SUS Hospital Research Articles

Hospitalizations due to malignant skin neoplasm in the unified health system: an ecological time-series study

To analyze hospitalizations due to malignant skin neoplasms in the Brazilian Unified Health System. This is a descriptive ecological study of time series, with data from the SUS Hospital Information System, analyzed using Prais-Winsten generalized linear regression. Between 2013 and 2022, 453.714 hospitalizations due to cutaneous malignancy were recorded, 80.4% of which were elective and the average mortality rate was 2.1%. On the other hand, hospitalizations that progressed to cure showed the highest values (22.7 and 69.1 cases/100,000) and an increasing trend. The hospitalization rate in Brazil grew, from 16.2 cases per 100 thousand inhabitants in 2013 to 28.6 per 100 inhabitants in 2022, however, there was a reduction in 2020 and 2021, the period of the Covid-19 pandemic. There was an increase in the coefficient of hospitalizations during the period analyzed, especially in the age group of 80 years, males and Southern Brazil, although a stationary mortality rate is maintained. Thus, it is important to improve public policies that raise awareness among the population about skin cancer, in order to carry out an early diagnosis and treatment, aiming at reducing complications and saving the public system.

BARIATRIC SURGERIES IN THE BRAZILIAN PUBLIC HEALTH SYSTEM FROM 2012 TO 2022: DESCRIPTIVE STUDY OF HOSPITALIZATIONS IN THE STATE OF PARANÁ.

Obesity is a chronic health condition with a multifactorial etiology, resulting from the interplay of genetic, environmental, and behavioral factors leading to an energy imbalance. To characterize hospitalizations for bariatric surgeries through the Brazilian Unified Health System (SUS) in the state of Paraná from 2012 to 2022. This is a descriptive and retrospective study, utilizing a time series design, based on secondary data. Public data from the SUS Hospital Information System for the period from 2012 to 2022 were consulted, focusing on the population of obese patients undergoing bariatric surgery. In Paraná, concerning SUS procedures data from 2012 to 2022, 39,793 hospitalizations for bariatric surgeries were observed. Among the five modalities, Roux-en-Y gastric bypass predominated with 38,849 hospitalizations (97.6%), showing a lower mortality rate. The research highlights a notable variation in costs, emphasizing the importance of economic evaluation. The correlation between obesity and diabetes underscores the complexity of the situation, justifying the superiority of surgical treatment in comorbidity remission. The study reveals a decline in bariatric surgeries in 2020, coinciding with the pandemic, and alerts to the increased vulnerability of obese patients to SARS-CoV-2.

The use of information as a strategy for management in SUS hospitals during the COVID-19 pandemic

OBJECTIVE: To understand the perception of health managers regarding the use of information for management in SUS hospitals. METHOD: This is an exploratory study with a qualitative approach. The central theme of the research refers to the use of health information and the role of information as a management strategy in SUS hospitals during the spread of the coronavirus (SARS-CoV-2) in the city of Campo Grande/MS. Three public hospitals, a reference in the care of suspected or confirmed cases of COVID-19, participated in the research. The interview was conducted with 12 managers responsible for the sectors: Administrative, Archive (SAME), Health Surveillance, Information Technology (IT) or Service/Reception. The interviews were analyzed and interpreted using Laurence Bardin's Content Analysis technique with the support of the IRaMuTeQ software. CONCLUSION: Health information and records were fundamental for defining health actions during the pandemic. The main impacts were the perception of health professionals regarding the importance of networking and, mainly, the use of information to generate knowledge in the SUS.

