Organization and Quality of Emergency Thoracic Surgical Care in Multidisciplinary Hospitals of Almaty, Kazakhstan: A Multicomponent Study Combining Hospital Data, Patient-Reported Experience, and Healthcare Professional Perspectives

Vollständiger Abstract

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Background: Emergency thoracic conditions remain an important cause of hospitalization, emergency surgery, and mortality, requiring well-organized multidisciplinary thoracic surgical services. Objectives: To comprehensively evaluate the organization of emergency thoracic surgical care in multidisciplinary hospitals in Almaty using retrospective hospital data together with patient and healthcare professional-reported assessments. Methods: A multicomponent study was conducted comprising three complementary components: (1) a retrospective analysis of official hospital data from five multidisciplinary hospitals providing emergency thoracic surgical care in Almaty during 2019–2023; (2) a questionnaire survey of patients evaluating their experiences with emergency thoracic care; and (3) a questionnaire survey of healthcare professionals assessing the organization of emergency thoracic surgical services. Descriptive statistics, Pearson’s χ2 test, Fisher’s exact test where appropriate, Spearman’s rank correlation coefficient, and multivariable ordinal logistic regression were used. Statistical significance was defined as p < 0.05. Results: During 2019–2023, the annual number of hospitalized patients averaged 519.0 ± 31.7. Chest injuries without internal organ involvement accounted for 50.9% of the 2152 cases included in the pathology-specific analysis, and the distribution of the main thoracic pathology groups changed significantly over time (χ2 = 158.8, df = 12, p< 0.001). Hospital mortality decreased from 3.13% to 2.59%, while the average length of hospital stay declined from 8.74 to 7.72 days. Patient-reported assessments were generally favorable. In the adjusted analysis, treatment type and treatment-related complications were independently associated with overall satisfaction, whereas age, gender and time to diagnosis were not. Healthcare professionals identified equipment availability, staff training, and interdepartmental coordination as areas requiring further improvement. Conclusions: Integrating hospital performance indicators with patient-reported experiences and healthcare professional perspectives provided a comprehensive assessment of emergency thoracic surgical care in Almaty. The observed reductions in mortality and length of hospital stay, together with findings from patient and healthcare professional surveys, identify several organizational priorities to strengthen emergency thoracic surgical services further.