Minor and Major Medical Complications Associated with Medical Tourism

Minor and Major Medical ComplicationsAssociated with Medical Tourism

Tripthi M. Mathew, MD, MPH, MBA, PhD President & CEO and Sr. Medical Director

Alpha & Omega Healthcare Management Consulting

Alpha & Omega Healthcare Management Consulting © 2015 www.alphanomega.info

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Organization of Lecture

• Objectives

• Background- Definition of Medical Tourism

- Why you should be a Medical Tourist?

- Medical Tourism: Treatments, Markets and Health System Implications

- Why You Should Be Wary of Medical Tourism?

- Medical tourism: Is the cost savings worth the risk?

- Examples of Worst Medical Tourist Disasters

- Minor and Major complications of Medical Tourism

- Quiz (3 Questions)

• Summary/Recommendation

• References

• About the Presenter

• Contact Info

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Objectives

1) The Participant will learn about the medical tourism markets and health systems

2) The participant will understand some of the common reasons why patients go abroad for treatment

3) The participant will be able to define and learn some of the minor and major complications of medical tourism


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Definitions

Medical Tourism According to the Centers for Disease Control and Prevention, medical tourism is

the term used to describe people who travel abroad from their home country to receive medical treatment (Lee VC, Balaban V, 2014).

Minor Medical Tourism Complication Most medical tourists travel abroad for surgery/procedure. Hence, minor

medical tourism complication is defined as any minor surgical complications that resulted from medical tourism. Minor surgical complication is defined as Grade I and II of the 2004 Dindo et al surgical complication classification .

Major Medical Tourism Complication Major medical tourism complication is defined as any major surgical

complication that resulted from medical tourism. Major surgical complication is defined as Grade III to Grade V of the 2004 Dindo et al surgical complication classification.

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Classification of Surgical Complications

Source: Dindo, D, Demartines, N, Clavien, PA. Classification of Surgical Complication. A New Proposal with Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann Surgery. 2004. 240 (2):205-213.

Grade DefinitionGrade I Any deviation from the normal postoperative course without the need for pharmacological treatment or surgical,

endoscopic, and radiological interventions.Allowed therapeutic regimens are: drugs as anti-emetics, antipyretics, analgesics, diuretics, electrolytes, and physiotherapy. This grade also includes wound infections opened at the bedside.

Grade II Requiring pharmacological treatment with drugs other than such allowed for Grade I complications. Blood Transfusion and total parenteral are also included.

Grade III Grade IIIa Grade IIIb

Requiring surgical, endoscopic, or radiological intervention Intervention not under general anesthesia Intervention under general anesthesia

Grade IV Grade IVa Grade IVb

Life threatening complication (including CNS complications)* requiring IC/ICU management Single organ dysfunction(including analysis) Multi-organ dysfunction

Grade V Death of a Patient*Note: Brain Hemorrhage, ischemic stroke, subarachnoid bleeding, but excluding transient ischemic attacks, CNS, central nervous system, IC, intermediate care, ICU, intensive care unit.

Suffix “d”: If the patient suffers from a complication at the time of discharge (see examples in Table 2), the suffix d (for disability) is added to the respective grade of complication. This label indicates the need for a follow-up to fully evaluate the complication.

Table 1. Classification of Surgical Complications by Grade

Table used with Permission from Dr.Clavien, May, 2015

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Table 2. Clinical Examples of Complications by Grade Grades Organ System ExamplesGrade I Cardiac Atrial Fibrillation converting after correction of K+ Level Respiratory Atelectasis requiring physiotherapy Neurological Transient confusion not requiring therapy Gastrointestinal Non-infectious diarrhea Renal Transient elevation of serum creatinine Other Wound infection treated by opening of the wound at the bedside Grade II Cardiac Tachyarrhythmia requiring β-receptor antagonists for heart rate control Respiratory Pneumonia treated with antibiotics on the ward Neurological TIA requiring treatment with anticoagulant Gastrointestinal Infectious diarrhea requiring antibiotics Renal Urinary tract infection requiring antibiotics Other Same as for 1 but followed by treatment with antibiotics because of additional phlegmonous infection Grade III a Cardiac Bradyarrhythmia requiring pacemaker implantation in local anesthesia Neurological See Grade IV Gastrointestinal Biloma after liver resection requiring percutaneous drainage Renal Stenosis of the ureter after kidney transplantation treated by stenting Other Closure of dehiscent noninfected wound in the OR under local anesthesia Grade III b Cardiac Cardiac tamponade after thoracic surgery requiring fenestration Respiratory Bronchopleural fistulas after thoracic surgery requiring surgical closure Gastrointestinal Anastomotic leakage after descendorectstomy requiring relaparatomy Renal Stenosis of the ureter after kidney transplantation treated by surgery Other Wound infection leading to enventration of small bowel Grade IV a Cardiac Heart Failure leading to low output syndrome Respiratory Lung Failure requiring intubation Neurological Ischemic stroke/brain hemorrhage Gastrointestinal Necrotizing Pancreatitis Renal Renal Insufficiency requiring dialysis Grade IV b Cardiac Same as for IV a but in combination with renal failure Respiratory Same as for IV a but in combination with renal failure Gastrointestinal Same as for IV a but in combination with hemodynamic instability Neurological Ischemic stroke/brain hemorrhage with respiratory failure Renal Same as for IV a but in combination with hemodynamic instability

