The Russian neurosurgery to and during COVID-19 pandemic
The pandemic of a new coronavirus (COVID-19) which captured the whole world undermined all aspects of life of society and health care in incomprehensible scales. Neurosurgeons were rather protected from the sudden overloads which fell upon narrow specialists in the field of emergency medical service, an intensive care, pulmonology, but, nevertheless, practice of neurosurgery also underwent changes. It causes relevance of the analysis of key indicators of work of neurosurgical service during the period to and during a pandemic of a new coronavirus infection.
Aim – the description and the analysis of key performance indicators of neurosurgical service during the period to and during a pandemic for the purpose of support of management decisions on ensuring availability to the population of profile specialized medical care.
Material and methods. Data for 2019–2020 on each of 85 territorial subjects of the Russian Federation which are contained in forms of the state statistical observation “Data on activity of the divisions of the medical organization providing medical care in stationary conditions” and “Data on the medical organization” are analysed. For assessment of the obtained data simple (unweighted) arithmetic-mean sizes, specific indicators, a mean square (standard) deviation of the weight of values from average sizes, coefficient of variation (the relation of a mean square deviation to average size) were used. The set was considered as uniform if coefficient of variation did not exceed 33%.
Results. For the end of 2020 of all in the Russian Federation 10 679 beds of a neurosurgical profile, including 1607 children’s beds were developed in general. In the sum it for 2278 beds (or for 18%) is, less, than in 2019. Differences between territorial subjects of the Russian Federation on the level of security with profile beds reach more than 5 multiple sizes. The total number of cases of hospitalization in 2020 on beds of a neurosurgical profile, all made 330.5 thousand cases (272.2 thousand cases of hospitalization of adult patients and 58.3 thousand children) that on 92.3 thousand cases it is less (or for 12%), than in 2019. In 2019 12.8 hospitalization, in 2020 – 9.6 hospitalization were the share of each case of death from an injury of the head on average. The average duration of treatment on beds of a neurosurgical profile was in 2020 8.82±2.24 days (11.15±3.10 days on beds for adults and 6.45±4.47 on beds for children). Average annual employment of one bed of a neurosurgical profile increased about 257.7±90.8 days in 2019 up to 312.9±130.8 days in 2020. All-hospital lethality of the Russian Federation on beds of a neurosurgical profile in 2020 averaged 1.38% (in 2019 – 1.22%). Total number of operations on a nervous system decreased from 179.1 thousand in 2019 to 155.5 thousand in 2020, or for 13%. In Russia the average annual number of operations within the last 2 years is ~1000 operations on 1 million population. Most often in Russia it is carried out neurosurgical operations at degenerative diseases of a backbone and a craniocereberal trauma. Postoperative lethality at nervous system operations on average in territorial subjects of the Russian Federation increased from 8.19±4.48% in 2019 to 10.12±6.52% in 2020. On one neurosurgeon in 2020 on average in territorial subjects of the Russian Federation 108.2±35.1 cases of hospitalization are the share of beds of a neurosurgical profile and 54.5±24.6 nervous system operations.
Conclusion. In Russia the essential deficiency of volumes of neurosurgical operations takes place. The main part of neurosurgical operations is carried out in Russia at degenerative diseases of a backbone and a craniocereberal trauma while in the developed foreign countries – at the craniocereberal trauma and a cerebral stroke which are around the world the leading causes of death. For accumulation of volumes of profile medical care, expansion of access for the population to the main and acute neurosurgical management in Russia there is enough neurosurgeons. Acceptance of organizational measures for reduction of structure and volume of neurosurgical interventions in compliance with needs of the population is necessary.
Keywords:COVID-19 pandemic; organization of the neurosurgical help; neurosurgery; neurosurgical service
Funding. The study had no sponsor support.
Conflict of interest. The author declares no conflict of interest.
