Surgery & anaesthesia review 2015

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