Аннотация
Background: Management of inguinal hernia repair (IHR) in transition economies remains a challenge where clinical adoption of international guidelines, such as HerniaSurge 2023, is often hindered by legacy funding models. This study evaluates the impact of surgical technique transition on clinical outcomes, cost-utility, and institutional resource turnover in Almaty, Kazakhstan. Methods: A prospective-retrospective analysis of 505 patients was conducted (January 2021 to December 2023). For clinical comparison, a matched subgroup (n=138) was analyzed, comparing Open Lichtenstein (n=56), Laparoscopic Totally Extraperitoneal (TEP, n=42), and Open Transinguinal Preperitoneal (TIPP, n=40) repairs. Clinical outcomes were quantified via the EuraHS-QoL scale. Economic efficiency was modeled using Quality-Adjusted Life Years (QALY). We introduced the System Burden Index (SBI) - calculated as the ratio of category mean length of stay (LOS) to population average - to identify productivity bottlenecks across financing channels (Commercial, Government Quotas, and City Budget). Results: Posterior approach techniques (TEP and TIPP) significantly reduced postoperative pain frequency compared to the Lichtenstein group (26.2% and 32.5% vs. 51.8%, p=0.013). TEP was identified as the dominant strategy for cost-utility. Management analysis revealed a significant "Efficiency Gap" across funding sectors: government quota cases showed a mean LOS of 8.31 days (SBI 1.28) compared to 5.37 days (SBI 0.83) in the commercial sector. Our predictive model suggests that transitioning state-funded sectors to rapid-recovery protocols could potentially reclaim 4.7 bed-days per patient. Conclusion: Transitioning to TEP/TIPP protocols is a key factor for enhancing healthcare capacity in Kazakhstan. Shifting reimbursement logic from bed-day occupancy to value-based outcome packages is essential to align regional practice with global surgical standards and optimize institutional throughput.