Ten-years of bariatric surgery in Brazil: in-hospital mortality rates for patients assisted by universal health system or a health maintenance organization

Abstract

BackgroundBariatric surgery is an option for sustained weight loss for the morbidly obese patient. In Brazil coexists the Unified Health System (SUS) with universal coverage and from which depend 150 million Brazilians and supplemental health security, predominantly private, with 50 million beneficiaries.AimTo compare access, in-hospital mortality, length of stay and costs for patients undergoing bariatric surgery, assisted in one or another system.MethodsData from DATASUS and IBGE were used for SUS patients' and database from one health plan of southeastern Brazil for the health insurance patients.ResultsBetween 2001 and 2010 there were 24,342 and 4,356 surgeries performed in SUS and in the health insurance company, respectively. The coverage rates for surgeries performed in 2010 were 5.3 and 91/100.000 individuals in SUS and health insurance respectively. The rate of in-hospital mortality in SUS, considering the entire country, was 0.55 %, 0.44 % considering SUS Southeast, and 0.30 % for the health insurance. The costs of surgery in the SUS and in the health insurance trend to equalization over the years.ConclusionDespite differences in access and characteristics that may compromise the outcome of bariatric surgery, patients treated at the Southeast SUS had similar rate of in-hospital mortality compared to the health insurance patients.

Cirurgias bariátricas realizadas pelo Sistema Único de Saúde no período 2010-2016: estudo descritivo das hospitalizações no Brasil*

“…We sought to give continuity and chronological sequence to the study conducted by Kelles, Machado and Barreto. 9 These authors compared access, in-hospital mortality, length of inpatient stay and cost in relation to patients undergoing bariatric surgery on the SUS in Brazil or at a supplementary health service in the city of Belo Horizonte between 2001 and 2010. We found no other similar studies involving national SUS data after 2010.…”

Real-world evidence of health outcomes and medication use 24 months after bariatric surgery in the public healthcare system in Brazil: a retrospective, single-center study

“…The present study also included publicly treated patients facing a multiyear wait before the bariatric procedure. The recorded waiting period of approximately 3 years is typical for the SUS (21). In Canada, a recent study indicates a waiting time of 412 months between referral and specialist consultation plus an additional 6-18 months until surgery (22), which could translate into comparable wait times.…”

Preoperative multidisciplinary program for bariatric surgery: a proposal for the Brazilian Public Health System

“…There are only about 50 public hospitals in the entire Brazilian territory in which bariatric surgeries are performed (18) , although recent studies observed that the obesity prevalence in Brazil is 17.9%, which corresponds to almost 30 million obese people (23) . Only about 10% of all bariatric surgeries in Brazil are performed in public services (18) .…”

“…There are only about 50 public hospitals in the entire Brazilian territory in which bariatric surgeries are performed (18) , although recent studies observed that the obesity prevalence in Brazil is 17.9%, which corresponds to almost 30 million obese people (23) . Only about 10% of all bariatric surgeries in Brazil are performed in public services (18) . The idea behind the establishment of the multidisciplinary preoperative approach was to aggregate and enable access to a larger number of individuals and therefore create a situation where those more apt to undergo surgery and follow the prescript recommendations would receive the surgical treatment, leading to better outcomes and fewer complications in all of the dimensions possibly affected.…”