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dc.contributor.authorRahman, AS
dc.contributor.authorChao, TE
dc.contributor.authorTrelles, M
dc.contributor.authorDominguez, L
dc.contributor.authorMupenda, J
dc.contributor.authorKasonga, C
dc.contributor.authorAkemani, C
dc.contributor.authorKondo, KM
dc.contributor.authorChu, KM
dc.date.accessioned2021-04-11T17:03:04Z
dc.date.available2021-04-11T17:03:04Z
dc.date.issued2021-02-09
dc.date.submitted2021-04-09
dc.identifier.pmid33560502
dc.identifier.doi10.1007/s00268-021-05972-1
dc.identifier.urihttp://hdl.handle.net/10144/619916
dc.descriptionWe regret that this article is behind a paywall. To access this article, please visit the journal page here: https://link.springer.com/article/10.1007%2Fs00268-021-05972-1.en_US
dc.description.abstractBackground 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.en_US
dc.language.isoenen_US
dc.publisherSpringer Natureen_US
dc.titleThe Effect of Conflict on Obstetric and Non-Obstetric Surgical Needs and Operative Mortality in Fragile States.en_US
dc.typeArticle
dc.identifier.eissn1432-2323
dc.identifier.journalWorld Journal of Surgeryen_US
dc.source.journaltitleWorld journal of surgery
dc.source.volume45
dc.source.issue5
dc.source.beginpage1400
dc.source.endpage1408
dc.source.countryUnited States


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