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
Thank youâ&#x20AC;Ś