M. Bryce Alberti1,2, L. Nunes Campos1,3, D. D. Del Valle1, S. K. Hill1, M. Zaigham1,4, S. Juran1,5, G. Anderson1,6,9, T. Uribe Leitz1,6,7,8 1Harvard Medical School, Program In Global Surgery And Social Change, Boston, MA, USA 2Universidad Peruana Cayetano Heredia, Faculty Of Medicne, Lima, OUTSIDE U.S AND CANADA, Peru 3Universidade de Pernambuco, Faculty Of Medical Sciences, Recife, OUTSIDE U.S AND CANADA, Brazil 4Lund University, Obstetrics And Gynecology Institution Of Clinical Sciences Lund, Lund, OUTSIDE U.S AND CANADA, Sweden 5United Nations Population Fund, Regional Office Latin America And The Caribbean, Panama City, OUTSIDE U.S AND CANADA, Panama 6Brigham And Women’s Hospital, Center For Surgery And Public Health, Boston, MA, USA 7Brigham And Women’s Hospital, Department Of Plastic Surgery, Boston, MA, USA 8Technical University Munich, Epidemiology, Department Of Sport And Health Sciences, Munich, OUTSIDE U.S AND CANADA, Germany 9Brigham And Women’s Hospital, Department Of Surgery, Boston, MA, USA
Introduction: A significant innovation in surgery has been the development of laparoscopic techniques, improving pain management, length of hospitalization, and costs compared to open techniques. Unfortunately, laparoscopic surgery is primarily available and reported in high-income countries. This study sought to examine the access to laparoscopic surgery in Mexican public hospitals across three common laparoscopic procedures.
Methods: We conducted a retrospective nationwide analysis of surgical procedures performed in Mexican public hospitals in 2021 using open data from the National Ministry of Health. We queried laparoscopic and open procedures using the International Classification of Diseases (ICD-9) Procedure Codes for cholecystectomy, appendectomy, and inguinal hernia repair cases. Procedures not identified as laparoscopic were assumed to be open and confirmed by matching their ICD-9 codes with ICD-10-PCS. Robotic techniques were excluded. Data from the Mexican Institute of Statistics and Geography were used to determine the municipalities' average altitude and population density. We considered municipalities as urban when composed of >2,500 inhabitants, and high-altitude if located at >1,500 meters above sea level (masl).
Results: Of 1,085,846 operations reported, 97,234 met inclusion criteria. These data were obtained from 676 hospitals across 538 municipalities. Hospitals had a median of 91 beds (IQR 47-189). All municipalities were urban and 54.3% (52,844/97,227) of the total surgeries were done in high-altitude settings. Laparoscopic procedures represented 16.5% of the total surgeries performed (16,061/97,234) (binomial test, 95% CI: 0.1628-0.1675; p<0.00001). Cholecystectomies (32%, 13,560/42,317) were more frequently performed laparoscopically, compared to appendectomies [5.5%, 2,298/41,174 (p<0.001, ANOVA)], and inguinal hernia repairs [1.4%, 203/13,743 (p<0.001, ANOVA)]. Municipalities located at an average of >1,500 masl had a greater proportion of laparoscopic procedures (19%, 10,125/52,844) compared to the ones located below this threshold [13%, 5,936/44,383 (p<0.001, ANOVA)]. Considering population density per municipality, those above the 75th percentile had more laparoscopic procedures (25%, 6,153/24,033) than those between the 25th and 75th percentiles [12%;5,917/48,983 (p<0.001)] and below the 25th percentile [(16%, 3,991/24,218 (p<0.001)].
Conclusions: Open surgical approach is the national standard of care in Mexico’s public hospitals. Laparoscopic techniques are more commonly used during cholecystectomies and in highly populated urban areas. Access to laparoscopic surgery remains unavailable in rural areas.