Evan G Wong1, Lynette Dominguez2, Miguel Trelles2, Samir Ayobi3, Khalil Rahman Hazraty4, Cheride Kasonga5, Jean-Paul Basimuoneye6, Lunick Santiague7, Mustafa Kamal8, Alaa Rahmoun9, Adam L Kushner10. 1. Centre for Global Surgery, McGill University Health Centre, Montreal, QC, Canada; Surgeons Over Seas (SOS), New York, NY. Electronic address: evan.wong@mail.mcgill.ca. 2. Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium. 3. Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; Trauma Centre, Médecins Sans Frontières, Kunduz, Afghanistan. 4. Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; Hospital Boost, Médecins Sans Frontières, Lashkar-Gah, Helmand, Afghanistan. 5. Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; General Referral Hospital, Médecins Sans Frontières, Niangara, Democratic Republic of the Congo. 6. Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; General Referral Hospital, Médecins Sans Frontières, Masisi, Democratic Republic of the Congo. 7. Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; Surgical and Trauma Centre Nap Kembe, Médecins Sans Frontières, Tabarre, Port-au-Prince, Haïti. 8. Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; District Headquarters Hospital, Médecins Sans Frontières, Timurgara, Lower Dir, Pakistan. 9. Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; Field Hospital, Médecins Sans Frontières, Jabal-Akkrad, Syria. 10. Surgeons Over Seas (SOS), New York, NY; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Surgery, Columbia University, New York, NY.
Abstract
BACKGROUND: Conflicts and disasters remain prevalent in low- and middle-income countries, and injury remains a leading cause of death worldwide. The objective of this study was to describe the operative procedures performed for injury-related pathologies at facilities supported by Médecins Sans Frontières (MSF) to guide the planning of future responses. METHODS: A retrospective review of a prospectively collected database of all MSF procedures performed between July 2008 and June 2014 for injury-related indications was completed. Individual data points included country of project and date of procedure; age, patient sex, and the American Society of Anesthesiologists' score of each patient; indication for surgery, including mechanism of injury; operative procedure; operative urgency; operative order; type of anesthesia; and intraoperative mortality. Injury severity was stratified according to operative order and urgency. RESULTS: A total of 79,715 procedures were performed in MSF projects that met the inclusion criteria. Of these, 35,756 (44.9%) were performed specifically for traumatic indications across 17 countries. Even after excluding trauma centers, 29.4% (18,329/62,288) of operative cases were for injuries. Operative trauma procedures were performed most commonly for road traffic injuries (29.9%; 10,686/35,756). The most common procedure for acute trauma was extensive wound debridement (31.6%; 3,165/10,022) whereas burn dressings were the most frequent planned reoperation (27.1%; 4,361/16,078). CONCLUSION: Trauma remains an important component of the operative care provided in humanitarian assistance. This review of procedures performed by MSF in a variety of settings provides valuable insight into demographics of trauma patients, mechanisms of injury, and surgical capabilities required in planning resource allocation for future humanitarian missions in low- and middle-income countries.
BACKGROUND: Conflicts and disasters remain prevalent in low- and middle-income countries, and injury remains a leading cause of death worldwide. The objective of this study was to describe the operative procedures performed for injury-related pathologies at facilities supported by Médecins Sans Frontières (MSF) to guide the planning of future responses. METHODS: A retrospective review of a prospectively collected database of all MSF procedures performed between July 2008 and June 2014 for injury-related indications was completed. Individual data points included country of project and date of procedure; age, patient sex, and the American Society of Anesthesiologists' score of each patient; indication for surgery, including mechanism of injury; operative procedure; operative urgency; operative order; type of anesthesia; and intraoperative mortality. Injury severity was stratified according to operative order and urgency. RESULTS: A total of 79,715 procedures were performed in MSF projects that met the inclusion criteria. Of these, 35,756 (44.9%) were performed specifically for traumatic indications across 17 countries. Even after excluding trauma centers, 29.4% (18,329/62,288) of operative cases were for injuries. Operative trauma procedures were performed most commonly for road traffic injuries (29.9%; 10,686/35,756). The most common procedure for acute trauma was extensive wound debridement (31.6%; 3,165/10,022) whereas burn dressings were the most frequent planned reoperation (27.1%; 4,361/16,078). CONCLUSION:Trauma remains an important component of the operative care provided in humanitarian assistance. This review of procedures performed by MSF in a variety of settings provides valuable insight into demographics of traumapatients, mechanisms of injury, and surgical capabilities required in planning resource allocation for future humanitarian missions in low- and middle-income countries.
Authors: Hannah Wild; Barclay T Stewart; Christopher LeBoa; Christopher D Stave; Sherry M Wren Journal: World J Surg Date: 2020-06 Impact factor: 3.352