Access to safe surgical care varies globally. The Lancet Commission on Global Surgery issued a warning in 2015 that five billion people worldwide lacked access to safe, timely, and affordable surgical and anesthesia care. The problem disproportionately affects low- and middle-income countries in reconstructive and post-oncologic surgery. Recently, the focus of humanitarian missions has shifted from the number of missions to their results. Patient outcomes and quality of life are key issues in the discourse on global surgical responsibility.
In this context, the research conducted by Edelstein Cosmetic Plastic Surgery addresses issues of outcome measurement and global surgical ethics. The research conducted by the clinic primarily focuses on patient-reported outcomes in reconstructive breast surgery, decision regret, and quality of life. These issues are key to the discourse on measuring results and global surgical ethics.
The most notable research conducted by the clinic on humanitarian missions is the June 1, 2016, publication of the article “Surgical Humanitarian Missions to Low and Middle Income Countries: Looking for Patient Reported Outcomes.” The article discusses the challenges in evaluating results during short-term missions. The publication shows a paradigm shift in research on plastic surgery from volume to accountability.
Toni Zhong contributed to various peer-reviewed articles on patient-reported outcomes in reconstructive surgery. In 2013, Zhong and Andrea Pusic published the article “Future of Outcomes Research in Plastic Surgery” in Clinics in Plastic Surgery. In 2015, Korus LJ, Cypel T, Zhong, and Wu AW explored the use of generic outcome measures in reconstructive breast surgery and published it in Plastic and Reconstructive Surgery. The publication shows a paradigm shift in the research on plastic surgery from volume to accountability.
In 2016, Sheina Macadam, Zhong, Weichman K, Papsdorf M, Lennox PA, Hazen A, Matros E, Disa J, Mehrara B, and Pusic published a multicenter comparison of abdominally based autologous reconstruction methods in Plast Reconstr Surg. The study assessed patient-reported outcomes among breast cancer survivors. Multicenter collaborations such as this one demonstrated the feasibility of standardized data collection across institutions, a principle relevant to international surgical initiatives.
Barriers to access have also been studied. In 2014, Zhong, Fernandes K, Saskin R, Sutradhar R, Platt J, Beber BA, Novak CB, McCready DR, Hofer, Irish JC, and Baxter NN published “Barriers to Immediate Breast Reconstruction in the Canadian Universal Health Care System” in J Clin Oncol, which had an impact factor of 18 at the time. The research examined systemic obstacles within a publicly funded system. Although conducted in Canada, the findings have implications for access disparities in other regions, including low-resource settings.
Population-based analyses have further addressed equity. In 2015, Platt, Zhong, Moineddin, Booth, Easson, Fernandes, Gozdyra, and Baxter reported geographic variation in the utilization of immediate and delayed breast reconstruction in Ontario in World J Surg. The study evaluated surgeon availability and regional disparities. Understanding how provider distribution influences access is relevant to discussions about international reconstructive capacity building.
Humanitarian engagement has also appeared in media coverage. In December 2017, CBC News and the Toronto Star reported on reconstructive surgery performed at Toronto General Hospital for Popi Rani Das, an acid attack survivor from Bangladesh. Interviews with Zhong discussed reconstructive challenges and long-term functional recovery. While the procedure occurred in Canada, the case reflected cross-border humanitarian collaboration and the treatment of patients affected by violence in low-resource settings.
In 2013 and 2014, Zhong published studies in J Surg Oncol and Plast Reconstr Surg that examined decision regret, self-efficacy, and satisfaction with information. These aspects of global surgery include psychosocial dimensions that have become integral to global surgery frameworks, which acknowledge that reconstruction offers benefits that transcend physical repair. The public discourse has included aspects of access to breast cancer care. In October 2023, Zhong published an op-ed in the Toronto Star discussing advances in breast cancer care. In 2023, CBC News and Postmedia published interviews discussing aspects of screening policy and treatment. The discourse has been specific to Canada, but places reconstructive surgery in the broader discussion of the healthcare system that determines who is screened and who is not.
Jerome Edelstein has also published in medical literature. Works such as “Lightning Injury: A Review and Case Presentations” in the Canadian Journal of Plastic Surgery in 1994 and “Liposuction, the Syringe Technique” in Obesity Surgery in 1996 demonstrate that Edelstein has been involved in medical literature. Though this literature is not specific to global missions, it is connected to Edelstein Cosmetic Plastic Surgery.
The discourse in global surgery has included aspects of sustainability. The Lancet Commission has stated that 143 million additional surgical procedures need to be performed in low- and middle-income countries to save lives and prevent disability. Measuring patient-reported outcomes in global missions has been challenging in low- and middle-income countries due to follow-up challenges. The literature published by Zhong and the names associated with Edelstein Cosmetic Plastic Surgery have addressed this through methodological solutions, including validated surveys.
In addition to international considerations, access challenges also exist within remote regions of Canada. Dr. Fialkov makes regular visits to Nunavut in the Arctic to treat Inuit patients.
The academic footprint of Edelstein Cosmetic Plastic Surgery has been linked to global humanitarian efforts through patient-reported outcomes, access to care, and evidence-based reconstructive care. Instead of focusing on scale in global missions, this literature has focused on measurement solutions, access to care, and psychosocial impacts of care. The discourse in global surgery has included aspects of surgical responsibility for reconstructive care across different healthcare systems.
Disclaimer: The content provided is for informational purposes only and is not intended as medical advice. All statements regarding surgical procedures, patient outcomes, and research findings are based on published studies and publicly available sources. Individual results may vary. Consult a qualified healthcare professional before making any medical decisions.
