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Main arrow Archive of previous Issues arrow ╣6 2016 (52) arrow VASCULAR SURGERY IN HOSPITALS OF DIFFERENT LEVELS
VASCULAR SURGERY IN HOSPITALS OF DIFFERENT LEVELS Print
Friday, 23 December 2016

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 amputationsĺ 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

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