Surgery & anaesthesia review MSF OCP jan sept 2014
Xavier Lassalle
Paris 6 dec 2014
MSF OCP Surgical missions dec 2014
Surgical activity MSF OCP jan-sept 2013: 24.583 procedures
+ 9%
2006
2007
2008
2009
2010
2011
2012
2013
Surgical activity MSF OCP jan-sept 2014 : 29.433 procedures / 12.392 patients
+9%
34689 31093 27793
21289 18534
2006
22267
25516
19503
2007
2008
2009
2010
2011
2012
2013
2014
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 activity MSF OCP jan-sept 2014 29.433 procedures
Emergencies 91%
4000 3500 3000
Delayable
2500
Planned
2000 1500 1000 500 0 jan
feb
mar
apr
may
jun
jul
aug
sep
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
Surgical activity MSF OCP jan-sept 2014 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
Surgical indications MSF OCP jan-sept 2013
69% 18000 16000 14000 12000 10000 8000 6000
violence 22% Traffic 12% other 7% burns 28%
15%
15%
4000 2000 0
TRAUMA
PATHOLOGY OBSTETRIC
Surgical indications MSF OCP jan-sept 2014
61, 5% Other 6% 18000 Traffic 8% 16000 14000 12000
Violence 18,5%
10000 8000 6000
Burns 29%
4000
17%
21,5%
2000 0
Trauma
Gyn-obs
Pathology
Surgical burn procedures MSF OCP jan-sept 2014 : 8535
12000
X
3 / 5 years
10000
29% procedures
9019
8000
6000
6280 5362
40003585
2000
0
2010 2011 2012 2013 2014
Burn management among surgical programs MSF 0CP 2014 12000
•
Port au Prince
–Drouillard 35 beds + SI –2015 New specific hospital
10000
8000
•
Gaza
–2014 Protective Edge Al shiffa –2015 Al Shiffa
6000
4000
2000
2010 0
2011
2012
2014 2013
•
Athma Syrie
•
Aweil S.Sudan 42 % surg acts
98 % surg acts
Type of anaesthesia MSF OCP 2014 4% 3% 16%
GA without intubation GA+ intubation Spinal
10% 67%
LocoRegional Anaesthesia AL + others
New classification for anaesthesia Main Anesthesia Technic GENERAL
GA with INTUBATION
GAO
GENERAL
GAI
GA with INTUBATION
GA with NOTHING or FACIAL MASK
GAO
GA with NOTHING or FACIAL MASK
GAL
GA with LARYNGEAL MASK
GAL
GA with LARYNGEAL MASK
RSA
SPINAL
RSA
SPINAL
PLEXIC or TRONCULAR : AXILLARY / FEMORAL / SCIATIC
RPX
PLEXIC or TRONCULAR : AXILLARY / FEMORAL / SCIATIC
RTA
TRANSVERSE ABDOMINAL PLANE BLOC
RTA
TRANSVERSE ABDOMINAL PLANE BLOC
RAO
OTHER
RAO
OTHER
LOCAL
LOA
LOCAL ANESTHESIA
LOCAL
LOA
LOCAL ANESTHESIA
SEDATION
SED
SEDATION
SEDATION
SED
SEDATION
INFILTRATION
INF
INFILTRATION BY SURGEON
INFILTRATION
INF
INFILTRATION BY SURGEON
REGIONAL
GAI
Associated Anesthesia Technic
RPX
REGIONAL
New classification for anaesthesia Main Anesthesia Technic GENERAL
GA with INTUBATION
GAO
GENERAL
GAI
GA with INTUBATION
GA with NOTHING or FACIAL MASK
GAO
GA with NOTHING or FACIAL MASK
GAL
GA with LARYNGEAL MASK
GAL
GA with LARYNGEAL MASK
RSA
SPINAL
RSA
SPINAL
PLEXIC or TRONCULAR : AXILLARY / FEMORAL / SCIATIC
RPX
PLEXIC or TRONCULAR : AXILLARY / FEMORAL / SCIATIC
RTA
TRANSVERSE ABDOMINAL PLANE BLOC
RTA
TRANSVERSE ABDOMINAL PLANE BLOC
RAO
OTHER
RAO
OTHER
LOCAL
LOA
LOCAL ANESTHESIA
LOCAL
LOA
LOCAL ANESTHESIA
SEDATION
SED
SEDATION
SEDATION
SED
SEDATION
INFILTRATION
INF
INFILTRATION BY SURGEON
INFILTRATION
INF
INFILTRATION BY SURGEON
REGIONAL
GAI
Associated Anesthesia Technic
RPX
REGIONAL
Mortality analysis MSF OCP 2014 100%
0 % 70 60 50 40
62
62 50
52
48
52
41
30 20
% mortality analysis
10
0%
0
2013
2014
Perioperative mortality MSF OCP jan-sept 2014
Pre
Per
Post
TOTAL
Hemorrage
11
3
14
28
Septic shock visceral failure
3
3
51
57
Others
5
5
14
24
TOTAL
19
11
79
17% 10%
post-op per-op pre- op
72%
Visibility
Data Quality anaesthesia (follow up pain mgt )
Mortality reports
2013
2014
100%
100%
70%
54%
41%
52%
Increase transparency • End of mission report
+ • Anaesthesia Quality Form
+ • Mortality review
OT data and tools – a new way OCP eHealth Unit
New System February 2015 release
Interface (to replace Excel)
Operating Theatre Encounter
Patient Case number
Intervention Urgency of intervention Mechanism of injury Time since injury Surgical Procedure Performed 1 Surgical Procedure Performed 2 Type of Anesthesia Number of units of blood transfused Intervention Event Outcome
Operating Theatre Encounters
Data Visualization Possibilities Current data 2012-2014 (September)
$
Thank you‌.
Event data type • Surgical procedure coding - International Classification of Health Interventions (ICHI) • Other procedure coding – ICD-10 • Mechanism of injury – MSF classification, ICRC classification and International Classification of External Causes of Injuries