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• W2117468574 abstract "The poorest third of the world's population is estimated to receive only 3·5% of the 234 million surgical procedures undertaken annually.1Weiser TG Regenbogen SE Thompson KD et al.An estimation of the global volume of surgery: a modelling strategy based on available data.Lancet. 2008; 372: 139-144Summary Full Text Full Text PDF PubMed Scopus (1651) Google Scholar Despite being a small proportion of global surgical output, such procedures represent a substantial challenge for health-care providers in low-resource settings. This challenge is compounded by the burden of managing postoperative complications (particularly delayed complications), which patients might not present with, as evidenced by the low rates of follow-up in many low-income and middle-income countries.2Limburg H Foster A Gilbert C Johnson GJ Kyndt M Myatt M Routine monitoring of visual outcome of cataract surgery. Part 2: results from eight study centres.Br J Ophthalmol. 2005; 89: 50-52Crossref PubMed Scopus (57) Google Scholar In the context of cataract surgery, Nathan Congdon and colleagues (August, p e37)3Congdon N Yan X Lansingh V et al.Assessment of cataract surgical outcomes in settings where follow-up is poor: PRECOG, a multicentre observational study.Lancet Glob Health. 2013; 1: e37-e45Summary Full Text Full Text PDF Scopus (44) Google Scholar propose the possibility of using early postoperative assessment of all patients or late assessment only of those who return for follow-up without additional prompting as practicable methods to improve long-term patient outcomes in settings where barriers to adequate post-operative follow-up exist. Such approaches would be feasible in many resource-limited settings, and where appropriate should be extended to postoperative follow-up of other surgical procedures. However, a potential exists for many patients to slip through the net by not returning for follow-up assessment despite developing harmful postoperative complications. Paternalistic medicine persists in many developing countries. Yousuf and colleagues4Yousuf RM Fauzi ARM How SH Rasool AG Rehana K Awareness, knowledge and attitude towards informed consent among doctors in two different cultures in Asia: a cross-sectional comparative study in Malaysia and Kashmir, India.Singapore Med J. 2007; 48: 559-565PubMed Google Scholar reported that most patients in Srinigar, India, avoid the responsibility of decision making and defer this responsibility to the doctor. Where self-reporting contradicts socially and culturally mediated beliefs, systems that rely on this mechanism might not be able to ensure continuity in patient care. We therefore recommend a protocol wherein the doctor explicitly advises the patient to return should they experience predefined complications. Furthermore, the health-care provider should attempt to facilitate travel and rebooking where possible. We declare that we have no conflicts of interest. Surgical follow-up in low-income and middle-income countries – Authors' replyWe thank Rele Ologunde and Sohaib Rufai for their interest in our study.1 Their conclusions echo those of the Comment by Yuzhen Jiang and Paul Foster2 that accompanied our report, in accepting the usefulness of early assessment of cataract surgery, while also stressing that good follow-up is crucial to “detect and treat postoperative complications in a timely manner”.2 Ologunde and Rufai suggest that doctors should actively advise patients when to return in order to promote compliance. Full-Text PDF Open Access" @default.
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• W2117468574 title "Surgical follow-up in low-income and middle-income countries" @default.
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• W2117468574 doi "https://doi.org/10.1016/s2214-109x(13)70061-5" @default.
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