Improvement of Russian clinical guidelines and reduction of mortality in perforated ulcers / O perspektivakh sovershenstvovaniya rossiiskikh klinicheskikh rekomendatsii i snizheniya letal'nosti pri probodnoi yazve.

OBJECTIVE: To analyze the results of laparoscopic surgery in patients with perforated ulcers using evidence-based medicine approaches. MATERIAL AND METHODS: We compared the efficacy and effectiveness of laparoscopic and open surgeries in patients with perforated ulcers. Meta-analysis of mortality after laparoscopic surgeries (randomized controlled trials) and trial sequential analysis were carried out. RESULTS: We clarified the differences between the efficacy and effectiveness of laparoscopic surgeries regarding postoperative mortality. In the Russian Federation, mortality after laparoscopic surgery is 9-11 times lower compared to open procedures. According to evidence-based researches (efficacy of laparoscopic interventions in 10 meta-analyses), these differences are less obvious (1.4-3.0 times) and not significant. The diversity-adjusted required information size to draw reasonable conclusions about differences in mortality in trial sequential analysis was 68 181 participants. Meta-analyses of RCTs also demonstrate lower incidence of wound complications (1.8-5.0% after laparoscopic surgery and 6.3-13.3% after laparotomy), shorter hospital-stay (mean difference from -0.13 to -2.84) and less severe pain syndrome (mean difference in VAS score from -2.08 to -2.45) after laparoscopic technologies. CONCLUSION: The obvious advantage of laparoscopic surgery in patients with perforated ulcers is fast-truck recovery following shorter hospital-stay, mild pain and rarer wound complications. Comparison of postoperative mortality regarding efficacy and effectiveness is difficult due to insufficient introduction of laparoscopic technologies in clinical practice and diversity-adjusted required information size.

[Prospects for development of laparoscopic surgery in the Central Federal District of the Russian Federation]. / O perspektive razvitiya laparoskopicheskoi khirurgii v Tsentral'nom federal'nom okruge Rossiiskoi Federatsii.

OBJECTIVE: To analyze the achievements of laparoscopic surgery in the Central Federal District of Russia and outline perspective trends for further application. MATERIAL AND METHODS: The study included adult patients with abdominal surgical diseases hospitalized in general surgical departments of the Central Federal District between 2014 and 2021. We analyzed the prevalence of elective and emergency laparoscopic surgeries. Incidence and results of laparoscopic interventions between 2018 and 2021 were estimated considering primary statistical data presented in the annual collections of the Chief Surgeon of the Ministry of Health of Russia «Surgical care in the Russian Federation¼. RESULTS: The absolute number of laparoscopic surgeries in the Central Federal District increased from 23.686 to 80.489 (by 3.4 times) between 2014 and 2021. The annual number of elective laparoscopic surgeries exceeded the number of emergency ones up to 2019. In 2020-2021, this situation changed in favor of emergency abdominal procedures. Laparoscopic surgeries are the most common for in acute cholecystitis (71.06-81.10% of all laparoscopic interventions annually) and acute appendicitis (46.85-55.60%). In 2020 and 2021, the absolute number of laparoscopic appendectomies exceeded the number of laparoscopic cholecystectomies. These values are lower for perforated ulcers (15.44-20.39%) and acute pancreatitis (32.40-36.71%). Laparoscopic operations are rare for acute intestinal obstruction, strangulated hernia and ulcerative gastroduodenal bleeding. In elective surgery, high availability of laparoscopic surgeries was noted in patients with cholelithiasis (89.40-93.78%), hiatal hernia (62.12-77.27%) and adrenal gland diseases (64.23-87.25%). The most intensive increment of availability (by 2.4 times) was noted for inguinal hernia from minimum level (10.98%) in 2018 to 26.00% in 2021. Mortality after some laparoscopic operations decreased in comparison with laparotomy by 12-45 times (2018-2021). However, this aspect and results of laparoscopic surgeries in case of delayed hospitalization require additional study. CONCLUSION: Analysis of laparoscopic surgery showed the timeliness of beginning and development of this direction In Russia. The prospect of further development of laparoscopic surgery for abdominal diseases is determined by modern trends. These are increase in the number of laparoscopic operations for acute appendicitis, acute cholecystitis and perforated ulcers, as well as higher number of early (after admission) operations.

