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01-05-2021 | Spinal Anesthesia | Original Scientific Report

The Effect of Conflict on Obstetric and Non-Obstetric Surgical Needs and Operative Mortality in Fragile States

Authors: Arifeen S. Rahman, Tiffany E. Chao, Miguel Trelles, Lynette Dominguez, Jerome Mupenda, Cheride Kasonga, Clemence Akemani, Kalla Moussa Kondo, Kathryn M. Chu

Published in: World Journal of Surgery | Issue 5/2021

Abstract

Background

Médecins Sans Frontières (MSF) provides surgical care in fragile states, which are more vulnerable to conflict. The primary objective of this study was to compare the indications for operative intervention in surgical projects in fragile states during periods of active conflict (CON) and non-conflict (NON-CON). In addition, risk factors for non-obstetric and obstetric operative mortality were identified.

Methods

This was a retrospective analysis of MSF surgical projects in fragile states January 1, 2008–December 31, 2017. Variables considered in the analysis include age, gender, American Society of Anesthesiology physical status, emergency status, re-intervention status, indication for surgical intervention, and conflict/non-conflict time period.

Results

There were 30 surgical projects in 13 fragile states with 87,968 surgical interventions in 68,667 patients. Obstetric needs were the most common indication for surgical intervention (n = 28,060, 31.9%) but were more common during NON-CON (n = 23,142, 35.7%) compared to CON periods (n = 4,918, 21.2%, p < 0.001). Trauma was more common during CON (42.0%) compared to NON-CON (23.0%) periods (p < 0.001). Non-obstetric operative mortality was similar during CON (0.2%) compared to NON-CON (0.2%, p = 0.920), but obstetric operative mortality was higher (0.5%) during CON compared to NON-CON (0.2%, p < 0.001) periods. Risk factors for obstetric and non-obstetric mortality included age ≥ 30 years, ASA greater than 1, and emergency intervention.

Conclusion

Humanitarian surgeons working in fragile states should be prepared to treat a range of surgical needs including trauma and obstetrics during conflict and non-conflict periods. The mortality in obstetric patients was higher during conflict periods, and further research to understand ways to protect this vulnerable group is needed.

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Title: The Effect of Conflict on Obstetric and Non-Obstetric Surgical Needs and Operative Mortality in Fragile States
Authors: Arifeen S. Rahman
Tiffany E. Chao
Miguel Trelles
Lynette Dominguez
Jerome Mupenda
Cheride Kasonga
Clemence Akemani
Kalla Moussa Kondo
Kathryn M. Chu
Publication date: 01-05-2021
Publisher: Springer International Publishing
Keyword: Spinal Anesthesia
Published in: World Journal of Surgery / Issue 5/2021
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-021-05972-1

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

The Effect of Conflict on Obstetric and Non-Obstetric Surgical Needs and Operative Mortality in Fragile States

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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