Surgery & anaesthesia review MSF OCP jan-sept 2015 Xavier Lassalle
Paris 5 dec 2015
MSF OCP dec 2015 14 surgical missions
General surgery Burns Gyn –obst Planned reconstructive surgery Opening
Surgical activity MSF OCP jan-sept 2015 : 28.330 procedures / 13.039 patients
2006
2007
2008
2009
2010
2011
2012
2013
2014
2015
Surgical activity MSF OCP
jan-sept 2014 : 28.330 procedures / 13.039 patients Emergencies 95%
Planned Delayable Acute
Surgical indications MSF OCP jan-sept 2015
Type of anaesthesia MSF OCP jan-sept 2015
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
RPX
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
REGIONAL
Type of anaesthesia MSF OCP jan-sept 2015
Missing data 13,5%
Regional anesthesia MSF OCP jan-sept 2015
• Regional block : 292 (141 associated ) • TAP block : 18 • Infiltration : 1534 – 3 912 Caesarean sections – 15 120 Wounds – 1 707 Abdo surgery
Visibility 2013
2014
2015
100%
100%
100%
anaesthesia
70%
54%
68%
Mortality reports
41%
52%
71%
•Data i
Quality (follow up pain mgt )
Visibility 2013
2014
2015
100%
100%
100%
anaesthesia
70%
54%
68%
Mortality reports
41%
52%
71%
•Data i
Quality (follow up pain mgt )
Improvement of the quality of the reports
Perioperative mortality MSF OCP jan-sept 2015
Haemorrage
Pre
Per
Post
TOTAL
4
7
8
19
1
28
29
4
46
51
2
1
3
5
5
88
107
Septic shock Multi visceral failure
1
Iatrogen Other TOTAL
5
14
Mortality patient-related • Age < 2 or > 75 yo : 27 • Burn > 50 % : 10 • Polytrauma : 9 • Head Trauma : 8 • Associated disease : 8 • AEG /Malnutrition :7 • Eclampsie : 3
Mortality organisation-related • Poor respect of protocols – Triage – PPH
6 7
• Lack of resources – Blood – Beds (ICU)
2 1 (under-estimated)
Merci