Care of surgical infections by Médecins Sans Frontières Operations Centre Brussels in 2008-14

Davina Sharma; Kate Hayman; Barclay T Stewart; Lynette Dominguez; Miguel Trelles; Sanaulhaq Saqeb; Cheride Kasonga; Theophile Kubuya Hangi; Jerome Mupenda; Aamer Naseer; Evan Wong; Adam L Kushner

doi:10.1016/S0140-6736(15)60826-1

Care of surgical infections by Médecins Sans Frontières Operations Centre Brussels in 2008-14

Lancet. 2015 Apr 27:385 Suppl 2:S31. doi: 10.1016/S0140-6736(15)60826-1. Epub 2015 Apr 26.

Authors

Affiliations

¹ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA.
² University of Washington, Seattle, WA, USA. Electronic address: [email protected].
³ Médecins sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium.
⁴ Médecins sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; Hospital Ahmad Sha Baba, Médecins Sans Frontières, Kabul, Afghanistan.
⁵ Médecins sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; General Referral Hospital, Médecins Sans Frontières, Niangara, DR Congo.
⁶ Médecins sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; General Referral Hospital, Médecins Sans Frontières, Masis, DR Congo.
⁷ Médecins sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; General Referral Hospital, Médecins Sans Frontières, Lubutu, DR Congo.
⁸ Médecins sans Frontières - Operational Centre Brussels, Surgical Unit, Brussels, Belgium; District Headquarters Hospital, Médecins Sans Frontières, Timurgara, Lower Dir, Occupied Palestinian Territory, Montreal, QC, Canada.
⁹ Centre for Global Surgery, Mc Gill University Health Centre, Montreal, QC, Canada.
¹⁰ Department of International Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA; Surgeons Over Seas (SOS), New York, NY, USA.

PMID: 26313079
DOI: 10.1016/S0140-6736(15)60826-1

Abstract

Background: Surgical infections represent a substantial yet undefined burden of disease in low-income and middle-income countries (LMICs). Médecins Sans Frontières (MSF) provides surgical care in LMICs and collects data useful to describe the operative epidemiology of surgical need that would otherwise be unmet by national health services. We aimed to describe the experience of MSF Operations Centre Brussels surgery for infections during crisis; aid effective resource allocation; prepare humanitarian surgical staff; and further characterise unmet surgical needs in LMICs.

Methods: We reviewed all procedures undertaken in operating theatres at facilities run by the MSF Operations Centre Brussels between July, 2008, and June, 2014. Projects providing only specialty care were excluded. Procedures for infections were quantified, related to demographics and reason for humanitarian response was described.

Findings: 96 239 operations were undertaken at 27 MSF Operations Centre Brussels sites in 15 countries. Of 61 177 general operations, 7762 (13%) were for infections. Operations for skin and soft tissue infections were the most common (64%), followed by intra-abdominal (26%), orthopaedic (6%), and tropical infections (3%). The proportion of operations for skin and soft tissue infections was highest during natural disaster missions, intra-abdominal infections during hospital support missions, and orthopaedic infections during conflict missions. Most procedures for skin and soft tissue infections were minor (76%), whereas most operations for intra-abdominal infections were major (98%).

Interpretation: Surgical infections are among the most common causes for operation in LMICs. Although many procedures were minor, they represent substantial use of perioperative resources. Growing evidence shows the need for improved perioperative capacity to aptly care for the volume and variety of conditions comprising the global burden of surgical disease.

Funding: Médecins Sans Frontières.