DOI: 10.21045/2071-5021-2016-52-6-2

Zubko A.V., Sabgayda T.P.
Federal Research Institute for Health Organization and Informatics of Ministry of Health of the Russian Federation, Moscow

Contacts: Alexander V. Zubko, e-mail: This e-mail address is being protected from spam bots, you need JavaScript enabled to view it

Abstract. Departments of interventional radiology diagnostics and treatment were set up not only at the third level hospitals, which could have affected quality of this high-tech medical care.

Purpose. To test this hypothesis, we analyzed data on surgical activities for vascular reconstruction and its results in hospitals of different levels.

Methods. Analysis was based on data of the A.N. Bakoulev Scientific Center for Cardiovascular Surgery on interventions in patients with occlusive diseases of aorta and arteries of lower extremities in 2010-2014.

Data from 188 vascular departments were divided into groups as follows: by the level of care delivery, i.d. hospitals of the first, second or third levels and by the average annual number of vascular reconstructions performed.

Results. 51.0% of interventions for vascular reconstruction are implemented at the second level of care delivery, 36.2% - at the first and 12.7% at the third level of care delivery. Frequency of amputations after the vessel reconstruction and repeat operations increase along with the increasing number of interventions performed: increase from 0.6% and 1.3% respectively in hospitals with the average annual number of reconstructions under 20 and to 1.9% and 2.5% in hospitals with the average annual number of reconstructions over 100; from 0.3% in the third level hospitals to 1.3% in hospitals of the first and second levels of care delivery in 2014.

Conclusions. Reallocation of patients with surgical vascular diseases across hospitals of different levels does not correspond to the current paradigm of the three-level care organization. The share of repeat operations (including amputations) proportionally increases along with the increasing patient flow (surgical activity). Resource provision of the second level hospitals is not sufficient to effectively treat patients with late stages of surgical vascular diseases. Measures to incentivize the third-level hospitals to increase the share of interventions for vascular reconstruction are required to avoid growth of the lower limb amputations’ frequency.

Keywords: treatment of surgical vascular diseases; frequency of vascular reconstructions ended by amputation; frequency of repeat angioplasty; departments of interventional radiology diagnostics and treatment.

References

1. Bogachevskaya S.A., Bogachevskiy A.N., Bondar' V.Yu. Trekhletniy vklad funktsionirovaniya federal'nykh tsentrov serdechno-sosudistoy khirurgii v razvitie vysokotekhnologichnoy meditsinskoy pomoshchi patsientam s serdechno-sosudistymi zabolevaniyami v Rossii [Three-year contribution of the Federal centers for cardiovascular surgery to the development of high-tech medical care for patients with cardiovascular diseases in Russia]. Sotsial'nye aspekty zdorov'ya naseleniya [serial online] 2016 [cited 2016 Sep 20]; 47(1). Available from: http://vestnik.mednet.ru/content/view/729/30/lang,ru/ (in Russian).
2. Bokeriya L.A., Alekyan B.G. Rentgenendovaskulyarnaya diagnostika i lechenie zabolevaniy serdtsa i sosudov v Rossiyskoy Federatsii - 2010 god. [Endovascular diagnosis and treatment of heart diseases and blood vessels in the Russian Federation – 2010]. Moscow: NTsSSKh im. A.N. Bakuleva RAMN; 2011. 142 p. (In Russian).
3. Bokeriya L.A., Alekyan B.G. Rentgenendovaskulyarnaya diagnostika i lechenie zabolevaniy serdtsa i sosudov v Rossiyskoy Federatsii - 2015. [Endovascular diagnosis and treatment of heart diseases and blood vessels in the Russian Federation – 2015]. Moscow: NTsSSKh im. A.N. Bakuleva; 2016. 222 p. (In Russian).
4. Bokeriya L.A., Gudkova R.G. Serdechno-sosudistaya khirurgiya-2012. Bolezni i vrozhdennye anomalii sistemy krovoobrashcheniya. [Cardiovascular surgery - 2012. Diseases and congenital anomalies of the circulatory system]. Moscow: NTsSSKh im. A.N. Bakuleva; 2013. 210 p. (In Russian).
5. Bokeriya L.A., Gudkova R.G. Serdechno-sosudistaya khirurgiya-2013. Bolezni i vrozhdennye anomalii sistemy krovoobrashcheniya. [Cardiovascular surgery - 2013. Diseases and congenital anomalies of the circulatory system]. Moscow: NTsSSKh im. A.N. Bakuleva; 2014. 220 p. (In Russian).
6. Bokeriya L.A., Gudkova R.G. Serdechno-sosudistaya khirurgiya-2014. Bolezni i vrozhdennye anomalii sistemy krovoobrashcheniya. [Cardiovascular surgery - 2014. Diseases and congenital anomalies of the circulatory system]. Moscow: NTsSSKh im. A.N. Bakuleva; 2015. 226 p. (In Russian).
7. Vertkina N., Khamitov F., Lisitsyn Yu. Kliniko-ekonomicheskiy analiz lecheniya bol'nykh obliteriruyushchim aterosklerozom nizhnikh konechnostey v zavisimosti ot metoda terapii. [Clinical and economic analysis of treatment of patients with obliterating atherosclerosis of lower limb arteries depending on the method of treatment]. Vrach 2007; (9): 69-72. (In Russian).
8. Katel'nitskiy I.I., Livadnyaya E.S. Metody lecheniya bol'nykh obliteriruyushchim aterosklerozom arteriy nizhnikh konechnostey pri kriticheskoy ishemii. [Methods of treatment of patients with obliterating atherosclerosis of lower limb arteries with critical ischemia]. Sovremennye problemy nauki i obrazovaniya [serial online] 2014 [cited 2016 Sep 19]; (3): 463. Available from: http://www.science-education.ru/ru/article/view?id=13206 (in Russian).
9. Ob aktual'nykh problemakh bor'by s serdechno-sosudistymi zabolevaniyami. [Concerning to actual problems of the struggle against cardiovascular diseases]. Analiticheskiy vestnik [serial online] 2015 [cited 2016 Sep 6]; 44(597): 1-108. Available from: http://www.budgetrf.ru/Publications/Magazines/VestnikSF/2015/44_597/VSF_NEW_44_597.pdf (in Russian).
10. Podzolkov V.P., Alekyan B.G., Kokshenev I.V., Cheban V.N. Povtornye operatsii posle korrektsii vrozhdennykh porokov serdtsa. [Repeated operations after correction of congenital heart disease]. Moscow: NTsSSKh im. A.N. Bakuleva RAMN; 2013. 364 p. (In Russian).
11. Savel'ev V.S., Koshkin V.M., Kunizhev A.S. Kriticheskaya ishemiya kak sledstvie neadekvatnogo lecheniya bol'nykh khronicheskimi obliteriruyushchimi zabolevaniyami arteriy nizhnikh konechnostey na ambulatornom etape. [Critical ischemia as a result of inadequate treatment of patients with chronic obliterating diseases of lower limb arteries at the outpatient stage]. Angiologiya i sosudistaya khirurgiya 2004; 10(1): 6-10. (In Russian).

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