Erez Eldad, Erez Ely, Golender Julius, Mafra Ibraheem, Shapira Oz M, Marzouqa Bisher
Cardiothoracic Surgery Department Hadassah Medical Center, Hebrew University School of Medicine, Jerusalem, Israel.
Technion, Israel Institute of Technology, School of Medicine, Haifa, Israel.
EClinicalMedicine. 2019 May 10;10:42-48. doi: 10.1016/j.eclinm.2019.05.001. eCollection 2019 Apr.
The treatment of congenital heart disease patients in the West Bank and Gaza involves both medical and political challenges. Understanding the difficulties faced in treating the Palestinian population is an important step to improving surgical care, better allocating resources and overcoming the region's unique problems.
The Hadassah Medical Center congenital heart disease database over the 2011-2017 period was analyzed. There were 872 operations performed in patients with Israeli health insurance and 207 operations in Palestinian patients. Patient characteristics and surgical outcome were compared between the two groups using standard statistical practices.
The Society of Thoracic Surgeons Complexity Scores were significantly higher in the Palestinian patients, p = 0.003 (d = 0.27, 95% CI, 0.12 to 0.42). Israeli neonates had surgery at an average age of 9.5 ± 7.8 days as compared to Palestinian neonates with an average age of 15.7 ± 8.2 days, p < 0.001 (d = 0.78, 95% CI, 0.41 to 1.15), a finding indicative of a possible delay of treatment. Overall in hospital mortality was not significantly different. Late mortality was significantly higher for the Palestinian 5.4% (9/168) compared to Israeli patients 2% (14/698), p = 0.015 (RR = 2.67, 95% CI, 1.18 to 6.07).
The findings suggest that Palestinian patients receive later treatment and poorer follow-up care than Israeli patients. Despite the political challenges in the region surgical results are excellent and comparable between the two groups. The challenges described are not unique to congenital heart disease and may affect many medical fields. We believe that extensive collaborations between Israeli and Palestinian physicians may be key to improving the Palestinian medical care.
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约旦河西岸和加沙地带先天性心脏病患者的治疗面临医学和政治两方面的挑战。了解治疗巴勒斯坦人口所面临的困难是改善外科护理、更好地分配资源以及克服该地区独特问题的重要一步。
分析了哈达萨医疗中心2011 - 2017年期间的先天性心脏病数据库。有872例手术是为有以色列医疗保险的患者实施的，207例手术是为巴勒斯坦患者实施的。使用标准统计方法比较了两组患者的特征和手术结果。
巴勒斯坦患者的胸外科医师协会复杂性评分显著更高，p = 0.003（d = 0.27，95%置信区间，0.12至0.42）。以色列新生儿接受手术的平均年龄为9.5±7.8天，而巴勒斯坦新生儿的平均年龄为15.7±8.2天，p < 0.001（d = 0.78，95%置信区间，0.41至1.15），这一发现表明可能存在治疗延迟。总体住院死亡率无显著差异。巴勒斯坦患者的晚期死亡率为5.4%（9/168），显著高于以色列患者的2%（14/698），p = 0.015（相对风险 = 2.67，95%置信区间，1.18至6.07）。
研究结果表明，巴勒斯坦患者比以色列患者接受治疗的时间更晚，后续护理也更差。尽管该地区存在政治挑战，但两组的手术结果都非常出色且相当。所描述的挑战并非先天性心脏病所特有，可能会影响许多医学领域。我们认为，以色列和巴勒斯坦医生之间的广泛合作可能是改善巴勒斯坦医疗护理的关键。
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