Helping Hands: A Cost-Effectiveness Study of a Humanitarian Hand Surgery Mission

Table 3

DALY averted.

Case; #	Age	Remaining life expectancy	Sex	Diagnosis	Procedure	Disability Wt.	DALY	Likelihood of permanent disability	Likelihood of treatment success	DALY averted
Day 1
1	9	77.27	F	Tendon adhesion	L wrist exploration w/tenolysis FDP	0.024	1.85448	0.7	0.7	0.9086952
2	16	70.3	M	Finger flexor tendon injury	R index finger Hunter rod placement	0.024	1.6872	0.7	0.7	0.826728
3	26	60.41	M	Finger flexor tendon injury and nerve laceration	R FPL repair w/tendon grafts; nerve repair with sural nerve graft	0.136	8.21576	0.7	0.7	4.0257224
4	60	27.81	M	Posttraumatic joint contracture	R long finger PIP joint arthrodesis	0.024	0.66744	0.7	0.7	0.3270456
5	68	20.68	F	Trigger finger	R LF trigger finger release	0.024	0.49632	0.7	0.7	0.2431968
6	3	83.23	F	Finger flexor tendon injury	L ring finger FDS/FDP-Hunter rod implant	0.024	1.99752	0.7	0.7	0.9787848
7	13	73.29	M	Cubitus varus	L lateral closing wedge osteotomy of supracondylar for cubitus varus	0.013	0.95277	0.7	0.7	0.4668573
8	14	72.29	M	Polydactyly	B/l thumb partial duplication repair; anlage excision	0.013	0.93977	0.7	0.7	0.4604873
9	47	39.9	M	Lipoma	Excision of L forearm mass	0.029	1.1571	0.7	0.7	0.566979
10	57	30.55	F	Trigger finger	R IF and LF trigger finger release	0.024	0.7332	0.7	0.7	0.359268
11	11	75.28	M	Burn scar contracture	L forearm excision of burn scar; STSG	0.018	1.35504	0.3	0.7	0.2845584
12	12	74.28	M	Burn scar contracture	R hand thumb webs space deepening with split thickness skin graft	0.024	1.78272	0.3	0.7	0.3743712
13	21	65.36	F	Partial traumatic amputation	L RF amputation completion	0.03	1.9608	0.7	0.7	0.960792
14	30	56.46	F	Nerve laceration	Nerve graft L ulnar nerve; anticlaw tendon transfer	0.136	7.67856	0.7	0.7	3.7624944
15	34	52.52	M	Skin contracture	L middle PIP contracture release and skin graft	0.024	1.26048	0.7	0.7	0.6176352
16	47	39.9	M	Radius and ulna fracture	ORIF L radius/ulna	0.065	2.5935	0.3	0.7	0.544635
Day 2
17	8	78.26	M	Metacarpal fracture	R LF pinning of metacarpal fracture	0.024	1.87824	0.7	0.7	0.9203376
18	11	75.28	M	Cubitus varus	R supracondylar osteotomy	0.013	0.97864	0.7	0.7	0.4795336
19	21	65.36	M	Burn scar contracture	R IF burn contracture release; FTSG	0.018	1.17648	0.7	0.7	0.5764752
20	45	41.8	M	Posttraumatic joint contracture	L index and long finger PIP fusion	0.024	1.0032	0.7	0.7	0.491568
21	48	38.95	M	Carpal tunnel syndrome	L carpal tunnel release	0.065	2.53175	0.7	0.7	1.2405575
22	51	36.12	F	Ganglion cyst	Excision of R wrist mass	0.029	1.04748	0.7	0.7	0.5132652
23	67	21.55	M	Dupuytren's contracture	L hand excision of Dupuytren's contracture	0.114	2.4567	0.7	0.7	1.203783
24	5	81.25	M	Burn scar contracture	R hand burn contracture release	0.018	1.4625	0.7	0.7	0.716625
25	7	79.26	M	Polydactyly	Reconstruction of R thumb polydactyly	0.013	1.03038	0.7	0.7	0.5048862
26	19	67.34	F	Tumor	Excision of L hand mass	0.029	1.95286	0.7	0.7	0.9569014
27	21	65.36	M	Tumor	Excision of bony tumor ×2 of L humerus	0.029	1.89544	0.7	0.7	0.9287656
28	31	55.48	M	Dorsal ganglion cyst	Excision of ganglion cyst	0.029	1.60892	0.7	0.7	0.7883708
