Территориальные особенности оказания экстренной хирургической помощи сельскому населению (на примере Республики Северная Осетия-Алания).

Abstract

The need to modernize healthcare dictates the study of healthcare organization at all levels. Special attention is paid to the territorial accessibility of medical care, including to the rural population, which differs in many specific features. The purpose of the study: to study the territorial features of providing emergency surgical care to the rural population, taking into account the number, density of population settlement, road infrastructure, and transport security in the Republic of North Ossetia-Alania. Research methods. Analytical and statistical research methods were used. The performance indicators of surgical departments of rural district hospitals for 2019–2022 have been studied. The analysis of the obtained data was carried out by the method of their structural description according to the selected main characteristics affecting territorial accessibility. Results. The Republic of Ossetia-Alania is characterized by high density and compactness of population settlement in rural areas. The creation of a modern transport infrastructure ensures the territorial accessibility of medical care. The republic has a fairly high level of provision with surgeons (2,53 per 10 thousand population) and a surgical bed fund (4,7 per 10 thousand population). However, there is a need to increase the efficiency of using the bed stock of rural surgical hospitals. The organization of surgical care in the republic in 2020–2021 was extremely negatively affected by the pandemic of coronavirus infection COVID‑19. The reduction of surgical and anesthesiological teams, beds and the volume of planned care due to the opening of additional infectious diseases hospitals has reduced the availability and quality of emergency surgical care. In rural district surgical departments, the bed function decreased from 283 days in 2019 to 243 days in 2020, and surgical activity up to 38,8%. In 2020–2021, planned medical care in the «surgery» profile has significantly decreased. The share of emergency hospitalizations increased to 79,7%. Negative trends in the growth of emergency hospitalization for surgical beds led to an increase in the hospital mortality rate compared to 2019 from 0,6% to 3,1% in 2021. The postoperative mortality rate has increased by more than 5 times. Our data correlate with similar trends of 33% increase in hospital mortality in the Russian Federation during the pandemic. Due to the creation of modern road transport infrastructure in the republic, high availability of surgical beds and surgeons, there is a potential to improve the quality indicators of rural surgical hospitals by improving the material and technical equipment and qualifications of surgical personnel.