Surgical methods of dysphagia correction in adult palliative patients according to the data of the compulsory health insurance system

Abstract

There is no single database of patients operated on for dysphagia n the Russian Federation or its individual subjects. In the Russian Federation, most of the medical care is paid for through the system of compulsory medical insurance (CHI), so you can find out the number of cases of palliative surgery for dysphagia, presented for payment. The aim of the work is to analyze a group of patients who underwent surgical treatment of dysphagia according to the information system of the CHI. The analysis of tariffs used to pay for gastrostomies, recanalization and stenting of the esophagus was carried out. A request was made to the St. Petersburg Territorial MHI Fund, and a sample of cases of presentation of the corresponding tariffs for the period from January, 01, 2015 to October, 26, 2020 was received. Some rates are applied for different operations, and cases with inappropriate ICD codes for the underlying disease are excluded from the sample. The results were obtained: for the period from January, 01, 2015 to October, 26, 2020, the St. Petersburg Territorial CHI Fund paid for 2119 cases corresponding to gastrostomy in adult patients and 847 cases corresponding to recanalization and stenting of the esophagus. Laparotomic gastrostomy was performed in 1561 (73.7%) cases, and PEG was performed in 558 (26.3%) cases. There was no significant difference in the gender and age composition of the groups. Thus, laparotomic gastrostomies remain relevant methods of surgical care for dysphagia in palliative patients. The frequency of use of minimally invasive percutaneous gastrostomas is negatively affected by the cost of single use imported kits for installation. The emergence of a domestic manufacturer will reduce the cost of production and lead to a wider application of this method. It is necessary to create national clinical guidelines on surgical care for dysphagia in palliative patients.