Availability of laparoscopic surgery in Mexico's public health system : a nationwide retrospective analysis
Bryce-Alberti, Mayte ; Campos, Letícia Nunes ; Dey, Tanujit ; Del Valle, Diana D ; Hill, Sarah K ; Zaigham, Mehreen LU
; Vela, Alejandro
; Juran, Sabrina
; Anderson, Geoffrey A
and Uribe-Leitz, Tarsicio
(2023)
In Lancet regional health. Americas
24.
- Abstract
BACKGROUND: Laparoscopic surgery remains limited in low-resource settings. We aimed to examine its use in Mexico and determine associated factors.
METHODS: By querying open-source databases, we conducted a nationwide retrospective analysis of three common surgical procedures (i.e., cholecystectomies, appendectomies, and inguinal hernia repairs) performed in Mexican public hospitals in 2021. Procedures were classified as laparoscopic based on ICD-9 codes. We extracted patient (e.g., insurance status), clinical (e.g., anaesthesia technique), and geographic data (e.g., region) from procedures performed in hospitals and ambulatories. Multivariable analysis with random forest modelling was performed to identify associated factors and... (More)
BACKGROUND: Laparoscopic surgery remains limited in low-resource settings. We aimed to examine its use in Mexico and determine associated factors.
METHODS: By querying open-source databases, we conducted a nationwide retrospective analysis of three common surgical procedures (i.e., cholecystectomies, appendectomies, and inguinal hernia repairs) performed in Mexican public hospitals in 2021. Procedures were classified as laparoscopic based on ICD-9 codes. We extracted patient (e.g., insurance status), clinical (e.g., anaesthesia technique), and geographic data (e.g., region) from procedures performed in hospitals and ambulatories. Multivariable analysis with random forest modelling was performed to identify associated factors and their importance in adopting laparoscopic approach.
FINDINGS: We included 97,234 surgical procedures across 676 public hospitals. In total, 16,061 (16.5%) were performed using laparoscopic approaches, which were less common across all procedure categories. The proportion of laparoscopic procedures per 100,000 inhabitants was highest in the northwest (22.2%, 16/72) while the southeast had the lowest (8.3%, 13/155). Significant factors associated with a laparoscopic approach were female sex, number of municipality inhabitants, region, anaesthesia technique, and type of procedure. The number of municipality inhabitants had the highest contribution to the multivariable model.
INTERPRETATION: Laparoscopic procedures were more commonly performed in highly populated, urban, and wealthy northern areas. Access to laparoscopic techniques was mostly influenced by the conditions of the settings where procedures are performed, rather than patients' non-modifiable characteristics. These findings call for tailored interventions to sustainably address equitable access to minimally invasive surgery in Mexico.
FUNDING: None.
(Less)
- author
- Bryce-Alberti, Mayte
; Campos, Letícia Nunes
; Dey, Tanujit
; Del Valle, Diana D
; Hill, Sarah K
; Zaigham, Mehreen
LU
; Vela, Alejandro
; Juran, Sabrina
; Anderson, Geoffrey A
and Uribe-Leitz, Tarsicio
- organization
- publishing date
- 2023-08
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Lancet regional health. Americas
- volume
- 24
- article number
- 100556
- publisher
- Elsevier
- external identifiers
-
- scopus:85166029600
- pmid:37521438
- ISSN
- 2667-193X
- DOI
- 10.1016/j.lana.2023.100556
- language
- English
- LU publication?
- yes
- additional info
- © 2023 The Author(s).
- id
- 1a19b7e6-9aa3-483c-9d87-9b310c7abca8
- date added to LUP
- 2023-08-05 20:48:25
- date last changed
- 2024-04-20 00:09:05
@article{1a19b7e6-9aa3-483c-9d87-9b310c7abca8,
abstract = {{<p>BACKGROUND: Laparoscopic surgery remains limited in low-resource settings. We aimed to examine its use in Mexico and determine associated factors.</p><p>METHODS: By querying open-source databases, we conducted a nationwide retrospective analysis of three common surgical procedures (i.e., cholecystectomies, appendectomies, and inguinal hernia repairs) performed in Mexican public hospitals in 2021. Procedures were classified as laparoscopic based on ICD-9 codes. We extracted patient (e.g., insurance status), clinical (e.g., anaesthesia technique), and geographic data (e.g., region) from procedures performed in hospitals and ambulatories. Multivariable analysis with random forest modelling was performed to identify associated factors and their importance in adopting laparoscopic approach.</p><p>FINDINGS: We included 97,234 surgical procedures across 676 public hospitals. In total, 16,061 (16.5%) were performed using laparoscopic approaches, which were less common across all procedure categories. The proportion of laparoscopic procedures per 100,000 inhabitants was highest in the northwest (22.2%, 16/72) while the southeast had the lowest (8.3%, 13/155). Significant factors associated with a laparoscopic approach were female sex, number of municipality inhabitants, region, anaesthesia technique, and type of procedure. The number of municipality inhabitants had the highest contribution to the multivariable model.</p><p>INTERPRETATION: Laparoscopic procedures were more commonly performed in highly populated, urban, and wealthy northern areas. Access to laparoscopic techniques was mostly influenced by the conditions of the settings where procedures are performed, rather than patients' non-modifiable characteristics. These findings call for tailored interventions to sustainably address equitable access to minimally invasive surgery in Mexico.</p><p>FUNDING: None.</p>}},
author = {{Bryce-Alberti, Mayte and Campos, Letícia Nunes and Dey, Tanujit and Del Valle, Diana D and Hill, Sarah K and Zaigham, Mehreen and Vela, Alejandro and Juran, Sabrina and Anderson, Geoffrey A and Uribe-Leitz, Tarsicio}},
issn = {{2667-193X}},
language = {{eng}},
publisher = {{Elsevier}},
series = {{Lancet regional health. Americas}},
title = {{Availability of laparoscopic surgery in Mexico's public health system : a nationwide retrospective analysis}},
url = {{http://dx.doi.org/10.1016/j.lana.2023.100556}},
doi = {{10.1016/j.lana.2023.100556}},
volume = {{24}},
year = {{2023}},
}