Surgical need in an ageing population: a cluster-based household survey in Nepal

Stewart, Barclay T; Wong, Even; Gupta, Shailvi; Bastola, Santosh; Shrestha, Sunil; Kushner, Adam L.; Nwomeh, Benedict C.

doi:10.1016/s0140-6736(15)60800-5

Cited by 8 publications

(6 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Improving outcomes in emergency surgery is particularly challenging in the elderly patient. Indeed, the growing geriatric population is a worldwide challenge, for both developed and developing countries. Surgical conditions that produce a high surgical workload, as well as high mortality, include: hip fracture surgery, ruptured abdominal aortic aneurysm (AAA) surgery and emergency laparotomy.…”

Section: Introductionmentioning

confidence: 99%

Emergency general surgery in the geriatric patient

Desserud

Veen

Søreide

2016

Journal of British Surgery

147

View full text Add to dashboard Cite

Background: Emergency general surgery in the elderly is a particular challenge to the surgeon in charge of their care. The aim was to review contemporary aspects of managing elderly patients needing emergency general surgery and possible alterations to their pathways of care.Methods: This was a narrative review based on a PubMed/MEDLINE literature search up until 15 September 2015 for publications relevant to emergency general surgery in the geriatric patient. Results:The number of patients presenting as an emergency with a general surgical condition increases with age. Up to one-quarter of all emergency admissions to hospital may be for general surgical conditions. Elderly patients are a particular challenge owing to added co-morbidity, use of drugs and risk of poor outcome. Frailty is an important potential risk factor, but difficult to monitor or manage in the emergency setting. Risk scores are not available universally. Outcomes are usually severalfold worse than after elective surgery, in terms of both higher morbidity and increased mortality. A care bundle including early diagnosis, resuscitation and organ system monitoring may benefit the elderly in particular. Communication with the patient and relatives throughout the care pathway is essential, as indications for surgery, level of care and likely outcomes may evolve. Ethical issues should also be addressed at every step on the pathway of care.Conclusion: Emergency general surgery in the geriatric patient needs a tailored approach to improve outcomes and avoid futile care. Although some high-quality studies exist in related fields, the overall evidence base informing perioperative acute care for the elderly remains limited.

show abstract

Section: Introductionmentioning

confidence: 99%

Emergency general surgery in the geriatric patient

Desserud

Veen

Søreide

2016

Journal of British Surgery

147

View full text Add to dashboard Cite

show abstract

“…The incidence of emergency conditions is increasing worldwide due to aging populations, urbanization and a lack of preventative care capacity [ 1 – 3 ]. This increasing burden falls disproportionately on low and middle-income countries (LMICs), which are ill equipped to provide emergency care [ 4 , 5 ].…”

Section: Introductionmentioning

confidence: 99%

Triage capabilities of medical trainees in Ghana using the South African triage scale: an opportunity to improve emergency care

et al. 2016

View full text Add to dashboard Cite

IntroductionThe incidence of emergency conditions is increasing worldwide, particularly in low- and middle-income countries (LMICs). However, triage and emergency care training has not been prioritized in LMICs. We aimed to assess the reliability and validity of the South African Triage Scale (SATS) when used by providers not specifically trained in SATS, as well as to compare triage capabilities between senior medical students and senior house officers to examine the effectiveness of our curriculum for house officer training with regards to triage.MethodsSixty each of senior medical students and senior house officers who had not undergone specific triage or SATS training were asked to triage 25 previously validated emergency vignettes using the SATS. Estimates of reliability and validity were calculated. Additionally, over- and under-triage, as well as triage performance between the medical students and house officers was assessed against a reference standard.ResultsFifty-nine senior medical students (98% response rate) and 43 senior house officers (72% response rate) completed the survey (84% response rate overall). A total of 2,550 triage assignments were included in the analysis (59 medical student and 43 house officer triage assignments for 25 vignettes each; 1,475 and 1,075 triage assignments, respectively). Inter-rater reliability was moderate (quadratically weighted κ 0.59 and 0.60 for medical students and house officers, respectively). Triage using SATS performed by these groups had low sensitivity (medical students: 54%, 95% CI 49–59; house officers: 55%, 95% CI 48–60) and moderate specificity (medical students: 84%, 95% CI 82 - 89; house officers: 84%, 95% CI 82 - 97). Both groups under-triaged most ‘emergency’ level vignette patients (i.e. SATS Red; 80 and 82% for medical students and house officers, respectively). There was no difference between the groups for any metric.ConclusionAlthough the SATS has proven utility in a number of different settings in LMICs, its success relies on its use by trained providers. Given the large and growing burden of emergency conditions, training current and future emergency care providers in triage is imperative.

show abstract

“…Many of these low-and-middle-income countries (LMICs) have a density of surgeons, anesthesiologists, and obstetricians (SAO) severely below recommended minimum level of 20 per 100,000 people [ 1 , 3 ]. In addition, large proportions of the population live too far from a hospital capable of providing surgery [ 4 – 6 ]. Billions of people cannot afford the cost of surgical care or the cost of seeking surgical care [ 7 , 8 ].…”

Section: Introductionmentioning

confidence: 99%

The Local Mission: Improving Access to Surgical Care in Middle‐Income Countries

et al. 2021

View full text Add to dashboard Cite

Background Billions of people lack access to quality surgical care. Short-term missions are used to supplement the delivery of surgical care in regions with poor access to care. Traditionally known for using international teams, Operation Smile has transitioned to using a local mission model, where surgical service is delivered to areas of need by teams originating within that country. This study investigates the proportion and location of Operation Smile missions that use the local mission model. Methods A retrospective review was performed of the Operation Smile mission database for fiscal years 2014 to 2019. Missions were classified into local or international missions. Countries were also classified by their income levels as well as their specialist surgical workforce (SAO) density. As no individual patient or provider data was recorded, ethics board approval was not warranted. Results Between 2014 and 2019, Operation Smile held an average of 144.8 (range 135–154) surgical missions per year. Local missions accounted for 97 ± 5.6 (67%) of the missions. Of the 34 program countries, 26 (76%) used local missions. Of the countries that had only international missions, six (75%) were low-income countries and the average SAO density was 1.54 (range 0.19–5.88) providers per 100,000 people. Of the countries with local missions, 24 (92%) were middle-income, and the average SAO density was 30.9 (range 3.4–142.4). Conclusion International investments may assist in the creation of local surgical teams. Once teams are established, local missions are a valuable way to provide specialized surgical care within a country’s own borders.

show abstract

Surgical need in an ageing population: a cluster-based household survey in Nepal

Cited by 8 publications

References 0 publications

Emergency general surgery in the geriatric patient

Emergency general surgery in the geriatric patient

Triage capabilities of medical trainees in Ghana using the South African triage scale: an opportunity to improve emergency care

The Local Mission: Improving Access to Surgical Care in Middle‐Income Countries

Contact Info

Product

Resources

About