BackgroundHeart surgery has developed with increasing patient complexity.ObjectiveTo assess the use of resources and real costs stratified by risk factors of
patients submitted to surgical cardiac procedures and to compare them with
the values reimbursed by the Brazilian Unified Health System (SUS).MethodAll cardiac surgery procedures performed between January and July 2013 in a
tertiary referral center were analyzed. Demographic and clinical data
allowed the calculation of the value reimbursed by the Brazilian SUS.
Patients were stratified as low, intermediate and high-risk categories
according to the EuroSCORE. Clinical outcomes, use of resources and costs
(real costs versus SUS) were compared between established risk groups.ResultsPostoperative mortality rates of low, intermediate and high-risk EuroSCORE
risk strata showed a significant linear positive correlation (EuroSCORE:
3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any
postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively;
p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and
29.2 days (p < 0.001). The real cost was parallel to increased resource
use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus
R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00,
respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00
± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ±
R$935,00; p < 0.001). However, as the EuroSCORE increased, there was
significant difference (p < 0.0001) between the real cost increasing
slope and the SUS reimbursement elevation per EuroSCORE risk strata.ConclusionHigher EuroSCORE was related to higher postoperative mortality,
complications, length of stay, and costs. Although SUS reimbursement
increased according to risk, it was not proportional to real costs.