Suffix d Cardiac Cardiac insufficiency after myocardial infarction (IVa-d) Respiratory Dyspnea after pneumonectomy for severe bleeding after chest tube placement (IIIb-d) Gastrointestinal Residual fecal incontinence after abscess following descendorectostomy with surgical evacuation (IIIb-d)

Neurological Stroke with sensorimotor hemisyndrome (IVa-d)Renal Residual renal insufficiency after sepsis with multiorgan dysfunction (IVb-d)Other Hoarseness after thyroid surgery (1-d)

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Why You Should be a Medical Tourist?

Five Reasons to Travel Abroad

Price

Service

Quality

Availability

Tourism


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Treatments, Markets & Health System Implications

Countries as Medical Specialists China- Stem cell therapy for ALS patients from Europe, Costa Rica- Dentistry India- Ayurveda/Spa Treatments Israel- Skin & Joint Diseases e.g. Psoriasis & Rheumatoid Arthritis (Dead sea minerals) Malaysia- Cardiac Bypass Surgery Taiwan- Bone Marrow Transplants NABH Accredited Specialty Chain (brand name) Hospitals Wockhardt Hospitals partnership with Partners Medical International & Harvard Medical School in different states in India e.g.• Wockhardt Hospitals and Kidney Institute, Kolkata, West Bengal, • Wockhardt Hospitals and Heart Institute, Bangalore, Karnataka• Wockhardt Brain & Spine Hospital, Bone & Joint Hospital, Eye Hospital and Minimal Access Surgery Hospital- Mumbai, General (High Tech) Hospitals with American Board Certified Doctors in

Singapore


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Medical tourism: Is the cost savings worth the risk?

• According to Reuters, there is the case of the Australian woman in her 50s who decided to take a “scalpel tour” from Sydney to a Bangkok hospital for a breast lift and tummy tuck in 2007.

• After she was discharged, within five days she developed an infection in her abdomen and left breast.

• The doctors offered to readmit her, but at her own cost (“pay or get out of the way!”)


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“Scalpel Tour ”/ “ Pay or get out of the way” Case

Source: Worst Medical Tourism Disasters. 2009. Internet. http://www.travelandleisure.com/articles/worst-medical- tourism-disasters

http://www.travelandleisure.com/articles/worst-medical-tourism-disasters




Eight Worst Medical Tourist Disasters (Botch Jobs)

1) Counterfeit Prescription Drugs Around the World *More than 700,000 people die every year from counterfeit drugs and alcohol.

2) Fertility Treatments in Romania * Egg Trafficking schemes in Romania, Eastern Europe and Israel

3) Leg Lengthening in Iran

4) Liposuction in Colombia

5) Skin Tucks in Costa Rica

6) Cosmetic Surgery in Thailand (discussed earlier)

7) Cosmetic Surgery in Brazil

8) Facelift in Singapore


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Minor Complications

• Bleeding• Rash• Infection at site of surgery• Hepatitis/Jaundice (e.g. patient

who went to Dominican Republic for surgery)

• Improper placement of Silicon implants (e.g. sticking from the nose after a patient went abroad for a nose job/rhinoplasty)


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Major Complications

*Sepsis

* Single (including renal dialysis) or Multi-Organ Dysfunction

*Eight Additional Surgeries for correction/ stabilizing patient upon return- case of Big Apple Native Stacey Cavaliere, travel to Costa Rica for nip and tuck work

* Death (case of Pierre Christian Lawlor- Travel to Bogota for liposurgery)


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Question #1

Q. What is one of the reason why medical tourists travel abroad?

a) For Leisureb) Pricec) For Fund) Adventuree) Sightseeing


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Question # 2

Q. Which of the following are minor complications of medical tourism?

a) Bleeding that requires blood transfusionb) Rash that resolved with antihistaminesc) Infection at site of surgeryd) Jaundicee) All of the above


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Question #3

What is a major complication of medical tourism?

a) Infection at site of surgeryb) Sepsisc) Deathd) Additional Surgery at home country upon return

from medical tourism abroade) b, c, and d


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Answers

1) b. Price. Price is one of the five reasons why people travel abroad for medical tourism. Other reasons are availability, quality, service and tourism

2) e. All of the above.

3) e. Infection at site of surgery is a minor surgical complication. All the others (Sepsis, Death, additional surgery at home country upon return from medical tourism abroad) are major surgical complications.


