Мodern opportunities of organizing complex obstetric and gynecological care using hospitalreplacing technologies

The authors analyzed their 25-year experience in organizing obstetric and gynecological care in outpatient settings of the branch clinical and diagnostic center of PJSC Gazprom using inpatient replacement technologies. Effective use of modern clinical, laboratory and instrumental methods of examination allows at the stage of primary treatment in the shortest possible time to establish a clinical diagnosis and determine the plan of invasive diagnostic and therapeutic measures. Cost-effectiveness of hospital-replacing forms of care delivery involves a significantly lower cost of services in day hospital, as well as a shorter average length of treatment in comparison with a day and night facility. Social efficiency is determined by the fact that treatment in a day hospital has a significant “deontological” advantage, most of the time the patient is at home, in a familiar comfortable environment, surrounded by the family which increases satisfaction with health care. Medical effectiveness of hospital-replacing forms of care delivery is determined by continuity of inpatient and outpatient care, ensuring continuity of the entire treatment process. Reduction of temporary disability in the patient, reduction of postoperative complications, nosocominal infections are high efficiency of the developed model of organization. The experience accumulated over 25 years in the organization of surgical gynecological care allowed us to reach the level when the patient’s age, the presence of several concomitant chronic diseases, compensated diabetes mellitus type 2, obesity of any degree, cicatricial adhesion of any prevalence have ceased to be absolute and relative contraindications for laparoscopic benefits under general anesthesia and sling operations for genital prolapse under general or regional anesthesia in the surgical day care center of the clinic of high medical technologies of the clinical diagnostic center.

1. Bredikhin S.V., Rudoy V.G. hospital-replacing technologies in the conditions of the new organizational structure. Ambulatornaya khirurgiya = Ambulatory Surgery (Russia). 2011;(3–4):29–30 (In Russ.).

2. Sorokin A.A., Osin L.A., Lebedev N.N., Shikhmetov A.N., Vorotnitskiy S.I. Possibilities and organization of hospitalreplacing surgical care for gynecological patients. Ambulatornaya khirurgiya = Ambulatory Surgery (Russia). 2011;(1–2):18–19 (In Russ.).

3. Shikhmetov A.N., Osin L.A., Zadikyan A.M., Pazichev A.A. Stationary replacement technologies in the surgical treatment of simultaneous pathology in gynecological patients. Ambulatornaya khirurgiya = Ambulatory Surgery (Russia). 2018;(1–2):64–71. (In Russ.) doi: 10.21518/1995-14772018-1-2-64-71.

4. Shikhmetov A.N., Pazychev A.A., Zadikyan A.M. Stationary replacement technologies in the surgical treatment of simultaneous pathology in gynecological patients. Problemy reproduktsii = Russian Journal of Human Reproduction. 2017;23(6):45–53. (In Russ.) doi: 10.17116/repro201723645-53.

5. Savel’eva G.M., Sukhikh G.T., Serov V.N., Radzinskiy V.E. (eds.). Obstetrics. 2nd ed. Moscow: GEOTAR-Media; 2018. 1088 р. (In Russ.) Available at: https://rosmedlib.ru/book/ISBN9785970433652.html.

6. Saveleva G.M., Sukhikh G.T., Serov V.N., Radzinskkiy V.E., Manukhin I.B. (eds.). Gynecology. 2nd ed. Moscow: GEOTARMedia; 2017. 1008 р. (In Russ.) Available at: https://rosmedlib.ru/book/ISBN9785970441527.html.