Abstract
BackgroundAlthough the effect of the recent Greek economic crisis and austerity on the population’s health and the health system effectiveness have been discussed a lot recently, data on common surgical conditions affecting large part of the population are missing. Using inguinal hernia as a model we investigated possible changes of citizens’ attitude regarding the time of referral, the perioperative details and the intraoperative findings of the emergency hernioplasties.MethodsThe present retrospective study was conducted by a Department of Surgery in a tertiary public hospital of the Greek capital. We reviewed the records of all hernioplasties performed during two 5-year periods: 2005–2009 and 2012–2016, i.e. before and during the crisis focusing on the emergency ones (either incarcerated or strangulated).ResultsAn equal number of hernioplasties was performed in both periods. During the crisis however, an emergency hernioplasty was significantly more probable (HR 1.269, 95% CI 1.108–1.1454, p = 0.001), at a younger age (p = 0.04), mainly in patients younger than 75 years old (p = 0.0013). More patients presented with intestinal ischemia (7 vs 18, p = 0.002), requiring longer hospitalization (5.2 vs 9.6 days, p = 0.04), with higher cost (560 ± 262.4€ vs 2125 ± 1180.8€ p < 0.001). In contrast the percentage of patients with intestinal resection, their hospitalization length and treatment-cost remained unchanged. During the crisis there was a non-significant increase of emergency patients requiring ICU postoperatively (0 vs 4, p = 0.07) and a non-significant 60% increase of emergency operations in migrants/refugees population (3.5% vs 5.8%, p = 0.28). Epidural anesthesia was significantly more frequent during the crisis.ConclusionDuring the crisis: (i) the emergency hernioplasties increased significantly, (ii) more patients (exclusively Greek) presented with intestinal ischemia requiring longer hospitalization and higher treatment cost, (iii) the mean age of the urgently treated patients decreased significantly (iv) regional (epidural) anesthesia was more frequent. Although a direct causal relation could not be proven by the present study most observations can be explained by an increase of the patients who delayed the elective treatment of their hernia, and by a redistribution of the surgical workload towards big central hospitals. This can be prevented by adequately supporting the small district hospitals.
Highlights
The effect of the recent Greek economic crisis and austerity on the population’s health and the health system effectiveness have been discussed a lot recently, data on common surgical conditions affecting large part of the population are missing
For Greece in particular, the protracted and severe financial crisis was combined with strict austerity measures implemented by the Greek Government since the beginning of 2010
In particular we focused on emergency operations where we analyzed data regarding surgical technique, signs of ischemia of the herniated organ, concomitant intestinal resections, length of hospital stay (LOHS) and cost of treatment per patient
Summary
The effect of the recent Greek economic crisis and austerity on the population’s health and the health system effectiveness have been discussed a lot recently, data on common surgical conditions affecting large part of the population are missing. Crisis has been appreciated as detrimental for the population health and the Healthcare Systems [12] but on the same time, as opportunity for reform and improvement [13] In this aspect a number of methods have been proposed for reduction of the cost of the daily surgical practice [14,15,16,17]. To the best of our knowledge, no report from Greece has been published yet on how the Greek citizens deal with a surgical problem during the crisis era On this purpose, we studied inguinal hernia and its treatment by inguinal hernioplasty, a common surgical condition and its cure by a routine operation. We focused on incarcerated or strangulated hernias which by definition call for an emergency, and unscheduled, operation
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