T. Uribe-Leitz1, S. R. Rosas Osuna2, M. M. Esquivel1, A. Cervantes Trejo3,4, N. Y. Garland1, J. Cervantes5,6, K. L. Staudenmayer1, D. A. Spain1, T. G. Weiser1 1Stanford University School Of Medicine,Department Of Surgery,PALO ALTO, CA, USA 2Mexican Ministry Of Health,National Council Of Injury Prevention,MEXICO, DF, Mexico 3National Institute For Educational Evaluation,MEXICO, DF, Mexico 4Anahuac University,Institute Of Public Health,Huxquilucan, MEXICO, Mexico 5Universidad Nacional Autónoma De México (UNAM),Facultad De Medicina,MEXICO, DF, Mexico 6American British Cowdray Medical Center,Department Of Surgery,MEXICO, DF, Mexico
Introduction: Mexico has a robust epidemiologic public hospital reporting system, yet little has been published about the volume and outcomes of surgical procedures. In light of the recent Lancet Commission on Global Surgery recommendations on indicators of capacity and outcomes, we sought to understand the volume of surgery and outcomes for public hospitals in Mexico in 2014. We also assessed four common procedures – cesarean delivery, appendectomy, cholecystectomy, and groin hernia repair – to better understand access to basic surgical care. Finally, we evaluated the number of clinicians available to provide care.
Methods: We queried the online public database of the Ministry of Health in Mexico to obtain information on the volume of operations occurring in public hospitals. We used ICD10 Current Procedural Terminology (CPT) codes reported per hospital discharge by state in 2014, filtered by procedure type, to ascertain the number of reported surgical procedures. We also identified deaths during hospitalizations that included a surgical procedure. We evaluated four commonly performed operations –cesarean delivery, appendectomy, cholecystectomy, and groin hernia repair– to assess both specific volume and proportion of total surgical volume. We also obtained in-hospital deaths, population data, and number of general and specialized surgeons and obstetricians/gynecologists (Ob/Gyns) in each state.
Results: A total of 1,655,468 operations were performed in public hospitals in 2014. Of this total, 22.6% were cesarean deliveries, 4.1% cholecystectomies, 3.6% appendectomies, and 1.8% groin hernia repairs. From these operations 13,277 patients died, yielding a mean case fatality rate (deaths per 1000 procedures) of 8.02. The mean case fatality rate ranged substantially by state (2.59-14.28). Mortality also varied by procedure. The national mean case fatality rate was 0.28 for cesarean deliveries (range 0-0.95 by state), 4.64 for cholecystectomy (range 0.73-12.42 by state), 3.03 for appendectomy (range 0-9.55 by state), and 3.78 for groin hernia repair (range 0-12.64 by per state). We identified 3,910 individual general and specialized surgeons and 4,802 Ob/Gyns. The mean number of providers per 100,000 people was 3.27 (range 0.92 -7.02 by state) for surgeons and 4.01 (range 2.19 –7.43 by state) for Ob/Gyn.
Conclusion:The national mean case fatality rate for the selected surgical procedures in Mexican public hospitals is low and is comparable to highly developed countries. However, closer examination reveals a large degree of variation by state, by procedure, and by provider density suggesting an opportunity for improvement. National standardized data collection systems are essential for analyzing access and provision of surgical care, and understanding patient outcomes. However, the private sector is not included in this reporting system.