Abstract 12228: Prognostic Role of Renal Replacement Therapy Among Hospitalized Patients With Heart Failure in the Brazilian National Public Health System

Introduction: Data on survival and prognostic factors of patients hospitalized with HF in Brazil are scarce. Aims: To determine the in-hospital all-cause mortality rate, in-hospital renal replacement therapy (RRT) rate, and its association with in-hospital mortality in a population of patients admitted with HF to hospitals from the Brazilian National Public Health System (SUS). Methods: We included adult patients with a documented diagnosis of HF (ICD-10 I50.X) admitted to any public hospital in the SUS Hospital Information System (SIHSUS) registry from April 2017 to August 2021. RRT included intermittent hemodialysis, continuous hemodialysis, and peritoneal dialysis. Descriptive statistics and univariate and multivariate Cox regression were employed. Results: Of the 910,128 HF hospitalizations identified, 106,383 (11.7%) resulted in in-hospital death (Table 1). RRT (required by 8,179 non-survivors [7.7%] and 11,496 survivors [1.4%, p < 0.001]) was associated with a 56% increase in the risk of death (HR 1.56, 95% CI 1.52 - 1.59) (Fig 1). All forms of RRT were independently associated with in-hospital mortality (Fig 2). Female sex (HR 1.04, 95% CI 1.03-1.06) and COVID-19 (HR 1.41, 95% CI 1.14-1.81) were identified as risk factors for in-hospital mortality, while heart transplantation improved survival (HR 0.37, 95% CI 0.29-0.47). Hospitalizations requiring RRT and hospitalizations resulting in death were both longer and costlier (Fig 3, 4). Conclusion: In this nationwide registry of patients admitted with HF to Brazilian public hospitals, we found an alarming mortality rate double the estimates reported in European and North American countries. RRT was strongly associated with a prolonged hospital stay, higher cost-of-hospitalization, and in-hospital death. Our findings highlight the significance of optimizing medical therapy for patients admitted with HF to prevent the deterioration of their renal function and the need for RRT.

Elderly surgical hospitalizations in the municipality of Rio de Janeiro, 2020

It is estimated that, by 2025, around 14% of the country's population will be aged over 60. The increase in the population's life expectancy has encouraged scientific work in healthcare for the elderly. The profile of illness generates greater demand for hospital admissions, drug treatments and rehabilitation. The study sought a comprehensive assessment of the current state of health of the elderly, especially those undergoing surgical interventions. Objective: To analyze the recorded hospitalizations of elderly surgical patients in the municipality of Rio de Janeiro in 2020. Methods: Quantitative, cross-sectional, retrospective, and analytical with a focus on secondary data from the SUS Hospital Information System (SIH). Results: Of the total number of hospitalizations, 28,318 (48.9%) were female and 29,535 (51.1%) were male. The average age was 70.4 years (± 7.9) among elderly hospitalizations, and this average was higher in women 71.2 (± 8.4) compared to men 69.5 (± 7.4). Conclusion: The results show the importance of the health information system in the state of Rio de Janeiro as a tool for drawing up, planning, and monitoring diagnostic, preventive and health promotion actions aimed at the elderly population.

PREVALENCE OF LOCOMOTOR SYSTEM INJURIES DUE TO TRAFFIC ACCIDENTS IN BRAZIL

Road traffic accidents (RTAs) are a public health problem worldwide, representing the leading cause of death in the 5-29 age group and the eighth leading cause of death in all age groups. It also accounts for 12% of all deaths on the planet and 20 to 50 million individuals with some kind of sequelae, whether osteoarticular or not. This is a literature review study, in addition to a cross-sectional data collection from 2018 to 2022 from the SUS Hospital Information System (SIH-SUS) by the SUS IT Department (DATASUS) and also by calculating data on the Compulsory Insurance for Personal Injury Caused by Land Vehicles platform. For this reason, public strategies for effective enforcement, strengthening mobility and accessibility policies, improving roads, implementing and improving traffic legislation and investing in safe and sustainable public transportation are necessary.

Alta responsável e relações interprofissionais na perspectiva e no agir da enfermagem em tempos de pandemia de COVID-19

Abstract A qualitative-case study was carried out aimed at analyzing the interprofessional relationships generated by the planned discharge from the nursing actions’ perspective during the COVID-19 pandemic. The study method was the participating observation by one nurse who works in a large SUS hospital in the city of São Paulo. The production of narratives and the micropolitics analysis resulted in two diverse visibility plans: beyond the planned discharge the anthropophagy of the technological arrangements for care and the ambivalence of the nursing staff in the production of interprofessional relationships; and the medical discharge and negotiated discharge: the intersecting with other professionals, with the families and with “real” life. The pandemic interrupted the multiprofessional visits and it was an analyzer of the interprofessional relationships. Wittingly, the nursing staff negotiates the discharges with physicians, who retain this power, and sets the team in motion using an elastic autonomy. The planned discharge alone was not able to guarantee a common interprofessional action plan, was not able to modify the constituted roles in the hospital, a situation that increased during the pandemic, but allowed the right setting aimed to increase the team’s professionalism.

