Stroke units in the world and Ukraine: requirements, realities and prospects

Abstract

Objective. To assess the state of neurosurgical care (NSC) provision to stroke patients in Ukraine, to determine the possibilities for integrating stroke units (including neurovascular ones) into a single network.Materials and methods. The results of the full-design statistical study of the clinical work of neurosurgical units (NSU) of Ukraine in the years 2008 to 2017 were analyzed. Statistical methods of sampling and grouping, time series studies were used. Calculations were performed using Microsoft Office Excel.Results. Over the last 10 years the number of hospital patients increased by 33 % (from 7,160 in 2008 to 9,520 in 2017), the number of those operated by 76 % (from 2,573 to 4,532). Per a million people the growth rate is even greater: the rate of hospitalization increased by 59 % (from 156 to 248), the rate of surgeries enlarged by 111 % (from 56 to 118).In the structure of patients operated in NSU, the share of those who underwent surgeries because of stroke increased from 6 % to 11 %.In 2017 85 NSU provided care to patients with stroke. Among them, 8 units are neurovascular, 7 units may be regarded as those ones by formal signs, the rest are multifaceted NSU.NSC for stroke is concentrated in the capital and large cities. In 2017, 45 % of surgeries relating to stroke were performed in the NSU of the capital (2,044 surgeries out of 4,532). Another 27 % (1,015) of operated patients received surgical treatment in the units in Dnipropetrovsk, Kharkiv, Vinnytsia, Lviv.In 2017, in Ukraine the share of operated persons among those to whom such surgery is indicated amounted to 16 %. The maximum rate of NSC provision is in Kyiv (126.3 %). However, it is wrong to analyze it as care provided to residents of Kyiv, because a major part of those operated there were residents of other regions. Among regions, the population of Ivano-Frankivsk (17.9 %), Dnipropetrovsk (16.2 %), Lviv regions (12.1 %) were the most provided with NSC for stroke; in 8 regions the coverage was 5–10 %; in 10 — less than 5 % of the need.The lack of information on the number of stroke units, their distribution throughout the country, the number of treated stroke patients cause the necessity of creation of a framework of stroke units, their certification and accounting of their activities.Conclusions. Over the last 10 years in Ukraine the indicators of NSC provision to stroke patients improved. However, the rate of coverage of stroke patients with NSC remains low, with a considerable swing in the rate by regions of Ukraine. The necessity of integrating stroke units (including neurovascular ones) into a single network, their certification and keeping statistical accounting have become urgent.