Katherine T Flynn-O'Brien1, Miguel Trelles2, Lynette Dominguez2, Ghulam Hiadar Hassani3, Clemence Akemani4, Aamer Naseer5, Innocent Bagura Ntawukiruwabo6, Adam L Kushner7, David H Rothstein8, Barclay T Stewart9. 1. Department of Surgery, University of Washington, Seattle, WA, USA; Harborview Injury Prevention and Research Center, Seattle, WA, USA. Electronic address: flynnobr@uw.edu. 2. Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium. 3. Médecins sans Frontières-Operational Centre Brussels, Surgical Unit, Brussels, Belgium; Boost General Hospital, Médecins sans Frontières, Lashkar-Gah, Afghanistan. 4. Médecins sans Frontières-Operational Centre Brussels, Surgical Unit, Brussels, Belgium; General Referral Hospital, Médecins sans Frontières, Lubutu, Democratic Republic of the Congo. 5. Surgery, Anesthesia, Gynecology, and Emergency Medicine Unit, Médecins Sans Frontières, Brussels, Belgium; Dargai DHQ Hospital, Dargai, Pakistan. 6. Médecins sans Frontières-Operational Centre Brussels, Surgical Unit, Brussels, Belgium; General Referral Hospital, Médecins sans Frontières, Masisi, Democratic Republic of the Congo. 7. Surgeons OverSeas (SOS), New York, NY, USA; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Department of Surgery, Columbia University, New York, NY, USA. 8. Department of Surgery, Women & Children's Hospital of Buffalo, NY, USA; Department of Surgery, University at Buffalo, SUNY, Buffalo, NY, USA. 9. Department of Surgery, University of Washington, Seattle, WA, USA; School of Medical Sciences, Kwame Nkrumah University of Science and Technology, Kumasi, Ghana; Department of Surgery, Komfo Anokye Teaching Hospital, Kumasi, Ghana.
Abstract
PURPOSE: Pediatric surgical care is deficient in developing countries disrupted by crisis. We aimed to describe pediatric surgical care at Médecins Sans Frontières-Brussels (MSF-OCB) projects to inform resource allocation and define the pediatric-specific skillset necessary for humanitarian surgical teams. METHODS: Procedures performed by MSF-OCB from July 2008 to December 2014 were reviewed. Project characteristics, patient demographics and clinical data were described. Multivariable logistic regression was performed to determine predictors of perioperative death. RESULTS: Of 109,828 procedures, 26,284 were performed for 24,576 children (22% of all procedures). The most common pediatric operative indication was trauma (13,984; 57%). Nine percent of all surgical indications were due to violence (e.g., land mines, firearms, gender-based violence, etc.). The majority of procedures (19,582; 75%) were general surgical, followed by orthopedic (4350; 17%), and obstetric/gynecologic/urologic (2135; 8%). Perioperative death was low (42; 0.17%); independent predictors of death included age <1year, use of general anesthesia with a definitive airway, and operation during conflict. CONCLUSION: Surgical care for children comprised nearly a quarter of all procedures performed by MSF-OCB between 2008 and 2014. Attention to trauma surgery and infant perioperative care is particularly needed. These findings are important when resourcing projects and training surgical staff for humanitarian missions.
PURPOSE: Pediatric surgical care is deficient in developing countries disrupted by crisis. We aimed to describe pediatric surgical care at Médecins Sans Frontières-Brussels (MSF-OCB) projects to inform resource allocation and define the pediatric-specific skillset necessary for humanitarian surgical teams. METHODS: Procedures performed by MSF-OCB from July 2008 to December 2014 were reviewed. Project characteristics, patient demographics and clinical data were described. Multivariable logistic regression was performed to determine predictors of perioperative death. RESULTS: Of 109,828 procedures, 26,284 were performed for 24,576 children (22% of all procedures). The most common pediatric operative indication was trauma (13,984; 57%). Nine percent of all surgical indications were due to violence (e.g., land mines, firearms, gender-based violence, etc.). The majority of procedures (19,582; 75%) were general surgical, followed by orthopedic (4350; 17%), and obstetric/gynecologic/urologic (2135; 8%). Perioperative death was low (42; 0.17%); independent predictors of death included age <1year, use of general anesthesia with a definitive airway, and operation during conflict. CONCLUSION: Surgical care for children comprised nearly a quarter of all procedures performed by MSF-OCB between 2008 and 2014. Attention to trauma surgery and infant perioperative care is particularly needed. These findings are important when resourcing projects and training surgical staff for humanitarian missions.
Authors: Reinou S Groen; Mohamed Samai; Kerry-Ann Stewart; Laura D Cassidy; Thaim B Kamara; Sahr E Yambasu; T Peter Kingham; Adam L Kushner Journal: Lancet Date: 2012-08-14 Impact factor: 79.321
Authors: James Ankomah; Barclay T Stewart; Victor Oppong-Nketia; Adofo Koranteng; Adam Gyedu; Robert Quansah; Peter Donkor; Francis Abantanga; Charles Mock Journal: J Pediatr Surg Date: 2015-03-26 Impact factor: 2.545
Authors: Adam L Kushner; Reinou S Groen; Thaim B Kamara; Richmond Dixon-Cole; Kisito S Daoh; T Peter Kingham; Benedict C Nwomeh Journal: World J Surg Date: 2012-11 Impact factor: 3.352
Authors: Essam A Elhalaby; Francis A Uba; Eric S Borgstein; Heinz Rode; Alastair J W Millar Journal: Semin Pediatr Surg Date: 2012-05 Impact factor: 2.754
Authors: Lohfa B Chirdan; Emmanuel A Ameh; Francis A Abantanga; Daniel Sidler; Essam A Elhalaby Journal: J Pediatr Surg Date: 2010-03 Impact factor: 2.545
Authors: Stephen Bickler; Doruk Ozgediz; Richard Gosselin; Thomas Weiser; David Spiegel; Renee Hsia; Peter Dunbar; Kelly McQueen; Dean Jamison Journal: World J Surg Date: 2010-03 Impact factor: 3.352
Authors: Nguyenvu Nguyen; Jeffrey P Jacobs; Joseph A Dearani; Samuel Weinstein; William M Novick; Marshall L Jacobs; Jeremy Massey; Sara K Pasquali; Henry L Walters; David Drullinsky; Giovanni Stellin; Christo I Tchervenkov Journal: World J Pediatr Congenit Heart Surg Date: 2014-04
Authors: Yuanting Zha; Barclay Stewart; Eugenia Lee; Kyle N Remick; David H Rothstein; Reinou S Groen; Gilbert Burnham; David K Imagawa; Adam L Kushner Journal: World J Surg Date: 2016-11 Impact factor: 3.352