Planned discharge and the inter-professional relationship from the perspective of the nursing actions during the COVID-19 pandemic.

A qualitative-case study was carried out aimed at analyzing the interprofessional relationships generated by the planned discharge from the nursing actions' perspective during the COVID-19 pandemic. The study method was the participating observation by one nurse who works in a large SUS hospital in the city of São Paulo. The production of narratives and the micropolitics analysis resulted in two diverse visibility plans: beyond the planned discharge the anthropophagy of the technological arrangements for care and the ambivalence of the nursing staff in the production of interprofessional relationships; and the medical discharge and negotiated discharge: the intersecting with other professionals, with the families and with "real" life. The pandemic interrupted the multiprofessional visits and it was an analyzer of the interprofessional relationships. Wittingly, the nursing staff negotiates the discharges with physicians, who retain this power, and sets the team in motion using an elastic autonomy. The planned discharge alone was not able to guarantee a common interprofessional action plan, was not able to modify the constituted roles in the hospital, a situation that increased during the pandemic, but allowed the right setting aimed to increase the team's professionalism.

Outline of Hospitalization Due to Venous Thromboembolism in Brazil Between 2010 and 2020

An important pathology that affects the cardiovascular system is venous thromboembolism (VTE), a disease characterized by the formation of clots in veins. VTE is divided into two clinical presentations: pulmonary thromboembolism (PT) and deep vein thrombosis (DVT). The general objective of the present work is to describe the profile of patients hospitalized for venous thromboembolism and other venous diseases, in Brazil between the years 2010 and 2020. The specific objectives are the following: describe the demographic characteristics of hospitalized patients; describe the epidemiological trend of venous thromboembolism over the period. Based on data extracted from the SUS Hospital Information System (SIH/SUS), it was possible to analyze the following variables: annual frequency; race/color; sex; age range; brazilian demographic regions. Of the 446.328 hospitalizations for phlebitis, thrombophlebitis, embolism, and venous thrombosis in Brazil, between 2010 and 2020, it was noticed that 61,22% (273.254) are women, of which 42.94% (191.673) are self-declared as white and that 54,43% (242.969) are concentrated in the Southeast Region. The profile of patients admitted between 2010 and 2020 was identified as being composed of white women between 50 and 59 years old.

Prognostic role of renal replacement therapy among hospitalized patients with heart failure in the Brazilian national public health system.

Data on patients hospitalized with acute heart failure in Brazil scarce. We performed a cross-sectional, retrospective, records-based study using data retrieved from a large public database of heart failure admissions to any hospital from the Brazilian National Public Health System (SUS) (SUS Hospital Information System [SIHSUS] registry) to determine the in-hospital all-cause mortality rate, in-hospital renal replacement therapy rate and its association with outcome. In total, 910,128 hospitalizations due to heart failure were identified in the SIHSUS registry between April 2017 and August 2021, of which 106,383 (11.7%) resulted in in-hospital death. Renal replacement therapy (required by 8,179 non-survivors [7.7%] and 11,496 survivors [1.4%, p < 0.001]) was associated with a 56% increase in the risk of death in the univariate regression model (HR 1.56, 95% CI 1.52 -1.59), a more than threefold increase of the duration of hospitalization, and a 45% or greater increase of cost per day. All forms of renal replacement therapy remained independently associated with in-hospital mortality in multivariable analysis (intermittent hemodialysis: HR 1.64, 95% CI 1.60 -1.69; continuous hemodialysis: HR 1.52, 95% CI 1.42 -1.63; peritoneal dialysis: HR 1.47, 95% CI 1.20 -1.88). The in-hospital mortality rate of 11.7% observed among patients with acute heart failure admitted to Brazilian public hospitals was alarmingly high, exceeding that of patients admitted to North American and European institutions. This is the first report to quantify the rate of renal replacement therapy in patients hospitalized with acute heart failure in Brazil.

