Noncardiac surgery in Brazil: a national registry of clinical, surgical, epidemiological and economical aspects

Abstract

Worldwide, very little data are available about economical, epidemiological and evolutional aspects related to noncardiac surgery. Previous surveys estimated that every year, in average, 234.2 millions of surgeries are performed but this number is probably underestimated. Moreover, the mortality and complication rates related to surgery are still elevated and show a big variation among different countries. The perioperative care of surgical patients greatly improved in the past years. Advances in perioperative care have provided new approaches for patients in the surgical setting and several strategies have been established as effective in perioperative risk reduction. However, there is an increase of health life expectancy of population in the past years and the number of elderly patients submitted to surgical procedures is growing as longevity increases. Age is a risk factor related to higher mortality and rate of complications in non-cardiac surgery and the presence of associated clinical conditions in elderly people may be responsible to the elevated cardiac risk with a worse surgical outcome. The increase of comorbidities related to aging is also associated to prolonged length of stay, higher surgical mortality and more post operative complications. Little is known about the information among non-cardiac surgery performed in Brazil. The available data about surgery, its actual global volume, the surgical mortality, the cost in public health system are scarse and inconclusive. The increase of health life expectancy associated to the changes in demographic characteristics of Brazilian population, besides the technological and medical advances that occurred in past years, may have caused modifications on surgery outcomes, complications rates, operative mortality, length of stay and health expenditure in Brazil. The purpose of our study is to evaluate the epidemiological characteristics of non-cardiac procedures performed in Brazil in the last years. We also intend to evaluate the health expenditure of these operations and their impact in public-health economic system.The data and variables will be collected from the DATASUS, a national database that contains all data about the brazilian public health system, organized and maintained by government on internet. We select from the electronic site of system DATASUS, information which is classified as surgical hospitalizations. The variables included in study are selected based on the relevance and the potential contribution to describe the reality of operative mortality and hospital expenses related to surgical hospitalizations. The variables included in our study were: number of volume of surgeries, in-hospital expenses, transfusion cost, length of stay and surgical mortality. We intend to identify variables or procedures which are related to higher operative mortality. We will analyze the economic aspects of the surgery cost and its impact on public expenditure in health and the relation to modifications in the economical indexes. (AU)