R Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

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dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorTITINGER, David Provenzale
dc.contributor.authorLISBOA, Luiz Augusto Ferreira
dc.contributor.authorMATRANGOLO, Bruna La Regina
dc.contributor.authorDALLAN, Luis Roberto Palma
dc.contributor.authorDALLAN, Luis Alberto Oliveira
dc.contributor.authorTRINDADE, Evelinda Marramon
dc.contributor.authorECKL, Ivone
dc.contributor.authorKALIL FILHO, Roberto
dc.contributor.authorMEJIA, Omar Asdrubal Vilca
dc.contributor.authorJATENE, Fabio Biscegli
dc.date.accessioned2015-12-10T16:41:35Z
dc.date.available2015-12-10T16:41:35Z
dc.date.issued2015
dc.description.abstractBackground: Heart surgery has developed with increasing patient complexity. Objective: To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS). Method: All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups. Results: Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001),as well as occurrence of any postoperative complication (EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 +/- R$ 13.928,00 versus R$ 34.854,00 +/- R$ 27.814,00 versus R$ 43.234,00 +/- R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 +/- R$ 4.571,00 versus R$ 16.217,00 +/- R$ 7.298,00 versus R$ 19.548,00 +/- R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata. Conclusion: Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.
dc.description.abstractFundamento: A cirurgia cardíaca evoluiu progressivamente com o aumento da complexidade dos pacientes. Objetivo: Avaliar a utilização de recursos e o custo real segundo o grupo de risco dos pacientes submetidos à cirurgia cardíaca, e compará-los com o valor ressarcido pelo Sistema Único de Saúde (SUS). Método: Foram analisadas todas as cirurgias cardíacas realizadas entre janeiro e julho de 2013 em um centro terciário. Dados demográficos e clínicos permitiram o cálculo do valor ressarcido pelo SUS. Os pacientes foram estratificados em baixo, médio e alto risco pelo EuroSCORE. Os resultados clínicos, o uso de recursos e os custos (real versus SUS) foram comparados entre os grupos de risco estabelecidos. Resultados: Taxas de mortalidade pós-operatória de baixo, intermediário e alto risco apresentaram correlação linear positiva (EuroSCORE: 3,8%, 10% e 25%, respectivamente; p < 0,0001), assim como a ocorrência de alguma complicação pós-operatória (EuroSCORE: 13,7%, 20,7% e 30,8%, respectivamente; p = 0,006). O tempo de internação aumentou de 20,9 para 24,8 e 29,2 dias, respectivamente (p < 0,001). O custo real foi paralelo ao aumento da utilização de recursos, segundo o EuroSCORE (R$ 27.116,00 ± R$13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectivamente; p < 0,001). O ressarcimento do SUS também aumentou (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$ 935,00; p < 0,001). Mesmo com aumento do EuroSCORE, houve diferença (p < 0,0001) progressiva entre o incremento do custo real e o ressarcimento do SUS. Conclusão: O aumento do EuroSCORE esteve relacionado a maiores morbimortalidade, tempo de internação e custos no pós-operatório. Embora o ressarcimento do SUS também aumente conforme o risco, ele não é proporcional ao custo real. (Arq Bras Cardiol. 2015; 105(2):130-138)
dc.description.indexMEDLINE
dc.description.sponsorshipFAFESP
dc.identifier.citationARQUIVOS BRASILEIROS DE CARDIOLOGIA, v.105, n.2, p.130-137, 2015
dc.identifier.doi10.5935/abc.20150068
dc.identifier.issn0066-782X
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/12338
dc.language.isoeng
dc.publisherARQUIVOS BRASILEIROS CARDIOLOGIA
dc.relation.ispartofArquivos Brasileiros de Cardiologia
dc.rightsopenAccess
dc.rights.holderCopyright ARQUIVOS BRASILEIROS CARDIOLOGIA
dc.subjectCardiac Surgical Procedures/economics
dc.subjectHospital Costs
dc.subjectUnified Health System
dc.subjectRisk Groups
dc.subjectPreoperative Care
dc.subjectHospital Mortality
dc.subjectMorbidity
dc.subjectProcedimentos Cirúrgicos Cardíacos/economia
dc.subjectCustos Hospitalares
dc.subjectSistema Único de Saúde (SUS)
dc.subjectGrupos de Risco
dc.subjectCuidados Pré-Operatórios
dc.subjectMortalidade Hospitalar
dc.subjectMorbidade
dc.subject.otheraortic-valve-replacement
dc.subject.other2000 bernstein-parsonnet
dc.subject.otherbypass graft-surgery
dc.subject.otherheart institute
dc.subject.othereuroscore
dc.subject.otheroctogenarians
dc.subject.othermortality
dc.subject.othertranscatheter
dc.subject.otherdefinitions
dc.subject.otherusp
dc.subject.wosCardiac & Cardiovascular Systems
dc.titleR Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System
dc.title.alternativeCustos das Cirurgias Cardíacas Segundo o Risco Pré-Operatório no Sistema Público de Saúde Brasileiro
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.author.externalMATRANGOLO, Bruna La Regina:Univ Sao Paulo, Hosp Clin, Fac Med, Inst Coracao, Sao Paulo, SP, Brazil
hcfmusp.citation.scopus9
hcfmusp.contributor.author-fmusphcDAVID PROVENZALE TITINGER
hcfmusp.contributor.author-fmusphcLUIZ AUGUSTO FERREIRA LISBOA
hcfmusp.contributor.author-fmusphcLUIS ROBERTO PALMA DALLAN
hcfmusp.contributor.author-fmusphcLUIS ALBERTO OLIVEIRA DALLAN
hcfmusp.contributor.author-fmusphcEVELINDA MARRAMON TRINDADE
hcfmusp.contributor.author-fmusphcIVONE ECKL DA SILVA SOUZA DA LUZ
hcfmusp.contributor.author-fmusphcROBERTO KALIL FILHO
hcfmusp.contributor.author-fmusphcOMAR ASDRUBAL VILCA MEJIA
hcfmusp.contributor.author-fmusphcFABIO BISCEGLI JATENE
hcfmusp.description.beginpage130
hcfmusp.description.endpage137
hcfmusp.description.issue2
hcfmusp.description.volume105
hcfmusp.origemWOS
hcfmusp.origem.pubmed26107813
hcfmusp.origem.scieloSCIELO:S0066-782X2015002100130
hcfmusp.origem.scopus2-s2.0-84943777995
hcfmusp.origem.wosWOS:000361057500005
hcfmusp.publisher.cityRIO DE JANEIRO
hcfmusp.publisher.countryBRAZIL
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