J. S. Broecker1, J. Rappaport1, W. Liu1, C. Poorman1, M. Lagina1, L. Philipp1, J. Srinivasan2, J. Sharma2 1Emory University,School Of Medicine,Atlanta, GA, USA 2Emory University,Department Of Surgery,Atlanta, GA, USA
Introduction:
Achieving adequate follow-up for surgical patients is challenging in resource-poor environments, especially for short-term surgical trips. The aim of this study was to evaluate the extent of follow-up for a short-term surgical trip, to evaluate the success of using mobile phones to reach patients at least one year post-operatively, and to evaluate post-surgical quality of life.
Methods:
At a single institution, the School of Medicine and Department of Surgery have provided surgical care yearly to patients at a public hospital in the central plateau of Haiti since 2008. During the 2016 surgical trip, operative patients from 2014-2015 trips were called on mobile phones to invite to clinic for further evaluation. Patients who were unable to return to clinic were interviewed over the phone. Clinical data from patients’ clinic visits or phone interviews were then reviewed. Post-surgical quality of life was determined using an institution-generated tool that measured patients’ ability to perform activities of daily living (ADLs). For patients who underwent a prostatectomy, the tool also incorporated the International-Prostate Symptom Score (I-PSS), and measured the extent of obstructive urinary symptoms.
Results:
With a mean length of follow-up of 17.8 months (range: 3-60), follow-up was achieved in 34 (28%) of 122 operative patients. 19 (56%) of these patients returned to clinic, 25 (74%) were able to be reached by phone, and 2 (6%) were reached via another source. Prior to using mobile phones to facilitate follow-up, during 2014 and 2015 clinics, four post-operative patients followed-up in clinic. Follow-up patients had received the following operations: 14 (41%) inguinal hernia repair, 8 (24%) open prostatectomy, 5 (15%) lipoma removal, 2 (6%) hydrocelectomy, 1 (3%) cystoscopy and dilation, 1 (3%) celiotomy for bilateral kidney stone obstruction, 1 (3%) meatoplasty, and 1 (3%) drainage for enlarged cervical lymph nodes. Mean age was 44 (range: 6-76). Mean minutes of travel time for patients was 65 minutes (range: 5-300 minutes); and the majority of patients used motorcycle to travel to clinic. There was a 41% improvement in patients’ ability to complete activities of daily living (ADLs) and a 38% reduction in patients who reported pain from the pre-operative to the post-operative time period. Among the prostatectomy patients, 7 (88%) pre-op vs 0 post-op were catheter-dependent.
Conclusion:
Achieving long-term follow-up for operative patients following short-term surgical trips is challenging but mobile phones facilitate patient follow-up. Barriers encountered that limited the extent of patient follow-up included language barriers, limited means of communication with patients, far distance for patients to travel, and limited time in country. The follow-up data obtained demonstrates that quality of life appears to improve after short-term surgical trips.