Problems of modern surgery in Russia and ways to solve them. On the 100th anniversary of S. P. Fedorov’s article «Surgery stands at the parting of the ways»

Abstract

The article discusses the current problems of organizing modern surgical care in Russia. A historical analysis of surgery development over the past century was carried out. It was based on the S. P. Fedorov’s ideas expressed in his work “Surgery stands at the parting of the ways” (1926).
The focus is on the issue of providing high quality, high-tech, especially emergency, surgical care to the population of rural areas. It is demonstrated that modern regulatory requirements and the introduction of complex diagnostic technologies (CT, MRI, and angiography) have made it impossible to fully deploy them in every region, which has led to the need for resource concentration.
The introduction of a three-level system of specialized medical care is proposed as a strategic way to solve the problem. A key element is the creation of a network of inter-district «flagship specialized care centers» equipped with a full range of equipment for invasive surgery, designed to serve 150–200 thousand people. These centers should be integrated into a unified system of emergency medical care and medical evacuation with centralized dispatching, which will provide effective patient routing within the first 24 hours. According to calculations, such system will allow for providing the care to the majority of emergency patients (80%) at district hospitals, and ensuring timely evacuation of others to specialized centers.
The proposed model is considered as the development of the principle of staged treatment with evacuation by destination, which has proven its effectiveness in military field surgery.