Measuring The Disability Averted Through Surgery For 14 Pediatric Congenital Conditions In A Kenyan Hospital

Sunday, October 27, 2013: 10:40 AM
Windermere Ballroom W (Hyatt Regency Orlando, formerly the Peabody)
Dan Poenaru, MD, MHPE1, Julia Pemberton, MSc, PhD (c)2, Claudia Frankfurter, BHSc (c)2 and Brian H Cameron, MD2, (1)BethanyKids at MyungSung Christian Medical Center, Addis Ababa, Ethiopia, (2)McMaster University, Hamilton, ON, Canada

Purpose

The spectrum of pediatric surgical practice is different in low- and middle-income countries (LMICs) as compared to North America.  Resources are often limited but the impact of pediatric surgical procedures is significant.  The World Health Organization (WHO) is increasingly using Disability-Adjusted Life Years (DALYs) as a method of quantifying the Burden of Disease (BoD) and establishing priorities for healthcare resource allocation. The impact of pediatric surgical treatment can then be measured by averted DALYs rather than simply by numbers of cases, and compared to the impact of other medical interventions.  Congenital conditions are one of the top ten causes of pediatric morbidity and mortality worldwide, and their correction prevents a lifetime of disability.  Since calculation of DALYs requires disease-specific disability weights (DWs), we have previously used multiple health utility exercises to derive DWs for 14 pediatric surgical conditions.  The objective of this study was to calculate the DALYS averted in one Kenyan hospital for a subset of pediatric congenital anomalies. 

Methods

Surgical records of children having undergone surgical procedures for 14 congenital conditions in a Kenyan hospital were collected for 2012. DALYs for each condition were calculated using our previously obtained DWs derived in the Kenyan context. Age-adjusted life expectancy rates from the WHO were used to determine years of life lost (YLL). Risk of permanent disability without surgery (RPD) and probability of successful treatment (PST) values were obtained from the literature and included in the DALY calculation.

Results

Out of the 14 congenital conditions studied, severe abdominal wall defects and intestinal atresia led to the highest mean averted BoD per patient (38.5 and 36.3 DALYs respectively), while hydrocephalus and spina bifida accounted for the greatest total BoD averted surgically (60.4% and 18.4% respectively). The total BoD averted through the 963 surgical procedures performed in 2012 on the congenital conditions studied was 21,455 DALYs. Of the total DALYs, 7.9% fell within the traditional field of pediatric plastic surgery, 13.6% pediatric urology, 22.3% pediatric neurosurgery and 32.4% pediatric general surgery. 

Conclusion

Using DALYs to calculate the disability averted by pediatric surgery is a useful method of measuring the impact of surgery compared to other interventions.  Treating congenital surgical conditions prevents a lifetime of disability. DALYs can be used to calculate cost-effectiveness of health care interventions and cost comparisons to help allocate scarce health care resources in LMICs. Our data highlight the BoD avertable through pediatric surgery and therefore the need for adequate resource allocation, training and surgeon retention for pediatric surgery in LMICs.