For citation: Korkhmazov V.T. The Russian neurosurgery to and during Covid-19 pandemic. ORGZDRAV: novosti, mneniya, obuchenie. Vestnik VSHOUZ [HEALTHCARE MANAGEMENT: News, Views, Education. Bulletin of VSHOUZ]. 2022; 8 (1): 114–29. DOI: https://doi.org/10.33029/2411-8621-2022-8-1-114-129 (in Russian)
1. Zoia C., Bongetta D., Veiceschi P., Cenzato M., Di Meco F., Locatelli D., et al. Neurosurgery during the COVID-19 pandemic: update from Lombardy, northern Italy. Acta Neurochir (Wien). 2020; 162 (6): 1221-2. DOI: https://doi.org/10.1007/s00701-020-04305-w
2. Galarza M., Gazzeri R. Letter: collateral pandemic in face of the present COVID-19 pandemic: a neurosurgical perspective. Neurosurgery. 2020; 87 (2): E186-8. DOI: https://doi.org/10.1093/neuros/nyaa155
3. Hulsbergen A.F.C., Eijkholt M.M., Balak N., Brennum J., Bolger C., Bohrer A.M., et al. Ethical triage during the COVID-19 pandemic: a toolkit for neurosurgical resource allocation. Acta Neurochir (Wien). 2020; 162 (7): 1485-90. DOI: https://doi.org/10.1007/s00701-020-04375-w
4. Jean W.C., Ironside N.T., Sack K.D., Felbaum D.R., Syed H.R. The impact of COVID-19 on neurosurgeons and the strategy for triaging non-emergent operations: a global neurosurgery study. Acta Neurochir (Wien). 2020; 162 (6): 1229-40. DOI: https://doi.org/10.1007/s00701-020-04342-5
5. Krylov V.V., et al. Lectures on neurosurgery. Moscow: LitRes, 2021. (in Russian)
6. Krylov V.V., et al. Neurosurgical care for patients with cerebrovascular diseases in the Russian Federation // Neurosurgery. 2018; (4): 11-20. (in Russian)
7. Tsermoulas G., Zisakis A., Flint G., Belli A. Challenges to neurosurgery during the coronavirus disease 2019 (COVID-19) pandemic. World Neurosurg [Electronic resource]. 2020; 139: 519-25. DOI: http://dx.doi.org/10.1016/j.wneu.2020.05.108
8. Erniyazov N.B., Aringazina A.M. Impact of the COVID-19 pandemic on the neurosurgical service // Bulletin of the Kazakh National Medical University. 2021; (1): 335-9. (in Kazakh)
9. Gantsev Sh.Kh., Menshikov K.V. Oncology service during the COVID-19 pandemic (literature review) // Creative Surgery and Oncology. 2020; (3): 233-40. (in Russian)
10. Timerbulatov V.M., Timerbulatov M.V. Health care during and after the COVID-19 pandemic // Bulletin of the Academy of Sciences of the Republic of Bashkortostan. 2020; 35 [2 (98)]: 77-87. DOI: https://doi.org/10.24411/1728-5283-2020-10209 (in Russian)
11. Pushkar D.Yu., et al. COVID-19: impact on the urological service of the Russian Federation // Experimental and Clinical Urology. 2020; (2): 13-7. (in Russian)
12. Krylov V.V. and others. The state of the neurosurgical service of the Russian Federation // Neurosurgery. 2016; (3): 3-44. URL: https://www.therjn.com/jour/article/viewFile/363/324 (in Russian)
13. Dewan M.C., et al. Operative and consultative proportions of neurosurgical disease worldwide: estimation from the surgeon perspective. J Neurosurg. 2018; 130 (4): 1098-106.
14. Dewan M.C., et al. Global neurosurgery: the current capacity and deficit in the provision of essential neurosurgical care. Executive Summary of the Global Neurosurgery Initiative at the Program in Global Surgery and Social Change. J Neurosurg. 2018; 130 (4): 1055-64.
15. Lei S., Jiang F., Su W., Chen C., Chen J., Mei W., et al. Clinical characteristics and outcomes of patients undergoing surgeries during the incubation period of COVID-19 infection. EClinicalMedicine. 2020; 21: 100331. DOI: https://doi.org/10.1016/j.eclinm.2020.100331