29	42	44.71	F	Nonunion radius	Repair nonunion radius	0.05	2.2355	0.7	0.7	1.095395
30	56	31.47	F	De Quervain's syndrome	De Quervain’s release	0.114	3.58758	0.7	0.7	1.7579142
31	11 mo	85.21	M	Thumb hypoplasia	R thumb amp, and pollicization	0.013	1.10773	0.7	0.7	0.5427877
32	23	63.38	M	Burn scar contracture	PIP arthrodesis; debulk flap	0.024	1.52112	0.7	0.7	0.7453488
33	33	53.5	M	Burn scar contracture	Contracture release of all fingers R hand; flexor tendon division	0.114	6.099	0.7	0.7	2.98851
34	37	49.58	F	Hook nail deformity	V-Y advancement L index fingertip	0.013	0.64454	0.7	0.7	0.3158246
35	48	38.95	M	Dupuytren's contracture	L little finger arthrodesis and k-wire for palmar scar revision w/FTSG	0.024	0.9348	0.7	0.7	0.458052
Day 3
36	8	78.26	M	Flexor tendon injury	2nd stage flexor tendon reconstruction; removal hunter rod and tendon graft from leg to finger	0.024	1.87824	0.7	0.7	0.9203376
37	10	76.27	F	Scar contracture	L hand scar revision; tenolysis; removal of k-wire	0.024	1.83048	0.7	0.7	0.8969352
38	20	66.35	M	Flexor tendon injury with nerve laceration	Repair flexor tendons wrist with tendon grafts, ulnar nerve repair with sural nerve graft	0.136	9.0236	0.7	0.7	4.421564
39	55	32.38	M	Carpal tunnel syndrome	R carpal tunnel release	0.065	2.1047	0.7	0.7	1.031303
40	5	81.25	M	Syndactyly	Syndactyly release L 4th web space	0.024	1.95	0.7	0.7	0.9555
41	17	69.32	M	Thumb hypoplasia	R thumb opponensplasty; R 1st web deepening; R thumb UCL reconstruction	0.114	7.90248	0.7	0.7	3.8722152
42	18	68.33	M	Foreign body with ulnar neuropathy	Excision of foreign body L hypothenar eminence; neurolysis ulnar nerve	0.065	4.44145	0.7	0.7	2.1763105
43	23	63.38	M	Foreign body	Bullet removal ×2 R hand	0.024	1.52112	0.7	0.7	0.7453488
44	34	52.52	M	Radial head fracture	L radial head excision	0.065	3.4138	0.7	0.7	1.672762
45	44	42.77	M	Posttraumatic joint contracture	L LF, RF, and SF PIP joint fusion	0.024	1.02648	0.7	0.7	0.5029752
46	49	38	M	Extensor tendon laceration	Tendon transfer for thumb extension PL → EPL	0.024	0.912	0.7	0.7	0.44688
47	20	66.35	M	Flexor tendon injury	Zone II IF, MF, and RF hunter rods	0.114	7.5639	0.7	0.7	3.706311
48	22	64.37	F	Posttraumatic joint contracture	L LF PIP joint arthrodesis	0.024	1.54488	0.7	0.7	0.7569912
49	22	64.37	M	Posttraumatic joint contracture	L thumb IP fusion	0.024	1.54488	0.7	0.7	0.7569912
50	47	39.9	M	Shoulder lipoma	Excision of R shoulder lipoma	0.029	1.1571	0.7	0.7	0.566979
51	61	26.91	F	Ganglion cyst and ulnocarpal abutment	R dorsal ganglion/L matched ulnar arthroplasty	0.114	3.06774	0.7	0.7	1.5031926
Day 4
52	5	81.25	M	Burn scar contracture	R hand burn scar contracture release; FTSG	0.018	1.4625	0.7	0.7	0.716625
53	32	54.49	M	Flexor tendon injury	R FDS → FDP transfer 2–5	0.114	6.21186	0.7	0.7	3.0438114
54	60	27.81	F	Ganglion cyst	L dorsal wrist excision of ganglion cyst	0.029	0.80649	0.7	0.7	0.3951801
55	61	26.91	M	Finger flexor tendon injury	L wrist ECRL to FDP; transfer of w/palmaris graft	0.114	3.06774	0.7	0.7	1.5031926
56	65	23.29	F	L ulna nonunion	ORIF with iliac crest bone graft	0.05	1.1645	0.7	0.7	0.570605
57	10	76.27	M	Syndactyly	Release syndactyly 2nd and 4th web spaces with flaps and grafts	0.024	1.83048	0.7	0.7	0.8969352
