MSF surgery & anaesthesia perspectives (Xavier Lassalle)

Surgery & anaesthesia 2013 MSF OCP Xavier Lassalle

Paris 29 nov 2013

Nov 2013 : 15 surgical missions

Surgical activity MSF OCP jan-sept 2013: 24.583 procedures 10.457 patients 35000

30000

25000

20000

+ 9%

15000

10000

5000

0 1

2006

2

2007

3

2008

4

2009

5

2010

6

2011

7

2012

8

2013

Surgical activity MSF OCP jan-sept 2013 24583 procedures Emergencies : 91%

3500

3000

2500

2000

planned delayable acute

1500

1000

500

0

jan

feb

mar

apr

may

june

july

aug

sept

Surgical indications MSF OCP jan-sept 2013

69% 18000

16000

violence 22%

14000

12000

Traffic 12% 10000

other 7% 8000

6000

burns 28%

15%

15%

4000

2000

0

TRAUMA

PATHOLOGY

OBSTETRIC

Surgical indications MSF OCP jan-sept 2013

69% 18000

16000

violence 22%

14000

12000

Traffic 12% 10000

other 7% 8000

6000

burns 28%

15%

15%

4000

2000

0

TRAUMA

PATHOLOGY

OBSTETRIC

Burns • « Neglected disease » – All missions – Poor or no expertise in places where MSF is working

• Large room for improvement • « Difficult » – Number & qualified staff, Surgery, ICU, lab, pain, blood, physio, psy..

– LOS (1,5 day / % BSAB)…

• Progressive expertise of MSF – CD protocol, Partnership specialized hosp

• Haiti example – Dressings / oral morphine – Diminution 50% dressing OT : 278 proc /month

Reintervention jan-sept 2013 24.583 procedures /10.457 patients

procedures / patient • Total

2,3

• Traumato : – Burns : – Violence :

3,4 6,7 1,6

• Obstetric:

1,1

• Pathologic :

1,8

Sex ratio Patients 10450 • Women 52% • Trauma 23% • Obst 100 % • Med 45%

• Men : 48% • Trauma 77% • Obst 0 % • Med 55%

MSF OCP surgery jan –sept 2013

Sex ratio

MSF OCP surgery jan –sept 2013

Patients 10450

Procedures 24553

• Women 52%

• Women 41%

• Trauma 23% • Obst 100 % • Med 45%

• Men : 48% • Trauma 77% • Obst 0 % • Med 55%

• Trauma 27% • Obst 100 % • Med 45%

• Men : 59% • Trauma 73% • Obst 0 % • Med 55%

Surgical activity MSF OCP jan-sept 2013 age distribution (procedures)

6%

10% 16%

48% 20%

10% < 2 years old 26% < 10 years old

< ou = 2 years old 2-10 years old 10-20 years old 20-50 years old > 50 years old

Visibility • Data 100% • Quality anaesthesia : 70% (Follow up for pain management)

• Mortality reports : 41%

Quality insurance • Analysis of mortality – MMR = powerful quality indic

• WHO check list – Safe Surgery * = Diminution of mortality by 50%

* Haynes N Engl J Med 2009;360:491-9.

Mortality review • Analysis collective, retrospective, systemic – Description – Analysis – Proposition of improvement – Follow up

• Non blaming • One of the most powerful tool of improvement • Quality insurance

Quality insurance • Analysis of mortality

70

62

60

– MMR = powerful quality indic

62 52

50

50

48 41

40

– MMR : 2-3 / 15 missions

30

20

– Reports 41%

10

0 1

2

3

4

2008 2009 2010 2011

5

2012

• WHO check list – Safe Surgery * = Diminution of mortality by 50% – MSF implementation < 1% * Haynes N Engl J Med 2009;360:491-9.

6

2013

Mortality • 110 reports • Pre op 11

= 10%

• Per op 22

= 20%

• Post op 77

= 70 %

Perioperative mortality Pre & per-op

Post op

• Hemorragic shock

• Septic shock • X organ failure

• • • •

• ICU level 1

Protocol polytrauma Acid tranexamic Warmers Blood bank

Need for improvement 70

62

60

62

% mortality analysis 52

50

50

48 41

40

32

31

30

28

26 22

21

20

X 1000 procedures

10

0 1

2008

2

2009

3

2010

4

2011

5

2012

6

2013

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