Availability of laparoscopic surgery in Mexico's public health system: a nationwide retrospective analysis

Mayte Bryce-Alberti; Letícia Nunes Campos; Tanujit Dey; Diana D Del Valle; Sarah K Hill; Mehreen Zaigham; Alejandro Vela; Sabrina Juran; Geoffrey A Anderson; Tarsicio Uribe-Leitz

doi:10.1016/j.lana.2023.100556

Availability of laparoscopic surgery in Mexico's public health system: a nationwide retrospective analysis

Lancet Reg Health Am. 2023 Jul 17:24:100556. doi: 10.1016/j.lana.2023.100556. eCollection 2023 Aug.

Authors

Mayte Bryce-Alberti^{1

2}, Letícia Nunes Campos^{1

3}, Tanujit Dey⁴, Diana D Del Valle¹, Sarah K Hill¹, Mehreen Zaigham^{1

5}, Alejandro Vela^{6

7}, Sabrina Juran¹, Geoffrey A Anderson^{1

4

8}, Tarsicio Uribe-Leitz^{1

9

10}

Affiliations

¹ Program in Global Surgery and Social Change, Harvard Medical School, Boston, MA, USA.
² Faculty of Medicine, Universidad Peruana Cayetano Heredia, Lima, Peru.
³ Faculty of Medical Sciences, Universidade de Pernambuco, Recife, PE, Brazil.
⁴ Center for Surgery and Public Health, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
⁵ Obstetrics and Gynecology, Institution of Clinical Sciences Lund, Lund University, Lund, Sweden.
⁶ Harvard T.H. Chan School of Public Health, Harvard University, Boston, MA, USA.
⁷ Department of Anesthesia, Complete Surgery Houston Northwest, Houston, TX, USA.
⁸ Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA.
⁹ Department of Plastic Surgery, Boston Children's Hospital, Boston, MA, USA.
¹⁰ Epidemiology, Department of Sport and Health Sciences, Technical University Munich, Munich, Germany.

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 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.

Keywords: Appendectomy; Cholecystectomy; Global surgery; Health disparities; Inguinal hernia repair; Minimally invasive surgery.