State of emergency surgical care in saint petersburg for acute abdominal diseases
Saint-Petersburg I.I. Dzhanelidze research institute of emergency medicine, Saint Petersburg, Budapeshtskaya str., 3
S.M. Kirov Military Medical Academy, Saint Petersburg, Akademika Lebedeva str., 6
The main trends in emergency surgical care of Saint Petersburg for acute diseases of the abdominal organs in the period 2017-2019 are presented. A comparative analysis of indicators was carried out, covering 15 city hospitals (excluding Federal and Departmental) in Saint Petersburg, where more than 90 % of emergency surgical interventions are performed for acute diseases of the abdominal cavity in adults with a number of nosological forms, united by the general concept of «sharp stomach» : acute appendicitis, acute cholecystitis, acute pancreatitis, perforated gastric and duodenal ulcers, acute gastroduodenal bleeding, strangulated hernias and acute intestinal obstruction. For the analyzed period, the number of operations remained at the level of 10,6-11 thousand per year. The increase was noted due to an increase in operational activity, which in 2019 amounted to 71,84 %. The incidence of acute appendicitis increased from 29,44 % to 34,06 %. The incidence rate of acute cholecystitis and acute pancreatitis did not change significantly during 2017-2019. On the 4th place in the frequency of occurrence remain acute gastroduodenal bleeding - 9,01 %. The number of patients with acute intestinal obstruction decreased to 6,79 % and strangulated hernias to 3,68 %. The proportion of patients with perforated gastric and duodenal ulcers over 3 years remained almost unchanged at 4,14 % in 2019. Postoperative mortality in 2018 and 2019 decreased to 3,28 % and 2,91 %, respectively. The highest mortality rates were observed in patients with acute pancreatitis, perforated gastric and duodenal ulcers, acute gastroduodenal bleeding and acute intestinal obstruction. About half of the total number of patients (47,84 %) with acute surgical pathology were hospitalized later than 24 hours from the onset of the first symptoms of the disease, while the rate in 2017 was 51,52 %, in 2018 - 51,36 %. Leading positions in terms of hospitalization after 24 hours are occupied by: acute intestinal obstruction, acute cholecystitis, acute pancreatitis and acute gastroduodenal bleeding. In 2019, there is an increase in the share of operations performed up to 6 hours (62,29 %) compared with 2017 (60,55 %) and 2018 (57,98 %).
emergency surgical care, abdominal surgery, «sharp stomach», surgery activity, mortality.
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