[Impact of late admission on mortality from acute abdominal diseases in the Central Federal District of the Russian Federation]. / Vliyanie pozdnei gospitalizatsii na letal'nost' pri ostrykh abdominal'nykh zabolevaniyakh v TsFO Rossiiskoi Federatsii.

OBJECTIVE: To analyze the effect of late hospitalization on mortality from acute abdominal diseases in the Central Federal District of the Russian Federation. MATERIAL AND METHODS: Analysis of late hospitalizations and in-hospital mortality was based on metadata (616.742 clinical observations between 2017 and 2021). Primary statistical data were obtained from reports of chief surgeons in 18 regions of the Central Federal District of the Russian Federation and presented in analytical collections «Surgical care in the Russian Federation¼. RESULTS: The number of patients admitted to surgical hospitals of the Central Federal District with acute abdominal diseases later than 24 hours from clinical manifestation varies depending on the underlying disease. The greatest number of late hospitalizations was observed in acute intestinal obstruction (50.82%), acute adhesive intestinal obstruction (48.49%) and acute pancreatitis (47.36%). In acute cholecystitis, gastrointestinal bleeding and acute appendicitis, admission after 24 hours was observed in 44.72, 38.65 and 33.83% of cases, respectively. Late hospitalization is even less typical for strangulated hernia (27.43%) and perforated ulcer (26.23%). In-hospital mortality significantly differs in both groups (within and after 24 hours) for all acute abdominal diseases. Extended surgery and widespread peritonitis increase these differences for strangulated hernia by 9.2 times (0.92% within 24 hours and 8.48% after 24 hours), for acute appendicitis by 8 times (0.05% within 24 hours and 0.40% after 24 hours) and for perforated ulcer by 6.3 times (4.50% within 24 hours and 28.59% after 24 hours). CONCLUSION: In the Central Federal District, about 25-50% of patients with acute abdominal diseases admitted to the hospital later than 24 hours after clinical manifestation depending on disease. We found the highest in-hospital mortality following late hospitalization in patients with strangulated hernia, acute appendicitis and perforated ulcers.

[In-hospital mortality in acute abdominal diseases in the Central Federal District of Russia depending on availability of laparoscopic procedures]. / Dinamika gospital'noi letal'nosti pri ostrykh abdominal'nykh zabolevaniyakh v Tsentral'nom federal'nom okruge Rossii v zavisimosti ot chastoty primeneniya laparoskopicheskikh operatsii.

OBJECTIVE: To study in-hospital mortality in acute abdominal diseases in the Central Federal District and compared effectiveness of laparoscopic and open surgeries. MATERIAL AND METHODS: The study was based on the previous data for 2017-2021. The odds ratio (OR) was used to assess significance of between-group differences. RESULTS: The absolute number of deceased patients with acute abdominal diseases increased significantly and exceeded 23 thousand in the Central Federal District between 2019 and 2021. This value approached 4% for the first time over the last 10 years. In-hospital mortality from acute abdominal diseases in the Central Federal District increased for 5 years and reached maximum value in 2021. The greatest changes occurred in perforated ulcers (mortality increased from 8.69% in 2017 to 14.01% in 2021), acute intestinal obstruction (from 4.7% to 9.0%) and ulcerative gastroduodenal bleeding (from 4.5% to 5.5%). In other diseases, in-hospital mortality is lower, but trends are similar. Laparoscopic surgeries are common in acute cholecystitis (71-81%). At the same time, in-hospital mortality is significantly lower in regions with more active use of laparoscopy (0.64% and 1.25% in 2020; 0.52% and 1.16% in 2021). Laparoscopic surgeries are significantly less actively used for other acute abdominal diseases. We analyzed availability of laparoscopic surgeries using the «Hype Cycle¼. Percentage range of introduction reached conditional «productivity plateau¼ only in acute cholecystitis. CONCLUSION: Most regions are stagnating in laparoscopic technologies for acute appendicitis and perforated ulcers. Laparoscopic operations are actively used for acute cholecystitis in most regions of the Central Federal District. Annual increase in the number of laparoscopic operations and their technical improvement are promising in reducing in-hospital mortality associated with acute appendicitis, perforated ulcers and acute cholecystitis.

[Impact of staffing on the results of treatment among surgical patients. Statistical study]. / Vliyanie kadrovoi ukomplektovannosti na rezul'taty lecheniya khirurgicheskikh bol'nykh. Statisticheskoe issledovanie.

OBJECTIVE: To study the influence of staffing index on the results of surgical treatment. MATERIAL AND METHODS: The study was based on the data of surgical service in the Russian Federation upon 2018 (A.Sh. Revishvili et al., 2019). Correlation and regression analysis was carried out using the Microsoft Excel 2019 software. To assess between-group differences, we analyzed odds ratio (OR) and contingency table using χ2 test. RESULTS: Correlation and regression analysis revealed strong direct functional relationships (r=0.889) between the staffing of surgical service and in-hospital mortality rates. We distinguished 3 formalized levels of surgical staffing (high, medium and low). Gradation of these categories depends on the annual average reference indicator of staffing (88.4% in 2018). In high level of surgical staffing (≥88.4%), in-hospital mortality was 2.19%. Low level of surgical staffing (<88.4%) is accompanied by in-hospital mortality of 2.65% (OR 0.83; 95% CI 0.81-0.84; p<0.05). CONCLUSION: We confirmed the hypothesis about correlation of in-hospital mortality and staffing of surgical personnel. Validation of scientific data requires further studies with multivariate analysis of various covariates. Long-term prospects of surgical personnel policy in Russia are associated with formulation of specific tasks for surgical services at each level of surgical care.

[Surgical care in the Russian Federation during the pandemic - the main results of 2020]. / Khirurgicheskaya pomoshch' v Rossiiskoi Federatsii v period pandemii ­ osnovnye itogi 2020 goda.

OBJECTIVE: To study the impact of the SARS-CoV-2 pandemic on surgical care in the Russian Federation. MATERIAL AND METHODS: A retrospective cohort study of surgical care in state medical organizations of the Russian Federation in 2020 was conducted in comparison with 2019. The electronic database of the annual reports of the Chief surgeon of the Ministry of Health of the Russian Federation was used, which includes data from 3.232 surgical departments and 413 outpatient clinics in all regions of the country. The main working hypothesis of the study: during the COVID-19 pandemic, the number of hospitalizations to general surgical departments decreases, but the hospital and postoperative mortality for any reason increases both in emergency and elective surgery. RESULTS: During the pandemic, the number of hospitalizations of patients with surgical diseases decreased by 21.0%. At the same time, there was a significant increase in mortality among the entire population of patients in surgical hospitals. Surgical activity decreased, but the share of minimally invasive operations increased and there was no predicted increase in the share of late treatment in emergency surgery. The percentage of planned operations decreased by 40.8%, and the increase of postoperative mortality was registered at the same time. CONCLUSION: The presented data may be valuable for surgical care managers in emergency situations such as the COVID-19 pandemic. The long-term negative consequences of the pandemic for surgical practice are still difficult to evaluate.

[Loop colostomy as a risk factor of postoperative ileus in elective colorectal cancer surgery]. / Petlevaya stoma kak faktor riska razvitiya posleoperatsionnogo ileusa v planovoi khirurgii kolorektal'nogo raka.

