Study examines surgical procedures in low-resource settings

A new study shows "that surgery can be safely performed in areas with minimal resources and little or no sophisticated technology," the Los Angeles Times' "Booster Shots" blog reports. The study, published in the Archives of Surgery, examines "almost 20,000 surgical procedures completed in resource-limited areas from 2001 to 2008" by Medecins Sans Frontieres (MSF) (Roan, 8/16). 

Among the surgical procedures assessed by the researchers, the data "revealed a surgical mortality rate of just 0.2 percent, suggesting that when well-trained and outfitted staff are available, surgery can be quite safe in areas of violent conflict, such as Southern Sudan," Scientific American's "Observations" blog reports.

For the study, researchers "assessed 19,643 surgical procedures completed between 2001 and 2008 by staffers and others involved in [MSF] programs in Burundi, Central African Republic, Chad, Democratic Republic of the Congo, Haiti, Indonesia, Ivory Coast, Mali, Niger, Pakistan, Sierra Leone, Somalia and Southern Sudan," according to the blog. "Those operations resulted in just 31 deaths, according to the organization, members of which performed the analysis."

The article notes that all the procedures occurred with "at least some professional surgical help in settings equipped with anesthetics, antibiotics, blood banks, clean water, electricity, operating rooms, painkillers, post-op and post-anesthesia care and sterilization units," and because of this "the surgeries in the assessment don't 'accurately reflect the burden of surgical disease for our catchment populations,' [study] the authors noted."

The researchers concluded that the study "demonstrat[es] that surgical care is feasible in resource-limited settings," but said "that the unmet burden of surgical disease in these communities is large" (Harmon, 8/16).

Looking at an accompanying commentary published in the same journal, Booster Shots writes, "[a]lthough about 230 million surgical procedures are performed worldwide each year, only about 4% of them take place in impoverished countries. Yet, those countries are the most likely to need surgical care. The authors of the opinion … pointed out that many individual doctors volunteer their time to perform surgery in poor countries. Yet, they say, surgical societies have done little to promote an organized and sustained system providing free surgical care to the poor" (8/16).

Medscape.com discusses limitations of the study, including "that the procedural coding system was insufficiently precise to analyze all procedures separately, leading to possible underestimation of operative mortality." The news service also cites a "lack of data on in-hospital postoperative morbidity and mortality" and poor long-term follow-up (Barclay, 8/16).