

– A survey of U.S. humanitarian surgical non-governmental organizations (NGOs) revealed a range of practices and suggests that a best-practices guide would be beneficial in helping them adhere more closely to standard protocols.

While most NGOs follow guideline-based practices, some deviations from standard of care do occur. Deviations occurred most often in the areas of preoperative workup, operative technique, and pain management, according to survey results presented at the annual clinical congress of the American College of Surgeons.

Consensus guidelines specific to the NGO sector would be used by the great majority of NGOs surveyed, reported Peter F. Johnston, MD, a general surgery resident and the Ben Rush Global Surgery Fellow at Rutgers New Jersey Medical School.

“There is a lot of heterogeneity in the sector, based on the different organizations doing general surgery and organizations doing plastics,” Dr. Johnston said in an interview. “What we think we can do in terms of low-hanging fruit is come up with guidelines for things like perioperative antibiotics that are pretty much common to all types of surgeries.”

The survey conducted by Dr. Johnston and colleagues is one of the first to characterize the clinical practices of U.S. humanitarian organizations that provide general or subspecialty care through short-term surgical missions. It was completed by representatives of 30 of 83 organizations (36%) that were contacted.

Of respondents, 20% said their organizations deviated from standard U.S. practice often or very often, Dr. Johnston said in his presentation. The respondents mentioned deviation from standard practice in pain management (18%), preoperative workup (16%), and operative technique (16%).

Only about one-third of respondents said they believed those deviations impacted patient outcomes, the results show.

In all, 67% of respondents adhered to at least four protocol-driven practices. Those NGOs that adhered most closely to standard protocol tended to be older, more established organizations, compared with those less protocolized organizations, according to Dr. Johnston (age of organization 22 vs. 14 years, P < .05).

“It makes sense... from my own experience of going back to the same countries,” said Dr. Johnston, who has participated in missions in countries including Ghana, Sierra Leone, and Peru. “As an organization, and even within different countries, the process gets smoother as you keep working at it.”

A total of 85% of respondents expressed interest in best-practice guidelines to guide short-term surgical missions, according to the survey data.

Dr. Johnston reported no conflicts of interest related to his presentation.

SOURCE: Johnston P, et al. Abstract SF121 presented at the American College of Surgeons Clinical Congress.

Next Article: