Health restarts. And it does so through the greater use of hospital care by Italians. Who, little by little, are returning to health care facilities after the two years of the pandemic. To tell this mended relationship are the data of the national program Outcomes, promoted by the National Agency for regional health services.
The 2022 edition on the 2021 data speaks of a slight recovery in hospitalizations, with 500,000 more hospitalizations than in 2020, which concerned scheduled and daytime hospitalizations. The rise in oncological interventions was significant, in particular with reference to malignant breast cancer which returns to the pre-pandemic trend thanks to the resumption of screening.
In 2020 there was a significant reduction, around -6,300 hospitalizations compared to 2019. In 2021 there was an important recovery, with an increase of 6,700 operations compared to the previous year and a realignment with the trend, around -800 hospitalizations compared to the previous year. ‘expected.
The 10 operating units that recorded the highest volumes of activity are: European Institute of Oncology in Milan, University Hospital «A. Gemelli” of Rome, AOU “Careggi” of Florence, Irccs Foundation “National Cancer Institute” of Milan, Hospital of Bellaria (Bo), Iov of Padua, Humanitas Clinical Institute of Catanese of Misterbianco (Ct), Institute of Advanced Technologies of Reggio Emilia , Aou Pisana of Pisa, University Hospital of Modena.
Furthermore, three quarters of the interventions at national level were carried out beyond the threshold of 150 interventions per year set by ministerial decree 70/2015, an increase compared to 66.6% in 2020. Italians are once again turning to specialists also for the cardiovascular area, where hospitalizations are growing and deaths at 30 days are decreasing.
There is a slight increase in hospitalizations for IMA equal to +900 hospitalizations compared to 2020, but with a reduction compared to the expected value based on the pre-pandemic trend of -11,300 hospitalizations. Furthermore, with reference to mortality 30 days after an episode of Ima, in 2021 there was a reduction compared to 2020 (7.7% against 8.4%) and a realignment with the trend (expected value equal to 7. 3%).
On the other hand, as regards the timeliness of access to coronary angioplasty in cases of Stemi infarction, the proportion of operations performed within 90 minutes remained constant overall in the two-year period, going from an average value of 49.9% in 2020 to 50.6% in 2021. In this case the heterogeneity between the structures stands out, with an intra-regional variability higher than the inter-regional one.
The 10 structures that have the highest proportions of primary angioplasty guaranteed within 90 minutes are: «Ospedale del Mare» hospital in Naples, «Policlinico Tor Vergata» university hospital in Rome, «Fabrizio Spaziani» hospital in Frosinone, «Giovanni Paolo II» of Sciacca, «Maria Vittoria» Hospital of Turin, PO«S. Antonio Abate» of Erice, Central Hospital of Bolzano, Aou. «Mater Domini» of Catanzaro, Po «Maria Santissima Addolorata» of Eboli, «Infermi di Rimini» hospital.
The by-pass interventions are also in line with the partial recovery line. In 2021 they will start to rise again compared to 2020, but a deviation from the trend of -14% (about 1,900 fewer hospitalizations) remains. With regard to the threshold of 200 operations per year indicated by decree 70/2015, a slight increase in structures above the threshold was observed in 2021 (15 compared to 10 in 2020), against a slightly reduced number of cardiac surgeries (108 in 2019 against 101 in 2021).
The structures that have carried out 200 or more coronary bypass surgeries are: “Agostino Gemelli” University Hospital of Rome, “Campus Biomedico” University Hospital of Rome, Villa Maria Cecilia Hospital of Cotignola (Ra), Aoor “San Giovanni di Dio e Ruggi D’Aragona” of Salerno, Hospital “Del Cuore G. Pasquinucci” of Pisa, PO “SS. Annunziata» of Chieti, Treviso Hospital, Vicenza Hospital, Civil Hospital of Legnano (MI), Montevergine Nursing Home of Mercogliano (Av), «Umberto I – GM Lancisi» Plant of Ancona, Hesperia Hospital srl of Modena, Aou Mater Domini of Catanzaro, Aou Careggi of Florence, Po «Santa Maria della Misericordia» seat of Udine, Ao «San Camillo Forlanini» of Rome.
The front of hospitalizations for fracture of the femoral neck records a partial rapprochement with the pre-pandemic trend, in 2021 there was a slight increase, equal to around 2,600 hospitalizations. The proportion of patients aged over 65 operated within 48 hours has instead remained substantially stable in the last two years, going from 50.3 in 2020 to 48.6 in 2021, below the 60% threshold indicated by decree 70/2015. In fact, only a third of the interventions were carried out in structures that reached the expected threshold.
The structures that in Italy in 2021 treated more than 100 cases of fracture of the femoral neck in the elderly are 327, of these, 106 guaranteed timely intervention in more than 60 percent of cases. Among them, the top ten structures with the highest proportions are: Po «Umberto I» of Syracuse, Hospital «Sandro Pertini» of Rome, University Hospital «Campus Biomedico» of Rome, Po «S. John of God” of Agrigento, San Donà di Piave Hospital (Ve), Humanitas Clinical Institute of Rozzano (MI), “Guzzardi” Hospital of Vittoria (Rg), Ao “San Camillo Forlanini” of Rome, Jesi plant and Institute Orthopedist «Villa Salus I. Galatioto» of Melilli (Sr).
On the other hand, the figure for hip prosthesis operations is significant, growing, yes, but in the private sector. Which, in 2021, reached higher levels of activity than in 2019 (+13.5%); on the other hand, the public sector saw the gap on 2019 narrow (from -20.7% in 2020 to -12.2% in 2021). All this has led to an increase in the relative weight of the accredited private sector in the field of hip prosthetic surgery, already growing even before the pandemic, from 44.7% in 2019 to 51.1% in 2021. Reversing this trend is one of the challenges that public health will have to face in the new post-pandemic era.