The Importance of Fast-Track Projects for the Outcome of Elderly Patients with Femur and Hip Fractures in the Decrease of all Evaluated Parameters

Background: Population aging is a worldwide phenomenon, and there are 37.7 million elderly people in Brazil. In the period between 2008-2012, showed that more than 181 thousand cases occurred, of hip and femur fractures in elderly patients. Through an Excel spreadsheet, designed in 2010, the objective of this study was to compare the results after the implementation of a fast-track project after femoral surgery in patients aged over 60 years, with predicted routine SUS Hospital. Methods: Patients were observed during two distinct periods: before implantation and after the implementation of the new project. Data evaluation was carried out in four stages of the study in both groups: before arrival to the operating room, during surgery, PACU and on the ward in the morning of day 1 postoperatively. The tests used for statistical analysis were the chi-square test, Fisher’s exact test, and the Kruskal-Wallis test. For all tests considered, the significance level is 0.05. Results: The implementation of the project significantly reduces from 8% to 99% of all parameters evaluated in the four stages of the study and increases the quality of postoperative analgesia by 30%. These data resulted in greater patient and family satisfaction, and probably lower cost. Conclusions: The Brazilian Public Health System (SUS) project has as its primordial objective the humanization of any medical treatment, and this study decreasing practically all the studied parameters and increasing analgesia (time and quality), should be the objective of the implantation of all SUS hospitals. Despite not having calculated the cost, these results probably contributed to its decrease.

Hospitalizations for oral and oropharyngeal cancer in Brazil by the SUS: impacts of the covid-19 pandemic.

To analyze the impact of the different phases of the covid-19 pandemic on hospitalizations for oral (CaB) and oropharyngeal (CaOR) cancer in Brazil, carried out within the scope of the Brazilian Unified Health System (SUS). We obtained data regarding hospital admissions due to CaB and CaOR between January 2018 and August 2021 from the SUS Hospital Information System, analyzing hospital admissions as rates per 100,000 inhabitants. We divided the pandemic (January 2020 to August 2021) and pre-pandemic (January 2018 to December 2019) periods into four-month periods, comparing the pandemic period rates with analogous rates for the pre-pandemic period - for Brazil, by macro-region and by a group of procedures performed during hospitalization. We also analyzed the impact of the pandemic on the average cost of hospitalizations, expressing the results in percentage change. Rates of hospitalization in the SUS due to CaB and CaOR decreased during the pandemic in Brazil. The most significant reduction occurred in the second four-month period of 2020 (18.42%), followed by decreases in the third four-month period of 2020 (17.76%) and the first and second four-month periods of 2021 (respectively, 14.64% and 17.07%), compared with 2019. The South and Southeast showed the most expressive and constant reductions between the different phases of the pandemic. Hospitalizations for clinical procedures suffered a more significant decrease than for surgical procedures. In Brazil, the average expenditure per hospitalization in the four-month pandemic periods was higher than in the reference periods. After more than a year of the pandemic's beginning in Brazil, the SUS hospital care network for CaB and CaOR had yet to be re-established. The repressed demand for hospitalizations for these diseases, which have fast evolution, will possibly result in delays in treatment, negatively impacting the survival of these patients. Future studies are needed to monitor this situation.

Validation of surgical care quality indicators in the Brazilian Unified Health System.

