Global Surgery Initiative, Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA.
Tanzania Red Cross Society, Dar es Salaam, Tanzania.
BMC Surg. 2021 Oct 29;21(1):381. doi: 10.1186/s12893-021-01365-2.
There are 80 million forcibly displaced persons worldwide, 26.3 million of whom are refugees. Many refugees live in camps and have complex health needs, including a high burden of non-communicable disease. It is estimated that 3 million procedures are needed for refugees worldwide, yet very few studies exist on surgery in refugee camps, particularly protracted refugee settings. This study utilizes a 20-year dataset, the longest dataset of surgery in a refugee setting to be published to date, to assess surgical output in a setting of protracted displacement.
A retrospective review of surgeries performed in Nyarugusu Camp was conducted using paper logbooks containing entries between November 2000 and September 2020 inclusive. Abstracted data were digitized into standard electronic form and included date, patient nationality, sex, age, indication, procedure performed, and anesthesia used. A second reviewer checked 10% of entries for accuracy. Entries illegible to both reviewers were excluded. Demographics, indication for surgery, procedures performed, and type of anesthesia were standardized for descriptive analysis, which was performed in STATA.
There were 10,799 operations performed over the 20-year period. Tanzanians underwent a quarter of the operations while refugees underwent the remaining 75%. Ninety percent of patients were female and 88% were 18 years of age or older. Caesarean sections were the most common performed procedure followed by herniorrhaphies, tubal ligations, exploratory laparotomies, hysterectomies, appendectomies, and repairs. The most common indications for laparotomy procedures were ectopic pregnancy, uterine rupture, and acute abdomen. Spinal anesthesia was the most common anesthesia type used. Although there was a consistent increase in procedural volume over the study period, this is largely explained by an increase in overall camp population and an increase in caesarean sections rather than increases in other, specific surgical procedures.
There is significant surgical volume in Nyarugusu Camp, performed by staff physicians and visiting surgeons. Both refugees and the host population utilize these surgical services. This work provides context to the surgical training these settings require, but further study is needed to assess the burden of surgical disease and the extent to which it is met in this setting and others.
全球有 8000 万被迫流离失所者，其中 2630 万人是难民。许多难民居住在难民营中，他们的健康需求复杂，包括非传染性疾病负担沉重。据估计，全球有 300 万例手术需求，但关于难民营中的手术，尤其是长期难民营中的手术，研究很少。本研究利用了 20 年的数据集，这是迄今为止发表的关于难民营中手术的最长数据集，评估了长期流离失所背景下的手术输出。
对 2000 年 11 月至 2020 年 9 月期间在尼亚鲁古苏难民营进行的手术进行了回顾性审查，使用包含 2000 年 11 月至 2020 年 9 月期间全部条目记录的纸质日志本。提取的数据被数字化为标准电子表格，包括日期、患者国籍、性别、年龄、适应证、手术方式和使用的麻醉方式。由第二名评审员检查 10%的条目以确保准确性。两名评审员均无法辨认的条目被排除在外。描述性分析标准化了人口统计学、手术适应证、手术方式和麻醉类型，这些分析在 STATA 中进行。
在 20 年期间进行了 10799 次手术。坦桑尼亚人进行了四分之一的手术，而难民则进行了其余 75%的手术。90%的患者为女性，88%的患者年龄在 18 岁或以上。剖宫产是最常见的手术，其次是疝修补术、输卵管结扎术、剖腹探查术、子宫切除术、阑尾切除术和修复术。剖腹手术最常见的适应证是异位妊娠、子宫破裂和急腹症。蛛网膜下腔麻醉是最常用的麻醉类型。尽管研究期间手术量持续增加，但这主要是由于营地总人口增加以及剖宫产增加所致，而不是其他特定手术的增加。
尼亚鲁古苏难民营的手术量很大，由主治医生和来访外科医生完成。难民和东道国居民都利用这些手术服务。这项工作为这些环境所需的手术培训提供了背景，但需要进一步研究来评估手术疾病的负担以及在这种环境和其他环境中满足手术需求的程度。
