Article ; Online: Anaesthesia care providers employed in humanitarian settings by Médecins Sans Frontières: a retrospective observational study of 173 084 surgical cases over 10 years.
2020 Volume 10, Issue 3, Page(s) e034891
Abstract: Objective: To describe the extent to which different categories of anaesthesia provider are used in humanitarian surgical projects and to explore the volume and nature of their surgical workload.: Design: Descriptive analysis using 10 years (2008- ... ...
| Abstract | Objective: To describe the extent to which different categories of anaesthesia provider are used in humanitarian surgical projects and to explore the volume and nature of their surgical workload. Design: Descriptive analysis using 10 years (2008-2017) of routine case-level data linked with routine programme-level data from surgical projects run exclusively by Médecins Sans Frontières-Operational Centre Brussels (MSF-OCB). Setting: Projects were in contexts of natural disaster (ND, entire expatriate team deployed by MSF-OCB), active conflict (AC) and stable healthcare gaps (HG). In AC and HG settings, MSF-OCB support pre-existing local facilities. Hospital facilities ranged from basic health centres with surgical capabilities to tertiary referral centres. Participants: The full dataset included 178 814 surgical cases. These were categorised by most senior anaesthetic provider for the project, according to qualification: specialist physician anaesthesiologists, qualified nurse anaesthetists and uncertified anaesthesia providers. Primary outcome measure: Volume and nature of surgical workload of different anaesthesia providers. Results: Full routine data were available for 173 084 cases (96.8%): 2518 in ND, 42 225 in AC, 126 936 in HG. Anaesthesia was predominantly led by physician anaesthesiologists (100% in ND, 66% in AC and HG), then nurse anaesthetists (19% in AC and HG) or uncertified anaesthesia providers (15% in AC and HG). Across all settings and provider groups, patients were mostly healthy young adults (median age range 24-27 years), with predominantly females in HG contexts, and males in AC contexts. Overall intra-operative mortality was 0.2%. Conclusion: Our findings contribute to existing knowledge of the nature of anaesthetic provision in humanitarian settings, while demonstrating the value of high-quality, routine data collection at scale in this sector. Further evaluation of perioperative outcomes associated with different models of humanitarian anaesthetic provision is required. |
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| MeSH term(s) | Adolescent ; Adult ; Anesthesiologists/statistics & numerical data ; Anesthesiology/organization & administration ; Developing Countries ; Global Health ; Humans ; International Agencies/statistics & numerical data ; Medical Missions ; Medically Underserved Area ; Nurse Anesthetists/statistics & numerical data ; Retrospective Studies ; Surgical Procedures, Operative/statistics & numerical data ; Young Adult |
| Language | English |
| Publishing date | 2020-03-04 |
| Publishing country | England |
| Document type | Journal Article ; Observational Study ; Research Support, Non-U.S. Gov't |
| ZDB-ID | 2599832-8 |
| ISSN | 2044-6055 ; 2044-6055 |
| ISSN (online) | 2044-6055 |
| ISSN | 2044-6055 |
| DOI | 10.1136/bmjopen-2019-034891 |
| Database | MEDical Literature Analysis and Retrieval System OnLINE |
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