Arquivos Brasileiros de Cardiologia (Nov 2009)
Cirurgia de revascularização miocárdica: resultados do Sistema Único de Saúde Cirugía de revascularización miocárdica: resultados del Sistema Único de Salud Myocardial revascularization surgery (MRS): results from National Health System (SUS)
Abstract
FUNDAMENTO: A cirurgia de revascularização do miocárdio (CRM) é a cirurgia cardíaca mais frequentemente praticada no país, sendo a maior parte realizada pelo Sistema Único de Saúde (SUS). OBJETIVO: Avaliar os resultados da CRM, não associada a outros procedimentos. MÉTODOS: Analisaram-se as informações do banco de dados SIH/DATASUS, disponibilizado on-line. Esse banco de dados contém informações relativas a: sexo, idade, permanência hospitalar, valor da autorização de internação hospitalar (AIH), número de cirurgias realizadas por hospital e mortalidade hospitalar. Avaliaram-se apenas as CRM realizadas sem procedimentos associados. RESULTADOS: Entre 2005 e 2007 foram realizadas 63.529 cirurgias em 191 hospitais. Foram excluídos 16 hospitais de muito baixo volume cirúrgico, restando 63.272 cirurgias para análise final. A mortalidade hospitalar total foi de 6,22%, sendo maior nos hospitais de pequeno volume do que nos de grande volume (> 300 cirurgias no período), 7,29% versus 5,77% (p 65 anos), 4,21% versus 9,36% (pFUNDAMENTO: La cirugía de revascularización de miocardio (CRM) es la cirugía cardiaca más frecuentemente practicada en el país, con la mayor parte realizada por el Sistema Único de Salud (SUS). OBJETIVO: Evaluar los resultados de la CRM no asociada a otros procedimientos. MÉTODOS: Se analizaron las informaciones del banco de datos SIH/DATASUS, disponible online. Este banco de datos contiene informaciones relativas a: sexo, edad, permanencia hospitalaria, valor de la autorización de internación hospitalaria (AIH), número de cirugías realizadas por hospital y mortalidad hospitalaria. Se evaluaron solamente las CRM realizadas sin procedimientos asociados. RESULTADOS: Entre 2005 y 2007 se llevaron a cabo 63.529 cirugías en 191 hospitales. Se excluyeron 16 hospitales de muy bajo volumen quirúrgico, restando 63.272 cirugías para análisis final. La mortalidad hospitalaria total fue del 6,22%, con mayor índice en los hospitales de pequeño volumen que en los de gran volumen (≥300 cirugías en el período), el 7,29% versus el 5,77% (pBACKGROUND: Myocardial revascularization surgery (MRS) is the most common surgery in this country, with most being performed through the National Health System(SUS). OBJECTIVES: To assess MRS results when not associated to other procedures. METHODS: The information from the Hospital Information System (SIH/DATASUS) made available online was submitted to analysis. The data include information on gender, age, hospital stay period, hospital admission authorization (AIH) costs, number of surgeries at each hospital, and in-hospital mortality rate. Only MRS with no associated procedures were analyzed. RESULTS: A total of 63,529 surgeries were performed in the period between 2005 and 2007 at 191 hospitals. Sixteen hospitals reporting very low surgery volume were excluded. The remaining total number of surgeries came down to 63,272 for the final analysis. In-hospital mortality rate was 6.22%, with small surgery volume hospitals reporting higher rate than high volume hospitals (≥300 surgeries in the time period under study), 7.29% versus 5.77% (p<0.001). Average hospital stay time length was 12 days, with no difference having been reported between low (12.08±5.52) and high volume (12.15±7.70) hospitals. Males reported lower mortality rate than females - 5.20% versus 8.25% (p<0.001), similarly to younger individuals when compared to the elderly (≥ 65 years of age), 4.21% versus 9.36% (p<0.001). A slight variation was observed in AIH values between the Southern Region (R$ 7.214,63 - approximately US$ 3,600.00) and the Northeastern Region (R$ 6.572,03 - approximately US$ 3,280.00) (p<0.01). Regional distribution of surgeries was not comparable in all regions in the country, with Southern and Southeastern Regions having reported 77% of them. CONCLUSION: MRS performed by SUS has reported high mortality rate in low volume hospitals, among women, and among the elderly. Future prospective studies are deemed to be necessary.
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