Revue de l'activité chirurgicale 2014

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 â&#x20AC;&#x201C; 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 youâ&#x20AC;Ś.

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