Operative trauma in low-resource settings: The experience of Médecins Sans Frontières in environments of conflict, postconflict, and disaster.
BACKGROUND
Conflicts and disasters remain prevalent in low- and middle-income countries, and injury remains a leading cause of death worldwide. The objective of this study was to describe the operative procedures performed for injury-related pathologies at facilities supported by Médecins Sans Frontières (MSF) to guide the planning of future responses.


METHODS
A retrospective review of a prospectively collected database of all MSF procedures performed between July 2008 and June 2014 for injury-related indications was completed. Individual data points included country of project and date of procedure; age, patient sex, and the American Society of Anesthesiologists' score of each patient; indication for surgery, including mechanism of injury; operative procedure; operative urgency; operative order; type of anesthesia; and intraoperative mortality. Injury severity was stratified according to operative order and urgency.


RESULTS
A total of 79,715 procedures were performed in MSF projects that met the inclusion criteria. Of these, 35,756 (44.9%) were performed specifically for traumatic indications across 17 countries. Even after excluding trauma centers, 29.4% (18,329/62,288) of operative cases were for injuries. Operative trauma procedures were performed most commonly for road traffic injuries (29.9%; 10,686/35,756). The most common procedure for acute trauma was extensive wound debridement (31.6%; 3,165/10,022) whereas burn dressings were the most frequent planned reoperation (27.1%; 4,361/16,078).


CONCLUSIONS
Trauma remains an important component of the operative care provided in humanitarian assistance. This review of procedures performed by MSF in a variety of settings provides valuable insight into demographics of trauma patients, mechanisms of injury, and surgical capabilities required in planning resource allocation for future humanitarian missions in low- and middle-income countries.
Centre for Global Surgery, McGill University Health Centre, Montreal, QC, Canada; Surgeons Over Seas (SOS), New York, NY. Electronic address: evan.wong@mail.mcgill.ca.
Evan G
EG
Wong
Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium.
Lynette
L
Dominguez
Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium.
Miguel
M
Trelles
Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; Trauma Centre, Médecins Sans Frontières, Kunduz, Afghanistan.
Samir
S
Ayobi
Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; Hospital Boost, Médecins Sans Frontières, Lashkar-Gah, Helmand, Afghanistan.
Khalil Rahman
KR
Hazraty
Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; General Referral Hospital, Médecins Sans Frontières, Niangara, Democratic Republic of the Congo.
Cheride
C
Kasonga
Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; General Referral Hospital, Médecins Sans Frontières, Masisi, Democratic Republic of the Congo.
Jean-Paul
JP
Basimuoneye
Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; Surgical and Trauma Centre Nap Kembe, Médecins Sans Frontières, Tabarre, Port-au-Prince, Haïti.
Lunick
L
Santiague
Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; District Headquarters Hospital, Médecins Sans Frontières, Timurgara, Lower Dir, Pakistan.
Mustafa
M
Kamal
Médecins Sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; Field Hospital, Médecins Sans Frontières, Jabal-Akkrad, Syria.
Alaa
A
Rahmoun
Surgeons Over Seas (SOS), New York, NY; Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD; Department of Surgery, Columbia University, New York, NY.
Adam L
AL
Kushner
D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D004190:Disasters; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D008493:Medical Missions / Q000706:statistics & numerical data*; D008875:Middle Aged; D012189:Retrospective Studies; D013514:Surgical Procedures, Operative / Q000706:statistics & numerical data*; D014857:Warfare; D014947:Wounds and Injuries / Q000601:surgery*; D055815:Young Adult