OBJECTIVE: To identify risk factors of postoperative ileus (POI) in elective colorectal cancer (CRC) surgery. MATERIAL AND METHODS: A non-randomized retrospective study included 220 patients who underwent elective surgery for colorectal tumors. The indication for surgery was CRC stage 0-IV in 213 (96.8%) cases, villous adenoma in 7 cases (3.2%). Risk factors of POI defined in univariate analysis were included into multivariate analysis. Logistic regression was used in this case. RESULTS: Risk factors of POI were male sex (p=0.04), multifocal CRC (p=0.03), intraoperative transfusion (p=0.005), postoperative transfusion (p=0.035), left-sided hemicolectomy (p=0.01), colostomy (p=0.02), loop transversostomy (p=0.003), loop colostomy (p=0.02). According to logistic regression, independent risk factors of POI were male sex (p=0.015), left-sided hemicolectomy (p=0.004), intraoperative transfusion p=0.002), loop transversostomy (p=0.019). CONCLUSION: Independent risk factors of POI in elective colorectal cancer surgery were male sex, left-sided hemicolectomy, intraoperative transfusion and loop transversostomy.

[Effectiveness of laparoscopic cholecystectomy for acute cholecystitis]. / Sravnitel'naya effektivnost' laparoskopicheskoi kholetsistektomii pri ostrom kholetsistite.

OBJECTIVE: To analyze the impact of laparoscopic cholecystectomy on in-hospital and postoperative mortality in patients with acute cholecystitis. MATERIAL AND METHODS: Comparative analysis was based on primary statistical data presented in public available analytical collections «Surgical care in the Russian Federation¼ (Revishvili A.Sh. et al. 2019, 2020). Depending on introduction of laparoscopic surgery, all regions were divided into 4 groups. Between-group analysis of differences was carried out using χ2 test. Statistical processing was performed using SPSS Statistics software package for Windows. RESULTS: According to 2-year follow-up data (2018, 2019), in-hospital mortality was 0.97 and 0.95% and postoperative mortality was 1.36 and 1.47%, respectively, in the regions with percentage of laparoscopic surgery for patients with acute cholecystitis was less than 25%. In the second group (percentage of laparoscopic surgery 25.01 - 50%), in-hospital mortality was 0.95 and 1.14%, postoperative mortality - 1.38 and 1.71%. In the third group (percentage of laparoscopic surgery 50.01 - 75%), in-hospital mortality was 0.92 and 0.99%, postoperative mortality - 1.27 and 1.38%. In the fourth group, percentage of laparoscopic surgery exceeded 75%. In-hospital mortality was 0.61 and 0.74%, postoperative mortality - 0.76 and 0.98%, respectively. Analysis of multi-field contingency tables revealed non-random between-group differences of in-hospital (p<0.001) and postoperative (p<0.001) mortality, as well as significant decrease of mortality following laparoscopic surgery. We also analyzed mortality after laparoscopic surgery considering technology maturity curve. CONCLUSION: In-hospital and postoperative mortality in acute cholecystitis depend on availability of laparoscopic technologies.

[Influence of the incidence of ulcerative gastroduodenal bleeding on the effectiveness of treatment. Statistical surveillance]. / Vliyanie zabolevaemosti yazvennym gastroduodenal'nym krovotecheniem na effektivnost' lecheniya. Statisticheskoe nablyudenie.

OBJECTIVE: To study and to justify statistically the influence of the incidence of ulcerative gastroduodenal bleeding on the results of treatment. MATERIAL AND METHODS: The results of treatment of 56.233 patients with ulcerative gastroduodenal bleeding in the Central Federal district have been analyzed throughout a 5-year follow-up period. Statistical analysis was performed in Microsoft Excel 2007 and Review Manager 5.3. RESULTS: Overall in-hospital mortality (r=0.871) and surgical activity (r=0.725) depend on the number of patients with ulcerative bleeding. Active surgical approach was followed by overall in-hospital mortality 6.9%, moderate surgical approach - 5.3% (OR 1.3%, 95% CI 1.18-1.4, p<0.05). CONCLUSION: The correlations between the number of patients with ulcerative bleeding and surgical activity, overall in-hospital and postoperative mortality were identified in a large sample.

