Impact of the COVID-19 pandemic on surgical procedures in Brazil: a descriptive study

Abstract

BackgroundThe COVID-19 pandemic has deeply affected medical practice, and changes in healthcare activities were needed to minimize the overload and avoid healthcare systems collapse. The aim of this study was to evaluate the impact of the pandemic on surgical procedures in Brazil.Materials and MethodsWe conducted a descriptive study of the number of hospitalizations for surgical procedures in Brazil from 2016 to 2020. Data were collected from the Brazilian Department of Informatics of the Unified Health System (DATASUS). Analyzes were performed according to the type of procedure, geographical region, subgroups of surgical procedures, and the number of surgeries from 2020 were compared with the average from 2016 to 2019.ResultsThere were 4,009,116 hospitalizations for surgical procedures in the Brazilian Public Health System in 2020. When comparing it to the average of hospitalizations from 2016-2019, there was a decrease of 14.88% [95%IC (14.82-14.93)]. Decrease rates were 34.82% [95%IC (34.73-34.90)] for elective procedures and 1.11% [95%IC (1.07-1.13)] for urgent procedures. Decrease rates were similar in all the five regions of the country (average 14.17%). Surgical procedure subgroups with the highest decrease rates were endocrine gland surgery (48.03%), breast surgery (40.68%), oral and maxillofacial surgery (37.03%), surgery of the upper airways, face, head and neck (36.06%), and minor surgeries and surgeries of skin, subcutaneous tissue and mucosa (33.16%). Conclusion: The overload of healthcare facilities has demanded a reduction of non-urgent activities to prevent a collapse of healthcare systems, resulting in a decrease in elective surgeries. Recommendations about the performance of surgical procedures were made, and continuous refinements of these recommendations are encouraged.

The Impact of the COVID-19 Pandemic on Surgical Services in Brazil's Healthcare System: A Retrospective Cross-Sectional Study

“…Our study found a statistically significant difference in the number of admissions for surgery in oncology across the study period, a 4.5% decrease, which is close to the 5.6% reduction reported by the study of Luizeti et al [ 23 ], inferring that Brazil showed a tendency to opt for surgical intervention for most oncology cases. This is because the management of oncological cases is crucial for health systems as treatment delays have severe consequences for patients and society.…”

“…This is in agreement with the findings of this study, indicating a decreased number of admissions and LOS for non-urgent surgeries in the same period, especially for endocrine surgery, which recorded the highest decrease (19.9%), followed by oral and maxillofacial surgery (17.3%). Given the elevated risk of COVID-19 infection in immunocompromised patients, for example, those undergoing oncological surgery, guidelines recommended delaying surgeries if feasible to minimize intrahospital COVID-19 transmission and making decisions based on the pandemic's impact on the health facility [ 23 ]. It is worth noting that surgeons performing more invasive procedures, such as ear, nose, and throat, thoracic, foregut, and endoscopy, were at higher risk of contracting COVID-19 during the pandemic due to the aerosol transmission of the virus [ 14 ].…”

The disruption of elective procedures due to COVID-19 in Brazil in 2020

“…Most of the studies conducted in Brazil are descriptive analysis, not accounting for causal effects between the reduction of elective procedures and the COVID-19 pandemic. That said, a descriptive study compared the average number of elective procedures from 2016 to 2019 with 2020, suggesting a reduction of 34.82% (95% CI 34.73–34.90) 20 . Another descriptive study conducted in the state of Ceará, Brazil, found a reduction of 89.3 and 67.9% in the number of transplants and organ donations, respectively, comparing Apr-Jun/2020 with Apr-Jun/2019 21 .…”

From SARS to COVID-19: lessons we should have learned (but we did not)

“…Epidemiological studies showed the potential underreporting of deaths by COVID-19 in Brazil. 50,51 There was an increase of unexpected deaths by natural causes in regions severely inflicted by COVID-19. 50, 51 The excess of deaths can be associated with indirect consequences of the COVID-19 pandemic, such as health care shortages or overburdened health care systems.…”

“…50,51 There was an increase of unexpected deaths by natural causes in regions severely inflicted by COVID-19. 50, 51 The excess of deaths can be associated with indirect consequences of the COVID-19 pandemic, such as health care shortages or overburdened health care systems. 52 However, although the number of elective surgeries decreased 34% in 2020, the urgent procedures decreased only 1.1%.…”