The Prevalence, Indications, Outcomes of the Most Common Major Gynecological Surgeries in Kazakhstan and Recommendations for Potential Improvements into Public Health and Clinical Practice: Analysis of the National Electronic Healthcare System (2014–2019)

Abstract

Objectives: Major gynecological surgeries are indicated for the treatment of female genital pathologies. It is key to examine trends in gynecologic surgical procedures and updated recommendations by international gynecological societies to find opportunities for improvement of local guidelines. To date, a very limited number of reports have been published on the epidemiology of gynecological surgeries in Kazakhstan. Moreover, some local guidelines for gynecological conditions do not comply with the international recommendations. Thus, this study aims to investigate the prevalence, indications, and outcomes of the most common major gynecological surgeries by analyzing large-scale Kazakhstani healthcare data, and identifying possible opportunities for improvement of the local public health and clinical practice. Methods: A descriptive, population-based study among women who underwent a gynecological surgery in healthcare settings across the Republic of Kazakhstan during the period of 2014–2019 was performed. Data were collected from the Unified Nationwide Electronic Health System (UNEHS). Results: In total, 80,401 surgery cases were identified and analyzed in the UNEHS database for a period of 6 years (2014–2019). The median age of the participants was 40 years old, with 61.1% in reproductive age. The most prevalent intervention was a unilateral salpingectomy—29.4%, with 72.6% patients aged between 18–34 years. The proportion of different types of hysterectomies was 49.4%. In 20% of cases, subtotal abdominal hysterectomy was performed due to uterine leiomyoma. The proportion of laparoscopic procedures in Kazakhstani gynecological practice is as low—11.59%. Conclusions: The Kazakhstani public health and gynecological care sector should reinforce implementation of contemporary treatment methods and up-to-date policies and guidelines. The overall trends in surgical procedures performed for gynecological pathologies, including uterine leiomyoma and ectopic pregnancy treatment, should be changed in favor of the minimally invasive methods in order to adopt a fertility-sparing approach.

Epidemiology of spontaneous pregnancy loss in Kazakhstan: A national population‐based cohort analysis during 2014–2019 using the national electronic healthcare system

“…This report does not include ectopic pregnancies, which previously were analyzed. 22 The findings of this study highlight the importance of proper prevention and personalized management of miscarriages. That is supported by an earlier study which documented a strong association between the history of SPL and RPL history with an increased risk of preterm delivery.…”

“…Moreover, this database does not include women who experienced SPL outside of a healthcare setting and did not seek medical attention and thus were not registered in the system. This report does not include ectopic pregnancies, which previously were analyzed 22 …”

“…2,5,6,19 Despite the identification of these and related factors, the exact cause is unexplained (idiopathic) and not clearly identified in >50% of the cases. 15,20 The Republic of Kazakhstan is a middle-income Central Asian country with a population of 19 million; 21,22 females account for 52%, of whom 51% are of reproductive age. [22][23][24] The annual number of deliveries is approximately 400 000.…”

“…15,20 The Republic of Kazakhstan is a middle-income Central Asian country with a population of 19 million; 21,22 females account for 52%, of whom 51% are of reproductive age. [22][23][24] The annual number of deliveries is approximately 400 000. The Kazakhstani government prioritizes support for maternity and childcare 22,25,26 and has approved a US$7.5 billion State Program for the Development of Healthcare 2020-2025, 26 which targets the reduction of maternal mortality to 14.5 per 100 000 live births and a reduction of infant mortality to 8.3 per 1000 live births.…”

Women’s Health and Gynecology: Old Challenges and New Insights

“…The Internet of Things, Big Data, Machine Learning, and Artificial Intelligence are changing the delivery of health services, providing faster decision-making in-patient diagnosis, treatment, and day-to-day monitoring, which can be especially valuable when healthcare professionals and systems experience extremely high workloads [ 29 ]. Sakko and colleagues [ 30 ] used the data available from the Unified Nationwide Electronic Health System (UNEHS) from the Republic of Kazakhstan during the period of 2014–2019 to investigate the prevalence, indications, and outcomes of the most common major gynecological surgeries by analyzing large-scale healthcare data and to identify possible opportunities for improvement in the local public health and clinical practice.…”