19,643 Surgeries Performed With Just 0.2% Death Rate In Resource-Limited Settings

Aug 17th, 2010 | By healthnews | Category: Health

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Main Category: Aid / Disasters
Article Date: 16 Aug 2010 – 13:00 PDT

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Médecins Sans Frontières (Doctors without Borders) reports that it performed nearly 20,000 surgical procedures with a death rate of just 0.2% in resource-limited settings between 2001 and 2008, showing that with appropriate minimal standards, surgical care can be provided safely and cheaply, says an article in Archives of Surgery, a JAMA/Archives journal.

No more than 4% of the 230 major surgical procedures that are performed globally are done in poor-income countries, the researchers say.

The authors write:

The fact that the latter bear the greatest burden of injury, violence and maternal mortality indicates a substantial unmet need for surgical care, although few data exist about the burden of unmet surgical disease in the developing world.

Developed nations comply with quality control programs to monitor and improve safety which are not yet available in poor-income countries.

Allegedly elevated rates of operative death in these countries have prompted a re-assessment of the safety of international surgical care. Kathryn M. Chu, M.D., M.P.H., of Johns Hopkins Medical Institutions, Baltimore, and Médecins Sans Frontières (MSF), Johannesburg, South Africa, carried out a retrospective study of 17 surgical programs from 13 nations performed by MSF, an international medical organization that provides surgical care in response to humanitarian crises.

A total of 19,643 surgical procedures were performed by MSF surgeons between 2001 and 2008 on 18,653 patients, of which:

  • 42% (8,329) were emergency procedures
  • 40% (7,993) were for obstetric-related problems
  • 14% (2,767) were trauma related.

Of the 13 programs, 8 reported no deaths. The overall death rate was 0.2%, with the higher overall death rate at 0.9%. The higher death rate was linked to programs in conflict settings, complex procedures and procedures performed in emergency conditions, as well as those done in patients given a higher score under the American Society of Anesthesiologists classification of severity.

The authors wrote:

As a large provider of surgical care in developing countries, assuring quality is paramount for MSF. Our low operative mortality, even in a variety of emergencies, was partly the result of strict protocols for all essential aspects of surgical care. In most humanitarian contexts outcome data are difficult to collect, which means that structural and process indicators are even more important, as are minimum standards for essential items such as water, a blood bank, electricity, sterilization equipment and a postanesthesia care unit.

Several different types of additional organizations, including government and non-governmental bodies and missionary groups provide surgical care in similar settings, the researchers wrote.

The authors concluded:

Quality improvement programs are needed to regulate the enormous body of surgical providers in resource-limited settings. In this respect, the World Health Organization’s Safe Surgery Saves Lives checklist is an important first step in a process of establishing global minimum standards in surgical care for humanitarian contexts. Operational research is needed to ensure such standardized approaches developed in relatively well-resourced settings are adapted to the complexities and constraints of humanitarian emergencies.

Arch Surg
Published August, 2010;145[8]:721-725.
Written by Christian Nordqvist

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