Pediatric neurosurgery in Ukraine in 2001-2020. Availability, workforce, performance indicators

Abstract

Objective: to analyze the development dynamics of pediatric neurosurgical care in Ukraine in 2001-2020. Materials and methods. The number of pediatric neurosurgical beds, pediatric neurosurgeons, hospitalization rates and surgical treatment of children in neurosurgical departments of Ukraine in 2001‒2020 were analyzed. Data for the years 2014-2020 were unavailable for departments located in temporarily non-government-controlled territories. Results. In 2020, there were 22 pediatric neurosurgery departments in Ukraine, with a total of 290 pediatric neurosurgical beds, representing a 26.6% increase compared to 2001. Pediatric neurosurgical departments or pediatric units with neurosurgical beds were operational in almost all regions. The distribution of pediatric neurosurgical beds in Ukraine did not statistically differ from countries with high-income levels (p=0.9987). The increased number of beds contributed to more than doubling the provision of neurosurgical beds per child population. In 2001, there were 17 beds per 1 million children, compared to 38 beds in 2020. In 2020, the number of pediatric neurosurgeons in Ukraine doubled compared to 2001 reaching 58 in 2020 (9.2% of the total number of neurosurgeons in Ukraine and 2.5% of the total number of pediatric neurosurgeons globally). The provision of pediatric neurosurgeons in Ukraine increased more than threefold from 2001 to 2020, reaching 7.7 per 1 million children, meeting the Ministry of Health of Ukraine's standard (7.5). Consequently, the workload per pediatric neurosurgeon decreased almost fourfold, with one specialist per 129,895 children. In 2020, the number of children hospitalized in neurosurgical departments was 9,045, operated on ‒ 3,144, representing a 15.8% decrease and a 3.3% increase, respectively compared to 2001. Per 1 million child population, the hospitalization rate increased by 53, 8% (1201 and 781), the surgery rate increased by 88.7% (417 and 221).Despite the decrease in the number of operated patients over 20 years, surgical activity in neurosurgical institutions of the country increased from 28.3% in 2001 to 34.8% in 2020 (by 23%), postoperative lethality during this period decreased from 2,1 to 1.0% (by 52%).Significant fluctuations in hospital morbidity (HM) rate of children for general neurosurgical pathology and its individual types were recorded during the studied period. In 2020, an increase in these indicators was noted compared to 2001: HM for pediatric neurosurgical pathology in general increased by 53.7% (from 781 to 1,201 cases per 1 million child population), for acute craniocerebral trauma - by 17,5% (from 595 to 699), for hydrocephalus - 5.1 times (from 29 to 149), for neuro-oncological diseases - 3.2 times (from 31 to 100), for congenital anomalies of the nervous system - 4 times ( from 15 to 60), for vascular lesions of the nervous system - 5.1 times (from 5 to 26), for acute spinal trauma - twice (from 9 to 18). Conclusions. Ukraine is a country with high availability of pediatric neurosurgical care. Over the past 20 years, there has been an increase in the provision of pediatric neurosurgery beds and pediatric neurosurgeons. In the first 13 years of the 21st century the trend towards a significant increase in both absolute and relative rates of hospitalization and surgery for children with neurosurgical pathology in subsequent years as a result of the annexation of Crimea, military actions in Donbas and the coronavirus epidemic has changed to a trend towards a decrease in these rates. However, in general, only the absolute number of hospitalized children decreased over 20 years, while the absolute number of operated on and the level of hospitalization and operated on increased. Surgical activity also increased accompanied by a decrease in postoperative lethality.