Respiratory complications after surgery in Vietnam: National estimates of the economic burden

Background

Estimating the cost of postoperative respiratory complications is crucial in developing appropriate strategies to mitigate the global and national economic burden. However, systematic analysis of the economic burden in low- and middle-income countries is lacking.

Methods

We used the nationwide database of the Vietnam Social Insurance agency and extracted data from January 2017 to September 2018. The data contain 1 241 893 surgical patients undergoing one of seven types of surgery. Propensity score matching method was used to match cases with and without complications. We used generalized gamma regressions to estimate the direct medical costs; logistic regressions to evaluate the impact of postoperative respiratory complications on re-hospitalization and outpatient visits.

Findings

Postoperative respiratory complications increased the odds of re-hospitalization and outpatient visits by 3·49 times (95% CI: 3·35–3·64) and 1·39 times (95% CI: 1·34–1·45) among surgical patients, respectively. The mean incremental cost associated with postoperative respiratory complications occurring within 30 days of the index admission was 1053·3 USD (95% CI: 940·7–1165·8) per procedure, which was equivalent to 41% of the GDP per capita of Vietnam in 2018. We estimated the national annual incremental cost due to respiratory complications occurring within 30 days after surgery was 13·87 million USD. Pneumonia contributed the greatest part of the annual cost burden of postoperative respiratory complications.

Interpretation

The economic burden of postoperative respiratory complications is substantial at both individual and national levels. Postoperative respiratory complications also increase the odds of re-hospitalization and outpatient visits and increase the length of hospital stay among surgical patients.

Funding

The authors did not receive any funds for conducting this study

Determination of Risk Factors for Venous Thromboembolism by an Adapted Caprini Scoring System in Surgical Patients

Venous thromboembolism (VTE) is a frequent preventable complication among surgical patients. Precise risk assessment is a necessary step for providing appropriate thromboprophylaxis and reducing mortality as well as morbidity caused by VTE. We carried out this work to define the rate of VTE postoperatively, following a Caprini score, and to determine VTE risk factors through a modified Caprini risk scoring system. This multicenter, observational, cohort study involved 2,790,027 patients who underwent surgery in four Vietnamese hospitals from 01/2017 to 12/2018. All patients who were evaluated before surgery by using a Caprini risk assessment model (RAM) and monitored within 90 days after surgery. The endpoint of the study was ultrasound-confirmed VTE. Our data showed that the 90-day postoperative VTE was found in 3068 patients. Most of VTE (46.97%) cases were found in the highest risk group (Caprini score > 5). A total of 37.19% were observed in the high risk group, while the rest (15.84%) were from low to moderate risk groups. The likelihood of occurring VTE was heightened 2.83 times for patients with a Caprini score of 3–4, 4.83 times for a Caprini score of 5–6, 8.84 times for a score of 7–8, and 11.42 times for a score of >8, comparing to ones with a score of 0 to 2 (all p values < 0.05). Thus, the frequency of postoperative VTE rises substantially, according to the advanced Caprini score. Further categorizing patients among the highest risk group need delivering more appropriate thromboprophylaxis.

Potential collaboration with the private sector for the provision of ambulatory care in the Mekong region, Vietnam

BACKGROUND

Over the past two decades, health insurance in Vietnam has expanded nationwide. Concurrently, Vietnam's private health sector has developed rapidly and become an increasingly integral part of the health system. To date, however, little is understood regarding the potential for expanding public-private partnerships to improve health care access and outcomes in Vietnam.

OBJECTIVE

To explore possibilities for public-private collaboration in the provision of ambulatory care at the primary level in the Mekong region, Vietnam.

DESIGN

We employed a mixed methods research approach. Qualitative methods included focus group discussions with health officials and in-depth interviews with managers of private health facilities. Quantitative methods encompassed facility assessments, and exit surveys of clients at the same private facilities.

RESULTS

Discussions with health officials indicated generally favorable attitudes towards partnerships with private providers. Concerns were also voiced, regarding the over- and irrational use of antibiotics, and in terms of limited capacity for regulation, monitoring, and quality assurance. Private facility managers expressed a willingness to collaborate in the provision of ambulatory care, and private providers facilites were relatively well staffed and equipped. The client surveys indicated that 80% of clients first sought treatment at a private facility, even though most lived closer to a public provider. This choice was motivated mainly by perceptions of quality of care. Clients who reported seeking care at both a public and private facility were more satisfied with the latter.

CONCLUSIONS

Public-private collaboration in the provision of ambulatory care at the primary level in Vietnam has substantial potential for improving access to quality services. We recommend that such collaboration be explored by Vietnamese policy-makers. If implemented, we strongly urge attention to effectively managing such partnerships, establishing a quality assurance system, and strengthening regulatory mechanisms.

The prevalence of epilepsy in a rural district of Vietnam: a population-based study from the EPIBAVI project

SUMMARY

A field survey was carried out to determine the prevalence of active epilepsy in northern Vietnam between January and December 2005, when members of approximately 13,000 households were screened for seizure disorders. A clinical examination of all screened positive was performed by a neurologist to verify the epilepsy diagnosis, and all epilepsy cases were offered an EEG. Out of 47,269 screened, 1,338 (2.8%) had a positive response to the questionnaire. Of these, 206 fulfilled the criteria for active epilepsy, yielding a prevalence of 4.4 per 1,000 (95% CI 3.8-5.0), higher among males (5.1) than females (3.7), among those with lower compared with higher education and among single compared with those married. Only 20.6% were seizure-free the year before the examination. The prevalence of active epilepsy in Vietnam is similar to some other Asian countries but lower than in developing countries from Africa and South America.

Knowledge attitudes and practice toward epilepsy among adults in BaVi, Vietnam: first report from the population-based EPIBAVI study

PURPOSE

We conducted a survey to assess knowledge, attitudes, and practice toward epilepsy in a population-based study in a rural district of Vietnam.

METHODS

We utilized an established knowledge-attitudes-practice questionnaire. This was applied by trained surveyors in face-to-face interviews of 2005 randomly selected adult residents (19-71 years of age) of the BaVi district, 60 km west of Hanoi.

RESULTS

Of the respondents, 67.0% had heard about epilepsy, 52.1% had known someone with seizures, and 49.3% had witnessed seizures. In total, 36.3% would object to their children playing with someone with seizures and 82.0% to their children marrying someone with epilepsy. Only 32.6% thought that epilepsy patients should be employed in a job as other people, while 10% thought that epilepsy was a form of insanity. Familiarity with epilepsy, having heard of epilepsy, known someone with epilepsy, or having seen seizures was associated with less negative attitudes. About half of the respondents (50.4%) thought epilepsy was caused by a brain disease and 80.1% would suggest consultation of a medical doctor for epilepsy.

CONCLUSIONS

Knowledge of epilepsy among Vietnamese people is still limited compared to some Western countries and the attitudes more negative. Our findings indicated more negative attitudes than in another recent survey from Vietnam. This may be due to differences in sociodemographic characteristics and educational level of the study populations. The discrepancies demonstrate the importance of selection of study population and the need for caution in generalizing from results of surveys.