The five-year dynamics of main indices of functioning of neurosurgical service of the Russian Federation

Abstract

The neurosurgery is one of the most innovative and hi-tech directions of scientific and clinical activity that significantly contribute into improvement of health and improvement of quality and longevity of human life. This positioning specifies actuality of implementing on regular basis the analysis of trends of its development with purpose to improve corresponding indices of its efficiency, to develop conditions for continuity of medical process, to ensure equal accessibility of specialized neurosurgical medical care to population in the Regions of the Russian Federation. The purpose of the study was to describe and to analyze indices of neurosurgical service functioning to support decision making related to development of professional partnership and ensuring for population of different regions of Russia equal access to profile specialized medical care. The data of 2015-2019 was collected from 85 Subjects of the Russian Federation contained in the forms of state statistical observation "Data on activity of divisions of medical organization providing medical care in hospital conditions" and "Data on medical organization". The analysis of the collected data was implemented using such statistical tools as simple (unweighted) arithmetical mean values, specific weight of indices values, mean-root-square (standard) deviation from average values, coefficient of variation (mean-square distance and average value ratio). The data set considered as homogeneous if coefficient of variation did not exceed 33%. The study revealed that in the Russian Federation, at the mean, provision of beds of neurosurgical profile to population in 2015-2019 decreased from 9.22 to 8.83 beds per 100 000 of population. In 2019, intensity of hospitalization made up to 2.77±1.06 cases per 1000 of population. The average duration of treatment for five years decreased for 1 day and in 2019 made up to 8.47 days (9.96±2.3 days on beds for adults and 7.00±2.1 on beds for children). The mean annual occupancy of one bed of neurosurgical profile for adults decreased from 319.6±31.3 days in 2015 to 311.7±29.8 days in 2019 and for children from 305.4±28.3 days in 2015 to 289.0±29.1 days in 2019. The total hospital lethality of neurosurgical beds in 2019 consisted 1.22±1.19% that is 22.7% less than in 2015 (1.50±1.37%). The number of implemented surgical operations increased from 146.4 in 2015 to 179.1 thousand in 2019, i.e. for 22.4% and made up to 2.7 operations per 1000 of population. The postoperative lethality decreased from 9.63±7.07% in 2016 to 8.19±4.48% in 2019. In 2019, there were 1.91±0.61 neurosurgeons (natural persons) per 100 000 of population. The total number of established posts of neurosurgeons in 2019 made up to 4792.25 units (in 2015 - 4629.75 units) and out of them 4318 units are occupied (in 2015 - 4264 units). The occupied units covered 2923 neurosurgeons as natural persons. On average, per one neurosurgeon (natural person) in the Subjects of the Russian Federation fall 4.7±1.30 beds of neurosurgical profile (from 2.6 to 10.7), 54.7± 24.6 surgical operations on nervous system per year (from 14 to 162), 137.8±41.1 cases of neurosurgical beds hospitalization (from 60 to 300). In five years, the structure of types of surgical operations on nervous system changed insignificantly. The surgeries in case of degenerative diseases of spline prevail and their specific weight increases. In Russia, significant differentiation of the Regions in level of resource support of medical care of neurosurgical profile continue to remain. At that, the Russian neurosurgeons in average implement three times less operation per year than their respective colleagues from Western Europe. In Russia, the main portion of neurosurgical operations is implemented in case of degenerative diseases of spine while in the developed foreign countries in case of cerebral stroke that is one of the main causes of death all around the world. To ensure equal access of population of different Subjects of Russia to profile specialized medical care an integration of clinical and administrative processes (vertical integration) is needed. The important role in solution of this task belongs to National medical research centers organized in Russia on the basis of leading Federal state scientific medical organizations.