Surgical skills needed for humanitarian missions in resource-limited settings: Common operative procedures performed at Médecins Sans Frontières facilities

Wong, Evan G.; Trelles, Miguel; Dominguez, Lynette; Gupta, Shailvi; Burnham, Gilbert; Kushner, Adam L.

doi:10.1016/j.surg.2014.02.002

Cited by 96 publications

(68 citation statements)

References 17 publications

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“…Two sets of data were used for the analysis: American College of Graduate Medical Education (ACGME) general surgery chief resident case logs spanning 2009-2015 [6], and previously published summary data of MSF-Brussels (MSF-OCB) case logs spanning June 2008 to December 2012 [7].…”

Section: Methodsmentioning

confidence: 99%

Are American Surgical Residents Prepared for Humanitarian Deployment?: A Comparative Analysis of Resident and Humanitarian Case Logs

et al. 2017

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Background Effective humanitarian surgeons require skills in general surgery, OB/GYN, orthopedics, and urology. With increasing specialization, it is unclear whether US general surgery residents are receiving exposure to these disparate fields. We sought to assess the preparedness of graduating American surgical residents for humanitarian deployment. Methods We retrospectively analyzed cases performed by American College of Graduate Medical Education general surgery graduates from 2009 to 2015 and cases performed at select Médecins Sans Frontières (MSF) facilities from 2008 to 2012. Cases were categorized by specialty (general surgery, orthopedics, OB/GYN, urology) and compared with Chi-squared testing. Non-operative care including basic wound and drain care was excluded from both data sets. Results US general surgery residents performed 41.3% MSF relevant general surgery cases, 1.9% orthopedic cases, 0.1% OB/GYN cases, and 0.3% urology cases; the remaining 56.4% of cases exceeded the standard MSF scope of care. In comparison, MSF cases were 30.1% general surgery, 21.2% orthopedics, 46.8% OB/GYN, and 1.9% urology. US residents performed fewer OB/GYN cases (p \ 0.01) and fewer orthopedic cases (p \ 0.01). Differences in general surgery and urology caseloads were not statistically significant. Key procedures in which residents lacked experience included cesarean sections, hysterectomies, and external bony fixation. Conclusion Current US surgical training is poorly aligned with typical MSF surgical caseloads, particularly in OB/ GYN and orthopedics. New mechanisms for obtaining relevant surgical skills should be developed to better prepare American surgical trainees interested in humanitarian work.

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Section: Methodsmentioning

confidence: 99%

Are American Surgical Residents Prepared for Humanitarian Deployment?: A Comparative Analysis of Resident and Humanitarian Case Logs

et al. 2017

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“…MSF collects data routinely to monitor the volume and types of procedures performed at each of the facilities they support. 12 For this report, patients were defined as individuals who underwent an operation in an operating theater; procedures were the specific operative tasks performed (eg, amputation, laparotomy).…”

Section: Methodsmentioning

confidence: 99%

“…The PSR was developed by MSF for operational research needs. 12 Therefore, patient identifiers for longitudinal evaluation were not recorded. The PSR variables are: age, sex, indication for operation, American Society of Anesthesia (ASA) physical status score, operation order and urgency, type of anesthesia given, procedure(s) performed, and perioperative death (ie, death from initiation of anesthesia care to discharge from the postanesthesia care unit).…”

Section: Methodsmentioning

confidence: 99%

Averted health burden over 4 years at Médecins Sans Frontières (MSF) Trauma Centre in Kunduz, Afghanistan, prior to its closure in 2015

Trelles

Stewart

Hemat

et al. 2016

Surgery

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“…Orthopaedic interventions and their characteristics were classified according to a standardised system described previously [13]. At the time of the study, it was not possible to stabilise and treat any type of spinal fractures or provide prosthetic treatment for hip fractures, including open reduction and internal fixation.…”

Section: Orthopaedic Proceduresmentioning

confidence: 99%

Orthopaedic surgery in natural disaster and conflict settings: how can quality care be ensured?

Alvarado

Trelles

Tayler‐Smith

et al. 2015

International Orthopaedics (SICOT)

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Purpose Médecins sans Frontières (MSF) is one of the main providers of orthopaedic surgery in natural disaster and conflict settings and strictly imposes a minimum set of contextspecific standards before any surgery can be performed. Based on MSF's experience of performing orthopaedic surgery in a number of such settings, we describe: (a) whether it was possible to implement the minimum standards for one of the more rigorous orthopaedic procedures-internal fixation-and when possible, the time frame, (b) the volume and type of interventions performed and (c) the intra-operative mortality rates and postoperative infection rates. Methods We conducted a retrospective review of routine programme data collected between 2007 and 2014 from three MSF emergency surgical interventions in Haiti (following the 2010 earthquake) and three ongoing MSF projects in Kunduz (Afghanistan), Masisi (Democratic Republic of the Congo) and Tabarre (Haiti). ResultsThe minimum standards for internal fixation were achieved in one emergency intervention site in Haiti, and in Kunduz and Tabarre, taking up to 18 months to implement in Kunduz. All sites achieved the minimum standards to perform amputations, reductions and external fixations, with a total of 9,409 orthopaedic procedures performed during the study period. Intraoperative mortality rates ranged from 0.6 to 1.9 % and postoperative infection rates from 2.4 to 3.5 %. Conclusions In settings affected by natural disaster or conflict, a high volume and wide repertoire of orthopaedic surgical procedures can be performed with good outcomes when minimum standards are in place. More demanding procedures like internal fixation may not always be feasible.

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Surgical skills needed for humanitarian missions in resource-limited settings: Common operative procedures performed at Médecins Sans Frontières facilities

Cited by 96 publications

References 17 publications

Are American Surgical Residents Prepared for Humanitarian Deployment?: A Comparative Analysis of Resident and Humanitarian Case Logs

Are American Surgical Residents Prepared for Humanitarian Deployment?: A Comparative Analysis of Resident and Humanitarian Case Logs

Averted health burden over 4 years at Médecins Sans Frontières (MSF) Trauma Centre in Kunduz, Afghanistan, prior to its closure in 2015

Orthopaedic surgery in natural disaster and conflict settings: how can quality care be ensured?

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