To validate a set of indicators for monitoring the quality of surgical procedures in the Brazilian Unified Health System (SUS). Validation study developed in 5 stages: 1) literature review; 2) prioritization of indicators; 3) content validation of indicators by RAND/UCLA consensus method; 4) pilot study for reliability analysis; and 5) development of instruction for tabulation of outcome indicators for monitoring via official information systems. From the literature review, 217 indicators of surgical quality were identified. The excluded indicators were: those based on scientific evidence lower than 1A, similar, specific, which corresponded to sentinel events; and those that did not apply to the SUS context. Twenty-six indicators with a high level of scientific evidence were submitted to expert consensus. Twenty-two indicators were validated, of which 14 process indicators and 8 outcome indicators with content validation index ≥80%. Of the validated process indicators, 6 were considered substantially reliable (Kappa coefficient between 0.6 and 0.8; p < 0.05) and 2 had almost perfect reliability (Kappa coefficient > 0.8, p < 0.05), when the inter-rater agreement was analyzed. One could measure and establish tabulation mechanism for TabWin for 7 outcome indicators. The study contributes to the development of a set of potentially effective surgical indicators for monitoring the quality of care and patient safety in SUS hospital services.

Cost Analysis of Hospitalization for COVID-19 in a Brazilian Public Teaching Hospital

ObjectivesThis study aimed to measure the hospitalization costs for suspect or confirmation cases of COVID-19 and aggregate knowledge in the costing process for future research on related topics. MethodsA cost calculation model was applied using absorption costing technique. Cost was allocated into 2 main groups: hospitalization and personnel. The cost analysis considers the hospital perspective. This is a retrospective study whose data were collected between April and September 2020, equivalent to the first wave of the disease in Brazil. This research uses data from Hospital Information System, Brazilian Unified Health System (SUS) Cost Calculation and Management System, and SUS Hospital Information System. ResultsThe average total cost per hospitalization was US$11 260 (R$63 504) for patients suspect or confirmed by COVID-19, and considering only detectable cases, the value was US$17 178 (R$96 886). The profile of hospitalized patients was male (51%), with a mean age of 59 years, white ethnicity (64%), and average length of stay of 9 days. ConclusionsThe amount approved by SUS for remuneration of hospitalizations by COVID-19 proved to be insufficient to cover the calculated costs. The results of this study collaborate to measure the expenditure of hospital institutions with COVID-19 hospitalizations, contribute as a parameter for health managers to identify whether the values attributed to hospitalization by COVID-19 by the SUS are adequate to cover all costs involved, and provide lessons learned on costs to the public health system in the event of new pandemics.

"Evaluation and Implementation of Health Quality Indicators in Anesthesia at Accredited SUS Hospital"

"Evaluation and Implementation of Health Quality Indicators in Anesthesia at Accredited SUS Hospital"

Costs of hospital admission authorizations due to falls among older people in the Brazilian National Health System, Brazil, 2000-2020: a descriptive study.

To describe the costs of hospital admission authorizations (AIHs) due to falls among older people within the Brazilian National Health System (SUS). This was a descriptive cost analysis study, based on data from the SUS's Hospital Information System, related to AIH due to falls among older people (60 years and older), between 2000 to 2020. A descriptive analysis was performed and cost measurement was based on a macro-costing method. 1,746,097 AIHs due to falls among older people were recorded, and the total cost was found to be BRL 2,315,395,702.75. The proportion of hospitalization costs was higher among those aged 80 years and older (36.9%), female (60.4%) and the Southeast region of the country (57.3%). The average length of stay in hospital ranged from 5.2 to 7.5 days. The high costs identified showed the need for investments in more effective measures in order to prevent and mitigate the damage caused by falls among older people.

Hospital admissions for treatment of ruptured and unruptured cerebral aneurysms within the Brazilian National Health System, 2009-2018: a descriptive study.

To analyze hospital admissions for treatment of ruptured and unruptured cerebral aneurysms with embolization and brain microsurgery performed within the Brazilian National Health System (SUS), 2009-2018. This was a descriptive study, using data from the SUS's Hospital Information System. Frequency of hospital admissions, procedures, use of intensive care unit (ICU), case fatality ratio and expenditures were described. Of the 43,927 hospital admissions, 22,622 (51.5%) resulted in microsurgery. Embolization and cerebral microsurgery were more frequent among females. Length of hospital stay with embolization procedure was 7.7 days (±9.0), and with microsurgery, 16.2 (±14.2) days, frequency of ICU admission, 58.6% and 85.3%, and case fatality ratio, 5.9% and 10.9% respectively. Of the total expenditure, USD 240 million, 66.3% corresponded to hospitalizations with embolization procedure. Hospital admissions with embolization procedure for treatment of cerebral aneurysms within the SUS showed a shorter length of stay, less frequent use of ICU and lower case fatality ratio, but higher expenditure when compared to brain microsurgery.

