Revisiting guidelines for global plastic and reconstructive surgical initiatives: Recommendations from a scoping review of two decades of published evidence.

Abstract

We have an opportunity to strengthen guidelines for global surgical initiatives, such as those established by the American Society of Plastic Surgeons (ASPS) and Lancet Commission on Global Surgery (LCOGS). To recommend improvements supporting health system resilience, we conducted a qualitative scoping review and thematic analysis of the literature on global surgical initiatives in Plastic and Reconstructive Surgery (PRS) and similar surgical and perioperative specialties. We queried four medical databases for publications from 2006 to 2023 pertaining to humanitarian surgical initiatives in PRS, otolaryngology, orthopedic surgery, ophthalmology, and anesthesiology. Two authors screened 1327 articles, yielding 366 articles for analysis with 91 qualitative markers/codes developed from the Partners in Health 5S framework (staff, stuff, space, systems, social support). We compared our findings with example guidelines from ASPS and LCOGS and provided evidence-based recommendations. The most discussed codes are staff education and training in the host country (39% of articles), surgical outreach sustainability (33%), and post-operative management (31%). Some important, but less frequently identified codes, include medical translators (11%), funding to offset patient cost burden (5%), and patient satisfaction (3%). Codes such as telehealth, patient-reported outcomes, cost burden, and medical translators were not identified in ASPS or LCOGS guidelines. We recommend that global surgical initiative guidelines (e.g., ASPS and LCOGS) be revisited to emphasize host capacity-building and offsetting costs associated with surgical care, extending existing recommendations to address barriers to patient care. Our findings can assist global surgical initiatives in ensuring safe, high-quality care delivery and strengthening local health systems.