[Modern aspects of the complex treatment of perforated gastric and duodenal ulcer]. / Sovremennye aspekty kompleksnogo lecheniya perforativnoi yazvy zheludka i dvenadtsatiperstnoi kishki.

OBJECTIVE: To study the effectiveness of pharmacotherapy for perforated gastric ulcer in a surgical hospital. MATERIAL AND METHODS: A retrospective analysis of the treatment of 693 patients with perforated gastric and duodenal ulcers was carried out. Laparoscopic and open surgeries were performed. Statistical analysis was performed using the Statistica and MS Excel software packages. Student t-test was applied for independent samples and Fisher's F-test was calculated. RESULTS: Combined therapy included surgical treatment (suturing of the ulcer as a rule) and medication with proton pump inhibitors, antibacterial drugs. Over the past 5 years, postoperative quality of life has been significantly improved in patients with perforated ulcers. Stomach resection and vagotomy for perforated ulcers will become historical in the near future. Laparoscopic and open procedures ensure similar periods of ulcer closure. CONCLUSION: Currently, successful treatment of perforated gastric and duodenal ulcers requires an integrated approach at all levels of specialized care and is impossible without modern pharmacotherapy.

[Current trends in emergency abdominal surgery in the Russian Federation]. / Sovremennye tendentsii v neotlozhnoi abdominal'noi khirurgii v Rossiiskoi Federatsii.

OBJECTIVE: To analyze morbidity and factors affecting mortality in emergency abdominal surgery in the Russian Federation. MATERIAL AND METHODS: The study included patients with acute abdominal diseases aged 18 years and older. All patients were hospitalized in emergency surgical care departments of 3.194 state healthcare institutions in 84 regions of the Russian Federation in 2018. Morbidity, surgical activity and mortality were analyzed. RESULTS: There were 680.337 cases of hospitalization in emergency surgical department, morbidity rate was 582 cases per 100 000. The most common emergency surgical diseases were acute appendicitis (142.3 cases per 100 000), acute cholecystitis (139.0 cases per 100 000) and acute pancreatitis (131.2 cases per 100 000). Surgery was performed in 399.051 (58.7%) patients. In-hospital mortality rate was 2.4% (16 051 cases). CONCLUSION: There are certain factors affecting mortality rate in acute abdominal diseases. The leading problems in organizing emergency surgical care in Russia are insufficient equipment of rural and small municipal surgical hospitals, different staffing with surgeons in rural areas and large cities and late hospitalization of patients.

[Large outpatient surgery. Are there prospects?] / Bol'shaia ambulatornaia khirurgiia. Est' li perspektivy?

AIM: To study frequency of 'hospital registry' operations in the polyclinics of the Central Federal district, to analyze previous experience of outpatient surgical care and to assess perspective directions of its development. MATERIAL AND METHODS: Over 48 million people who referred to polyclinics for medical care in 17 regions of Central Federal district for 6 years (2011-2016) were studied. RESULTS: Mean surgical activity in the polyclinics of Central Federal district is 4.5%. The annual number of 'hospital registry' operations does not exceed 150-200 (0.01%) for the entire district. Large outpatient surgery in Russia has evolved from active development to complete apathy and was almost always associated with health care reforming and attempts to reduce the volume of 24-hour in-patient surgical care. CONCLUSION: Advanced outpatient surgery is able to compensate routine in-hospital operations and to focus resources of these hospitals on the development of high-tech surgical care. It is necessary to change the insurance share of financing of patients operated in day surgical hospitals for successful development of 'large outpatient surgery'.