Supply/demand ratio for medical consultations, diagnostic tests and chronic kidney disease monitoring in the Brazilian National Health System: a descriptive study, state of São Paulo, Brazil, 2019.

To determine the supply/demand ratio for procedures related to diagnosis and treatment for chronic kidney disease in the Brazilian National Health System (SUS), in the state of São Paulo, Brazil, 2019. This was a descriptive study, using data from the SUS outpatient and hospital information systems. The numbers of medical consultations, diagnostic and chronic kidney disease monitoring tests, performed in the period, were compared with the demand estimation, obtained through ministerial guidelines. Exclusive SUS users were 28,791,244, and individuals with arterial hypertension and/or diabetes mellitus, 5,176,188. The number of procedures performed and the ratio between this number and the needs of the population were 389,414 consultations with nephrologists (85%); 11,540,371 serum creatinine tests (223%); 705,709 proteinuria tests (14%); 438,123 kidney ultrasounds (190%); and 1,045 kidney biopsies (36%). In the chronic kidney disease care in the SUS it could be seen simultaneous existence of lack of supply, waste and inadequate screening of important procedures.

Epidemiological profile of surgical treatment of varicose veins in Brazil from 2010 to 2020.

Varicose veins have become more common over recent years and in the most serious cases surgical treatment is necessary to resolve patients' clinical status. Despite their importance, there are no epidemiological studies that cover the whole of Brazil, showing how surgery to correct varicose veins conducted by the Unified Health System (SUS) is distributed in the country. To describe the ecological profile of surgical treatment to correct varicose veins in Brazil from 2010 to 2020. This is a descriptive-analytical study of data obtained from the SUS Hospital Information System. These data were tabulated and categorized by state, region, type of procedure, and year. BioEstat 5.3 was used to conduct chi-square statistical tests with a 95% confidence interval and significance cutoff of p <0.05. From 2010 to 2020, 755,752 surgical operations to treat varicose veins were conducted; 292,538 were unilateral (38.71%) and 463,214 (61.29%) were bilateral. Of these, 418,791 (55.41%) procedures were performed in the Southeast region, followed by 180,689 (23.91%) in the South region. A total of 40 deaths were registered in connection with these procedures during the period, 26 of which (65%) were associated with bilateral surgery and the majority of which occurred in the Southeast (24 deaths). It was observed that the majority of procedures are performed in the Southeast and South regions, and that bilateral elective surgery is the most prevalent.

Variações sazonais na incidência de fraturas do fêmur no estado do Rio Grande do Sul, sul do Brasil

Abstract Introduction Femoral fractures are a major cause of morbidity and mortality, mainly among older people. Objective To examine the effect of seasonality on hospitalizations due to femur fracture among people residing in the Rio Grande do Sul state, southern Brazil, from 2008 to 2019. Methods Ecological study based on secondary data from the SUS Hospital Information System (SIH/SUS). A total of 74,374 reports of hospital admissions was considered. The generalized additive model (GAM) approach was employed to assess the seasonality of the time series, with stratification by sex and age groups and considering the monthly average number of events of femoral fractures per day as a dependent variable. Results A considerably higher incidence of femoral fractures in women aged 70 years or more was described. Among people aged less than 50 years, there is not an apparent seasonal effect. Men aged 70 years or older and women aged 50 years or older have a higher frequency of hospitalizations due to femur fractures in the colder months. Conclusion Among older people, more femoral fractures occurred during the winter compared to summer. This supports findings from other studies, although reasons for this seasonal variation are uncertain. The knowledge of these seasonal variations can help to plan the health care in the public health system.