Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA
Department of Surgery, University of Utah Health, Salt Lake City, Utah, USA.
BMJ Open. 2022 Jul 21;12(7):e051838. doi: 10.1136/bmjopen-2021-051838.
To inform national planning, six indicators posed by the Commission on Global Surgery were collected for the Mongolian surgical system. This situational analysis shows one lower middle-income country's ability to collect the indicators aided by a well-developed health information system.
An 11-year retrospective analysis of the Mongolian surgical system using data from the Health Development Center, National Statistics Office and Household Socio-Economic Survey. Access estimates were based on travel time to capable hospitals. Provider density, surgical volume and postoperative mortality were calculated at national and regional levels. Protection against impoverishing and catastrophic expenditures was assessed against standard out-of-pocket expenditure at government hospitals for individual operations.
Mongolia's 81 public hospitals with surgical capability, including tertiary, secondary and primary/secondary facilities.
All operative patients in Mongolia's public hospitals, 2006-2016.
Primary outcomes were national-level results of the indicators. Secondary outcomes include regional access; surgeons, anaesthesiologists and obstetricians (SAO) density; surgical volume; and perioperative mortality.
In 2016, 80.1% of the population had 2-hour access to essential surgery, including 60% of those outside the capital. SAO density was 47.4/100 000 population. A coding change increased surgical volume to 5784/100 000 population, and in-hospital mortality decreased from 0.27% to 0.14%. All households were financially protected from caesarean section. Appendectomy carried 99.4% and 98.4% protection, external femur fixation carried 75.4% and 50.7% protection from impoverishing and catastrophic expenditures, respectively. Laparoscopic cholecystectomy carried 42.9% protection from both.
Mongolia meets national benchmarks for access, provider density, surgical volume and postoperative mortality with notable limitations. Significant disparities exist between regions. Unequal access may be efficiently addressed by strengthening or building key district hospitals in population-dense areas. Increased financial protections are needed for operations involving hardware or technology. Ongoing monitoring and evaluation will support the development of context-specific interventions to improve surgical care in Mongolia.
为了给国家规划提供信息，我们收集了全球外科学委员会提出的六个指标，以了解蒙古的外科学体系。本情况分析展示了一个中下等收入国家在拥有完善的卫生信息系统的情况下收集这些指标的能力。
利用来自健康发展中心、国家统计局和家庭社会经济调查的数据，对蒙古外科学体系进行了为期 11 年的回顾性分析。获取估计值是基于到有能力的医院的旅行时间。在国家和地区层面计算了提供者密度、手术量和术后死亡率。针对政府医院个别手术的标准自付费用，评估了对致贫和灾难性支出的保护。
蒙古 81 家具有外科能力的公立医院，包括三级、二级和二级/二级设施。
2006 年至 2016 年期间在蒙古公立医院接受手术的所有患者。
主要结果是指标的国家级结果。次要结果包括区域获取；外科医生、麻醉师和妇产科医生（SAO）密度；手术量；和围手术期死亡率。
2016 年，80.1%的人口有 2 小时内获得基本手术的机会，其中包括首都以外的 60%的人口。SAO 密度为每 10 万人 47.4 人。由于编码变更，手术量增加到每 10 万人 5784 例，院内死亡率从 0.27%下降到 0.14%。所有家庭都在经济上免受剖宫产的影响。阑尾切除术的保护率分别为 99.4%和 98.4%，股骨外固定术的保护率分别为致贫和灾难性支出的 75.4%和 50.7%，腹腔镜胆囊切除术的保护率分别为 42.9%。
蒙古在获得机会、提供者密度、手术量和术后死亡率方面达到了国家基准，但存在显著的局限性。地区之间存在显著差异。通过加强或建立人口密集地区的关键地区医院，可以有效地解决不平等的获得机会问题。需要增加对涉及硬件或技术的手术的财务保护。持续的监测和评估将支持制定针对具体情况的干预措施，以改善蒙古的外科护理。