58	24	62.39	M	Malunion	R thumb MCP joint arthrodesis	0.114	7.11246	0.7	0.7	3.4851054
59	35	51.53	F	Nerve laceration	Tendon transfer for L wrist extension and thumb extension; FCU → ECRB, PL → EPL	0.136	7.00808	0.7	0.7	3.4339592
60	38	48.6	M	Nerve laceration	R forearm sural nerve graft	0.136	6.6096	0.7	0.3	1.388016
61	10 mo	85.21	M	L MF-RF syndactyly	L MF-RF syndactyly release	0.024	2.04504	0.7	0.7	1.0020696
62	17	69.32	M	Malunion	Thumb osteotomy and alignment-ORIF; removal of foreign body thumb	0.016	1.10912	0.7	0.7	0.5434688
63	18	68.33	M	Flexor tendon injury	L forearm FDS → FDP tendon transfer	0.114	7.78962	0.7	0.7	3.8169138
64	28	58.44	M	Radial nerve laceration	Tendon transfer radial nerve palsy; FCR → EDC; PT → ECRB; ring sublimis → EPL	0.136	7.94784	0.7	0.7	3.8944416
65	42	44.71	F	Carpal tunnel syndrome	L carpal tunnel release	0.065	2.90615	0.7	0.7	1.4240135
Day 5
66	14	72.29	M	Flexor tendon injury with nerve laceration	R FDS/FDP ring and small finger tenorrhaphy and digital nerve repair	0.114	8.24106	0.7	0.7	4.0381194
67	23	63.38	F	Burn scar contracture	L hand burn scar contracture release	0.018	1.14084	0.7	0.7	0.5590116
68	50	37.05	M	Radial nerve laceration	Tendon transfer of radial nerve palsy; FCR → EDC; PT → ECRB; ring sublimis → EPL	0.136	5.0388	0.7	0.7	2.469012
69	9	77.27	F	Burn scar contracture	Web space deepening and scar revision	0.018	1.39086	0.7	0.7	0.6815214
70	16	70.3	F	Malunion	R RF MCP arthrodesis	0.024	1.6872	0.7	0.7	0.826728
71	31	55.48	F	Ganglion cyst	Excision of R wrist dorsal ganglion	0.029	1.60892	0.7	0.7	0.7883708
72	47	39.9	F	Ulnocarpal abutment	L ulnar shortening	0.114	4.5486	0.7	0.7	2.228814
73	55	32.38	F	Carpal tunnel syndrome	R carpal tunnel release	0.065	2.1047	0.7	0.7	1.031303
74	14	72.29	F	Burn scar contracture	L LF PIP burn contracture release and fusion; FTSG; Z plasty L elbow burn scar	0.114	8.24106	0.7	0.7	4.0381194
75	39	47.62	F	Ganglion cyst	Excision of R volar wrist ganglion cyst	0.029	1.38098	0.7	0.7	0.6766802
76	42	44.71	M	Posttraumatic joint contracture	L thumb MCP arthrodesis	0.024	1.07304	0.7	0.7	0.5257896
77	46	40.85	M	Posttraumatic joint contracture	L long finger PIP joint arthrodesis	0.024	0.9804	0.7	0.7	0.480396
78	57	30.55	F	Carpal tunnel syndrome	L carpal tunnel release	0.065	1.98575	0.7	0.7	0.9730175
79	23	63.38	M	Finger mass	Excision of L ring finger mass	0.029	1.83802	0.7	0.7	0.9006298
80	62	26	M	Skin lesion	Excision of L hand skin lesion	0.029	0.754	0.7	0.7	0.36946
Mean:	30.759	55.938				Total:	220.009		Total:	104.349028

R = right; L = left; IF= index finger; LF = long finger; RF = ring finger; SF = small finger; PIP = proximal interphalangeal; MCP = metacarpal phalangeal; FPL = flexor pollicis longs; FDS = flexor digitorum superficialis; FDP = flexor digitorum profundus; FCR = flexor carpi radials; FCU = flexor carpi ulnaris; PL = palmaris longus; EPL = extensor pollicis longus; ECRL = extensor carpi radialis longus; ECRB = extensor; carpi radialis brevis; EDC = extensor digitorum communis; FCU = flexor carpi ulnaris; UCL = ulnar collateral ligament; STSG = split thickness skin graft; FTSG = full thickness skin graft; ORIF = open reduction internal fixation.