Acute appendicitis is the leading cause of abdominal emergency surgery worldwide and appendectomy continues to be the definitive treatment of choice. This cost-effectiveness analysis evaluates laparoscopic versus open appendectomies performed in public health services in the state of Bahia (Brazil). We conducted a retrospective observational study using the database from the Department of Informatics of the Unified Health System (DATASUS). Available data on appendectomies between 2008 and 2019 were included, and we evaluated the temporal trend of hospital admissions, procedure-related mortality rates, length of stay, and costs. Statistical analysis was performed using the R-software (R Foundation, v.4.0.3) and the BioEstat software (IMDS, v. 5.3), considering p<0.05 as significant. During 2008-2019, 53,024 appendectomies were performed in the public health services in Bahia, of which 94.9% were open surgeries. The open technique was associated with a higher mortality rate (4.9/1,000 procedures; p<0.05) and a higher risk of death (RR=4.5; p<0.05) compared to laparoscopy (1.1/1,000 procedures). Laparoscopic appendectomy (median of 2.7 days) had a shorter length of stay compared to laparotomy (median of 4.15 days) (p<0.05). There was no difference in the medians of costs nor hospital services, per procedure (p=0.08 and p=0.08, respectively). Laparoscopic professional median costs were higher by US$ 1.39 (p<0.05). Minimally invasive surgery for appendicitis is a safe and efficacious procedure in Brazilian public health care services, as it provides advantages over the open method (including lower procedure-related mortality rate and earlier discharges), and it did not imply higher expenses for public service budgets in the state of Bahia.

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- BACKGROUND: Gallbladder diseases (GBD) are one of the most common medical conditions requiring surgical intervention, both electively and urgently. It is widely accepted that sex and ethnic characteristics mighty influence both prevalence and outcomes. AIM: This study aimed to evaluate the differences on distributions of gender and ethnicity related to the epidemiology of GBD in the Brazilian public health system. METHODS: DATASUS was used to retrieve patients’ data recorded under the International Code of Diseases (ICD-10) - code K80 from January 2008 to December 2019. The number of admissions, modality of care, number of deaths, and in-hospital mortality rate were analyzed by gender and ethnic groups. RESULTS: Between 2008 and 2019, a total of 2,899,712 patients with cholelithiasis/cholecystitis (K80) were admitted to the hospitals of the Brazilian Unified Health System, of whom only 22.7% were males. Yet, the in-hospital mortality rate was significantly higher in males (15.9 per 1,000 male patients) than females (6.3 per 1,000 female patients) (p<0.05). Moreover, men presented a significantly higher risk of death (RR=2.5; p<0.05) and longer hospital stay (4.4 days vs. 3.3 days; p<0.05) than females. Compared to females, men presented a higher risk of death across all self-declared ethnic groups: whites (RR=2.4; p<0.05), blacks (RR=2.7; p<0.05), browns (RR=2.6; p<0.05), and Brazilian Indians (RR=2.13; p<0.05). CONCLUSION: In the years 2008-2019, women presented the highest prevalence of hospital admissions for GBD in Brazil, and men were associated with worse outcomes, including all ethnic groups.

INTRODUCTION: Academic Leagues of Medicine are extracurricular activities, which recognize the student’s protagonism in knowledge's production, such as training and teaching-learning experiences developed by students.  OBJECTIVE: To assess the training’s efficiency in surgical technique applied at the Academic League of Internal and Surgical Medicine (LAMIC).  METHODS AND MATERIALS: We evaluated the effect of the LAMIC’s training promoted to its associated students, comparing them to a non-exposed group. A questionnaire was used as an evaluation tool. It contained 20 objective questions and all students had up to 30 minutes to answer it. The 60% mark of correct answers was set as a threshold for considering proficient knowledge. For statistical analyses, Mann-Whiney U test and Fisher's exact test were performed, adopting p<0.01 as significant.  RESULTS: Sixty-nine students composed the sample population, whom 24 LAMIC-students were exposed to internal training and 45 non-exposed students. Among LAMIC-students, 91.7% had supraliminal results, while only 2.2% of non-exposed students reached this mark (p<0.01; odds ratio, OR = 354.8). There was statistically significant association between LAMIC-students’ results and good performance in: fundamentals in surgery (p<0.01, OR = 5.0), surgical risk assessment (p<0.01, OR = 3.4), patient (p<0.01, OR = 183.5) and surgical team (p<0.01, OR = 9.6) positioning, surgical center (p<0.01, OR = 84.0), and instrumentation (p<0.01, OR = 125.3).  CONCLUSION: Participation in internal training promoted by the academic league fostered better results in surgical knowledge, corroborating the concept that student’s leadership in teaching experiences may contribute to a better learning experience and medical formation.