[Surgical treatment of ulcerative pyloroduodenal stenosis]. / Khirurgicheskoe lechenie iazvennogo piloroduodenal'nogo stenoza.

AIM: To obtain the most reliable information about surgical treatment of ulcerative pyloroduodenal stenosis based on the methodology of evidence-based medicine. MATERIAL AND METHODS: Searching platforms were elibrary, Cochrane Library and PubMed database. The probability of major systematic errors in randomized controlled trials (RCTs) was evaluated. RESULTS: Systematic review included 20 RCTs for the period 1968-2009 with overall sample of 1794 patients. Evaluation of external validity allows to generalize the results of these studies to the entire population of patients with ulcerative pyloroduodenal stenosis. Assessment of internal validity based on the number of systematic errors showed that 7 (35%) of 20 of RCTs corresponded to the highest level of evidence (level 1), 13 (65%) of 20 had systematic errors and were downgraded in the rating (level 1-). Significant heterogeneity of RCTs impedes metaanalysis. Conclusions and practical recommendations for the treatment of ulcerative pyloroduodenal stenosis are formed according to the results of individual RCTs. CONCLUSION: Selective vagotomy may be performed for functional stenosis. In case of organic stenosis, truncal vagotomy should be combined with drainage surgery (pyloroplasty, gastroenterostomy) or Roux/Billroth-1 antrectomy. Treatment of decompensated stenosis within evidence-based medicine is unclear. We have not identified target researches with evidence level 1 for this form of stenosis.

[Emergency surgery in Russian Federation (in Russian only)]. / Sostoianie ékstrennoi khirurgicheskoi pomoshchi v Rossiiskoi Federatsii.

In the following article, we present the key trends in emergency surgical care in the Russian Federation between 2000 and 2017. The study used data from federal statistical observations and a survey of state medical institutions in 80 regions encompassing 99.3% of the country's population. We discovered a change in the correlation between acute abdominal diseases, particularly a significant reduction in the occurrence of acute appendicitis and perforated peptic ulcer. Reduction in the number of emergency surgeries by 27.8% annually was also observed. Mortality rate decreased in cases of strangulated hernia, acute cholecystitis and acute pancreatitis, while it is stable for bowel obstruction and acute appendicitis and increasing in perforated peptic ulcer cases. The total annual number of lethal outcomes due to acute abdominal diseases was decreased by 1900 cases. Significant changes were observed in mortality rate and minimally invasive surgeries proportions between federal districts and individual regions of the country. The range of administrative measures was proposed.

[Current directions in professional training of surgeon]. / Sovremennye napravleniia professional'noi podgotovki vracha-khirurga.

AIM: To develop 'Cadaveric Course' of operative surgery for severe combined trauma for students, surgical residents, postgraduate students of medical universities and to compare its effectiveness with other approaches. MATERIAL AND METHODS: 'Cadaveric course' program of operative surgery for severe combined trauma consisted of four stages. The first stage is theoretical course (2 weeks), the second stage - students' work in cadaveric operating theatre with instructors (5 weeks), the third stage - their independent work in 'cadaveric operating theatre (10 weeks), the fourth stage - analysis of the results and their comparison with those of 5 2-year residents (control group). RESULTS: There were significant differences in practical skills between students. Mean time of surgery and expert assessment score were 32.0±9.5 min and 4.6±0.5 in the main group, respectively, in the control group - 46.0±7.5 min and 3.6±0.5 scores, respectively (p=0.03 and p=0.02). Theoretical background was similar in both groups (p>0.05). CONCLUSION: Research has opened new opportunities to introduce 'cadaveric course' into educational process, to analyze its outcomes and further improvement.

[Reality and prospects of sepsis epidemiology research]. / Real'nost' i perspektivy izucheniia épidemiologii sepsisa.

