Abstract 19700: Recent Trends in Procedure Type, Morbidity and In-hospital Outcomes of Patients With Peripheral Artery Disease: Data From the Brazilian Public Health System

Abstract

Introduction: The prevalence of peripheral artery disease (PAD) is rising worldwide, with a considerable impact on health care systems. We aimed to characterize the recent trends in surgical, percutaneous and clinical therapeutic procedures and in-hospital outcomes of PAD among all hospitalized patients in the Brazilian Public Health System between 2008 and 2012. Methods: Nationwide data of all hospitalizations in the Brazilian Public Health System (DataSUS) database in 2008, 2010, and 2012 were analyzed regarding the frequency of hospitalizations due to PAD (endovascular - EVR, surgical revascularizations - SR and clinical treatment - CT), length of hospital stay and in-hospital mortality and associated costs to the health system. Results: The number of hospitalizations related to PAD (EVR, SR and CT) remained stable from 2008 to 2012: 28,091 and 28,151 respectively, accounting for 0.25% and 0.24% of all in-hospital procedures. However, there was a significant change in the proportions of treatment modalities used in this period. In 2008: SR = 8,001 (29%), EVR = 3,207 (11%) and CT = 16,887 (60%); in 2010: SR = 7,999 (30%), EVR = 4,020 (15%) and CT: 14,849 (55%); and in 2012: SR = 7,882 (28%), EVR = 5,044 (18%) and CT = 15,225 (54%); p<0.001. The results show a 57% increase in EVR, and a 9.8% decrease in CT in this period. Total costs raised 23%, from US$ 18.6 million in 2008 to R$ 22.9 million in 2012 (p< 0.001), with a marked 92% increase in EVR costs (R$ 5.3 to 10.0 million), compared to SR (11%) and CT (30%). Global mean hospital days did not change from 2008 to 2012 (5.8 to 5.7 days), whereas it decreased for EVR (5.7 to 4.8, p<0,001). Hospital mortality decreased from 2008 to 2012 for EVR (2.0 to 1.4%, p=0.048), increased for CT (5.1 to 5.8%, p=0.002) and remained stable for SR (8.5 to 8.8%, p=0.44). Overall mortality, however, increased from 6.2% in 2008 to 6.7% in 2012 (p=0.004). Conclusion: There is an increasing proportion of EVR for PAD in Brazil, with a concomitant increase in costs, mainly related to these procedures. Our administrative data-based analysis depicts the significant rise of overall PAD mortality in Brazil, especially in clinically treated patients, emphasizing the need of controlling PAD risk factors and promoting its early diagnosis and effective management.