• Surgery · May 2015

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

    • Evan G Wong, Lynette Dominguez, Miguel Trelles, Samir Ayobi, Khalil Rahman Hazraty, Cheride Kasonga, Jean-Paul Basimuoneye, Lunick Santiague, Mustafa Kamal, Alaa Rahmoun, and Adam L Kushner.
    • 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.
    • Surgery. 2015 May 1; 157 (5): 850-6.

    BackgroundConflicts 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.MethodsA 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.ResultsA 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).ConclusionTrauma 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.Copyright © 2015 Elsevier Inc. All rights reserved.

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