Current foreign and Russian literature for sepsis epidemiology is reviewed. There is advanced incidence of sepsis in developing countries among young people as a rule. Absent high-quality epidemiological studies lead to overdiagnosis of sepsis and increased morbidity. National and territorial screening and diagnostic programs for sepsis became possible with introduction of new recommendations 'Sepsis-3'. Thus, there is a possibility to systematize regular epidemiological studies devoted to sepsis.

[Specialist's training for laparoscopic surgery in Wet-lab educational operating theatre]. / Sistema podgotovki spetsialista po laparoskopicheskoi khirurgii v uchebnoi operatsionnoi Wet-lab.

AIM: To develop system for students training in laparoscopic surgery by using of Wet-lab educational operating theatre. MATERIAL AND METHODS: We have launched laparoscopic surgery teaching program for students of Ryazan State Medical University. This system includes several stages. At the first stage professional selection was carried out on 'dry' laparoscopic simulators among III-IV-year students of medical faculty. So, 10 people were selected. The second stage included theoretical and practical parts consisting of development of basic laparoscopic skills on 'dry' simulators. 5 students who scored the maximum points were admitted to the next stage. The third stage is working in Wet-lab operating theatre with a mentor. There were 10 sessions on 10 laboratory pigs. Final stage of our study compares two groups of participants: main group - 5 students who underwent above-described program and control group of 5 residents without experience for laparoscopic operations. RESULTS: The participants of the main group had significantly higher OSATS score compared with another group (20 vs. 10; p<0.05). Movements effectiveness estimated by measuring of movements trajectory total length was also higher in main group than in control group (6 vs. 20; p<0.05). Experts' subjective assessment according to 10-point scale was also higher for students than for interns (9 vs. 5, p<0.05). Participants in the main group required significantly less time to complete the task compared with the control group (40 vs. 90 minutes, p<0.05). CONCLUSION: Our experience has shown that training system with Wet-lab operating theatre is effective for quick and efficient training of medical students in main laparoscopic procedures. In our opinion, introduction of students into 'advanced' surgery from early age will make it possible to get finally highly professional specialists.

[Law and educational components of patient's safety in surgery]. / Pravovye i obrazovatel'nye komponenty bezopasnosti patsientov v khirurgii.

AIM: To evaluate law and educational components of patient's safety (PS) in surgery. MATERIAL AND METHODS: In order to analyze complex causes of adverse outcomes in surgery we performed an interviewing of 110 surgeons, 42 emergency physicians and 25 health care managers. The main keynote consisted in assessing law and educational components of PS. RESULTS: The study revealed significant professional shortcomings in law PS level and low educational and motivational activity of physicians of all specialties. CONCLUSION: Multi-faceted nature of PS problem requires multidisciplinary training of modern surgeons not only in the knowledge of key risk factors for adverse outcomes, but also in satisfaction of non-medical expectations of patients. Due to numerous objective reasons Russian surgical school should have the opportunity not to blindly copy the experience of our foreign colleagues, but to scientifically substantiate the development of own national security system both for surgical patients and medical workers themselves.

[The definition of sepsis. 25-year experience of concept development]. / Chto takoe sepsis: 25-letnii opyt razvitiia kontseptsii.

The review, presented in chronological order the stages of formation of the modern definition of sepsis syndrome, since the recommendations of the conciliation conference ACCP/SCCM (1991), the experience of the practical use of which has been extensively critically assessed in future studies. As a result, it formed a strong opinion that the global challenge of early diagnosis of sepsis, under the previously proposed definitive categories have not been solved, moreover, in the scientific community formed a firm belief in the need to make fundamental changes in the definition of the term 'sepsis'. As a result, in 2016 the scientific community were presented the recommendations of the working group 'Sepsis-3', in which sepsis is defined as life-threatening organ dysfunction due to dysregulated response to infection, and fundamentally distinguish them from the former, is a laconic definitions and availability of diagnostic criteria. National expert community to analyze, discuss and define the field of clinical testing 'Sepsis-3' in the Russian Federation.