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Recommendations

Find out first if there are other options available for the condition requiring medical procedure

(non-invasive) at home country

To receive continuity of care (follow up), check if medical complications (minor and major) are covered in the insurance/treatment plan (telemedicine)

Make sure to include in the budget, money for complications

To receive quality service, find out on the Credentials of the Physician, their experience handling such procedures and accreditation of the Hospitals at the destination country


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References

1) Runckel, C. Why you should be a Medical Tourist? 2007. Internet. http://www.business-in-asia.com/asia/medical_tourism.html

2) Mitrečić, D, Bilic, E, Gajovic, S. How Croatian patients suffering from amyotrophic lateral sclerosis have been turned into medical tourists – a comment on a medical and social phenomenon. Croat Med J. 2014;55:443-5

3) Lunt et al. “Medical Tourism: Treatments, Markets and Health System Implications: A scoping review”. OECD. Internet. http://www.oecd.org/els/health-systems/48723982.pdf 4) Medical Tourism Magazine.2013.Internet. http://www.medicaltourismmag.com/wp-content/uploads/2013/06/issue-28.pdf

5) Why You Should Be Wary of Medical Tourism? Cooper, A. Anderson Live. Dec 12, 2012. Interview of Dr. Andrew Jacono. Internet. https://www.youtube.com/watch?v=sKyKqvy1TvE 6) Medical tourism: Is the cost savings worth the risk? CBS This Morning. Interview with Dr. Caudette Lajam, NYU Langone. Oct 9, 2013. Internet. https://www.youtube.com/watch?v=wAF6bKfUD0E 7) Worst Medical Tourism Disasters. 2009. Internet. http://www.travelandleisure.com/articles/worst-medical-tourism-disasters

8) Cohen, GI. Patients with Passports. Medical Tourism, Law and Ethics. Oxford University Press. 2014.

9) Lee, VC, Balaban, V. Medical Tourism. Chapter 2. The Pre-Travel Consultation. Counseling & Advice for Travelers. Centers for Disease Control and Prevention. Yellow Book, 2014.

10) Dindo, D, Demartines, N, Clavien, PA. Classification of Surgical Complication. A New Proposal with Evaluation in a Cohort of 6336 Patients and Results of a Survey. Ann Surgery. 2004. 240 (2):205-213.

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http://www.oecd.org/els/health-systems/48723982.pdf



http://www.medicaltourismmag.com/wp-content/uploads/2013/06/issue-28.pdf



https://www.youtube.com/watch?v=sKyKqvy1TvE

https://www.youtube.com/watch?v=wAF6bKfUD0E

https://www.youtube.com/watch?v=wAF6bKfUD0E



About the Presenter

Dr. Tripthi Mary Mathew received her MD degree (7 yr program) from the former Soviet Union (Georgia & Belarus), MPH (2 yr full-time) degree from Drexel University, MBA from University of Warwick, UK and PhD in Business Management with Distinction from Ashwood University, Texas. She has an Offer for Master of Laws (L.L.M) at the University of Nottingham, UK

Dr. Mathew has over 10 years of experience in the healthcare industry in various sectors: Private, Public (Federal, State and Local), Academia and Non-profit. Dr.Mathew has made several presentations, lectures and has authored articles, chapters and book.

Dr. Mathew is Board Certified in Aerospace Medicine, General Medicine, Public Health and Preventive Medicine by the International Board of Medicine and Surgery (IBMS). Dr. Mathew was nominated as a member to the Global Advisory Board of the American Academy of Project Management; the Editorial Advisory Committee of the Nations Health-American Public Health Association’s Newspaper and is a member of the Harvard Business Review Advisory Council

Dr. Mathew is a member of the World Medical Association, European Medical Association, Aerospace Medical Association, International Committee on Insurance Medicine, American Academy of Insurance Medicine and member of 50 groups and associations on Linkedin.com

Dr. Mathew has presented at UTMB, Principles and Practices of Aerospace Medicine Course, 2013, at the International Congress on Aerospace Medicine, Israel, 2013 and at the 85 th Aerospace Medical Association meeting, 2014. She drafted/updated Air Sickness and Traveler’s Diarrhea section of ASMA’s Medical Guidelines for Airline Travel. Dr. Mathew is currently involved with research on aerospace safety, air and space law, and developing a genetic aerospace database. Dr. Mathew is a trained and certified UAV/Drone recreational pilot (FAA Wings Pilot Proficiency Program).Ώα

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Contact

http://www.youtube.com/user/DrMathewTM

https://twitter.com/TMMathew

Alpha & Omega Healthcare Management Consulting

http://www.linkedin.com/in/mathewtm

DrTripthiM

[email protected]

Bon Voyage!


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Minor and Major Medical Complications Associated with Medical Tourism

Health & Medicine

Transcript of Minor and Major Medical Complications Associated with Medical Tourism