Organizational problems and possible ways of its resolve when providing emergency surgical care to patients with comorbid status in a highly specialized medical institution

Purpose of the study. To demonstrate the difficulties of objective interpretation of providing medical care to patients with critical limb ischemia.

Materials and methods. The results of treatment of more than 29 thousand patients of one of the highly specialized medical organizations of St. Petersburg were studied, in which the main activity of the staff is the examination of patients with surgical infection of soft tissues (particularly, the critical limb ischemia).

Results. It has been ascertained that, despite the unconditional success of providing medical care to patients with critical limb ischemia, a high frequency of unsatisfactory treatment results for this category of patients remains (in 2017, among 685 patients of the specialized department of the highly specialized medical organization, the proportion of cases of performing high amputations of limbs and mortality, respectively, was 11,7% (80) and 2,6% (18)). It has been demonstrated on clinical examples that the pronounced comorbidity of critical limb ischemia patients and the severity of their general condition (combined with organizational difficulties in providing them with providing medical care in conditions of highly specialized medical organization) contribute to the formation of complications (up to lethal outcomes) of not only the underlying, but also concomitant diseases. Difficulties in providing medical care of adequate quality in life-threatening conditions for patients of highly specialized medical organization in cases of critical limb ischemia necessitate a wider interaction between specialists in narrow and multidisciplinary hospitals as part of the emergency surgery service.

Conclusion. When creating specialized medical centers outside of multidisciplinary medical institutions, the possibilities should be provided for the regulated involvement of highly professional consultants with a reasonable algorithm for routing patients in cases of the need for their emergency re-hospitalization to other medical institutions.

1. National recommendations for the diagnosis and treatment of lower limb artery diseases.M., 2019: 89 p.

2. Belov YuV, Vinokurov IA. Concept of approach to surgical treatment of critical lower limb ischemia. Cardiology and Cardiovascular Surgery. 2015; 8(5): 9–13.

3. Artyushin BS, Movchan KN, Sukhov VK, Shloydo EA, Shlomin VV. Results of application of endovascular technologies in removal of critical limb ischemia in regional vascular centers, developed on the basis of multidisciplinary stationaries. Modern problems of science and education. 2018; (4): 188.

4. Asfandiyarova NS, Dashkevich OV, Doroshina NV, Suchkova EI. Type 2 diabetes mellitus and multiple chronic diseases. Diabetes. 2018; 21(6): 455–461. https://doi.org/10.14341/DM9605

5. Oganov RG, Drapkina OM. Polymorbidity: specifics of co-development and concomitance of several diseases in one patient. Cardiovascular therapy and prevention. 2016; 15(4): 4–9. https://doi.org/10.15829/1728–8800–2016–4-4–9

6. Hospital surgery: textbook for medical schools: in 2 vol. Ed by B.N. Kotiv, L.N. Bisenkova. Saint Petersburg: Speclit. 2016; 1: 753.

7. Movchan KN, Yeroshkin VV, Tarasov AD, Grinenko OA, Yakovenko TV, Rusakevich KI. Evaluating the effectiveness of screening and treatment of patients with surgical pathology according to expert examination the data quality of medical care. Bulletin of the Russian Military Medical Academy. 2016; (4(56)): 164–169.