Epidemiology and costs of surgical treatment of developmental dysplasia of hip in the Brazilian Public Health System in a decade

Abstract

Objective: To describe and analyze the epidemiology and costs of surgical treatment of hip dysplasia in the Brazilian Public Health System. Methods: An ecological analytical study that evaluated a time series and the geographic distribution of surgical treatment of hip dysplasia in Brazil. Frequencies of cases, number of cases and associated factors were analyzed. Correlations, frequency maps and flow maps are presented and discussed. Results: During the study, 14,584 patients with dysplasia were admitted to hospitals according to Information Technology Department of the Public Health System. Patients underwent hospital treatment specific for dysplasia in 8,592 cases (at an average cost of R$ 2.225,50, total cost of R$ 19.124.086,25– updated values). In this group, mortality rate was 0.046% and mean hospitalization time was 4.41 days (standard deviation of 2,39 days). Age between 1 and 4 years (37.7%), female sex (64.5%) and white race (46%) were more frequent. Greater rates of specialists (R²=0.82; p<0.001), greater proportion of counties with high/very high human development index (R²=0.79; p<0.001), and higher per capita income (R²=0.68; p<0.001) correlated to greater rates of treatments undertaken per 1,000 live births (as per State of treatment). The factor most related to treatment rate per 1,000 live births (as per State of residence) was white race (R²=0.90; p<0.001). Southern states had higher treatment rates (as per State of residence, rate of 0.73/1,000), and Southeast states had greater absolute frequency of cases (46.7%) and greater flow of patients. Conclusion: The surgical treatment of hip dysplasia in Brazil occurs frequently, at relevant costs, and is distributed in a heterogenous and unequal fashion in the Public Health System. Southern states have a higher incidence of cases, and there is an association with racial and socioeconomic factors. There was no large variation in the incidence of cases over time.

Del diagnóstico oportuno a la disminución de las secuelas de la Displasia de ca-dera en desarrollo

“…La carga de la DCD es alta dado que en una revisión hecha en el Complejo Hospitalario San Borja Arriarán de Santiago de Chile, el 15 a 18 % de las artroplastias totales de cadera, efectuadas en mayores de 65 años, corresponden a secuelas de DCD con o sin tratamiento previo (40) y los costos de la detección tardía de DCD generan una carga económica que varía según el tipo de procedimiento quirúrgico en los Estados Unidos (41) y en Brasil (42), ya que la incongruencia de la articulación coxofemoral genera desgaste articular prematuro, desviación de la columna, acortamiento importante de la extremidad comprometida, deformidades en rodilla y en la cadera contralateral; además de provocar dolor y pérdida de movilidad de la articulación mencionada. Genera discapacidad con carga social y económica para su familia y la sociedad como lo ha resumido desde el 2011 el Colegio Mexicano de Ortopedia y traumatología (25).…”

The reality of sonography of the infant hip in Brazil: results and recommendations

“…Developmental dysplasia of the hip (DDH) is an orthopedic condition that involves morphological changes in the hip at birth or early infancy, ranging from delayed maturation to hip dislocation [1]. Although the exact cause of DDH remains unknown, it is the most common congenital anomaly of the musculoskeletal system, with an incidence ranging from 0.06 per 1,000 live births among some groups of Africans to 76.1 per 1,000 live births among Native Americans, as demonstrated by Loder and Skopelja [2]. These authors identified significant variability in incidence within ethnic groups by geographic location, which also occurs in Brazil [3], mainly because it is a vast country in which there are many people of mixed ethnic and racial backgrounds.…”