Operative trauma in low-resource settings: The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster

Evan Wong, Lynette Dominguez, Miguel Trelles, Samir Ayobi, Khalil Rahman Hazraty, Cheride Kasonga, Jean Paul Basimuoneye, Lunick Santiague, Mustafa Kamal, Alaa Rahmoun, Adam L. Kushner

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)850-856
Number of pages7
JournalSurgery (United States)
Volume157
Issue number5
DOIs
StatePublished - Jan 1 2015
Externally publishedYes

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Disasters
Wounds and Injuries
Operative Surgical Procedures
Relief Work
Resource Allocation
Trauma Centers
Intraoperative Complications
Debridement
Bandages
Reoperation
Cause of Death
Anesthesia
Demography
Databases
Pathology

ASJC Scopus subject areas

  • Surgery
  • Medicine(all)

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Operative trauma in low-resource settings : The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster. / Wong, Evan; Dominguez, Lynette; Trelles, Miguel; Ayobi, Samir; Hazraty, Khalil Rahman; Kasonga, Cheride; Basimuoneye, Jean Paul; Santiague, Lunick; Kamal, Mustafa; Rahmoun, Alaa; Kushner, Adam L.

In: Surgery (United States), Vol. 157, No. 5, 01.01.2015, p. 850-856.

Research output: Contribution to journalArticle

Wong, E, Dominguez, L, Trelles, M, Ayobi, S, Hazraty, KR, Kasonga, C, Basimuoneye, JP, Santiague, L, Kamal, M, Rahmoun, A & Kushner, AL 2015, 'Operative trauma in low-resource settings: The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster', Surgery (United States), vol. 157, no. 5, pp. 850-856. https://doi.org/10.1016/j.surg.2014.12.021
Wong, Evan ; Dominguez, Lynette ; Trelles, Miguel ; Ayobi, Samir ; Hazraty, Khalil Rahman ; Kasonga, Cheride ; Basimuoneye, Jean Paul ; Santiague, Lunick ; Kamal, Mustafa ; Rahmoun, Alaa ; Kushner, Adam L. / Operative trauma in low-resource settings : The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster. In: Surgery (United States). 2015 ; Vol. 157, No. 5. pp. 850-856.
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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 M{\'e}decins Sans Fronti{\`e}res (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.",
author = "Evan Wong and Lynette Dominguez and Miguel Trelles and Samir Ayobi and Hazraty, {Khalil Rahman} and Cheride Kasonga and Basimuoneye, {Jean Paul} and Lunick Santiague and Mustafa Kamal and Alaa Rahmoun and Kushner, {Adam L.}",
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T1 - Operative trauma in low-resource settings

T2 - The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster

AU - Wong, Evan

AU - Dominguez, Lynette

AU - Trelles, Miguel

AU - Ayobi, Samir

AU - Hazraty, Khalil Rahman

AU - Kasonga, Cheride

AU - Basimuoneye, Jean Paul

AU - Santiague, Lunick

AU - Kamal, Mustafa

AU - Rahmoun, Alaa

AU - Kushner, Adam L.

PY - 2015/1/1

Y1 - 2015/1/1

N2 - 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.

AB - 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.

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