- Hospital Nossa Senhora da Conceição (HNSC), Serviço de Endocrinologia Clínica e Cirúrgica - Porto Alegre - RS - Brasil.
- Hospital Militar de Área de Porto Alegre (HMAPA), Serviço de Cirurgia - Porto Alegre - RS - Brasil.
Rev Col Bras Cir. 2022 Jul 15;49:e20223180. doi: 10.1590/0100-6991e-20223180-en. eCollection 2022.
videosurgery in Brazil started in 1990 with the performance of laparoscopic cholecystectomy, being included by the public health system in 2008. We evaluated the current situation of the use of this technology in the Unified Health System (SUS - Sistema Único de Saúde).
from 2013 to 2019, 1,406,654 patients registered at the SUS Informatics Department (DATASUS) were analyzed to calculate the rate of laparoscopic cholecystectomies (LC) in relation to open cholecystectomies (OC). Patient characteristics, disease presentation and postoperative mortality were evaluated.
the LC rate reached 41.5% (growth of 68%) with no decrease in the absolute number of OC. In University Hospitals (UH), the LC rate reached 91.96%. The open technique in emergencies was more associated with male patients, aged 60 years or older, with prolonged hospitalization and in the ICU. Those undergoing LC were less predisposed to postoperative death, both electively (OR 0.49; 95% CI 0.42 - 0.56; NNT=20) and urgently (OR 0.23; 95% CI 0.20 - 0.25; NNT ≅1), providing a protective effect.
despite the increase in the indication of LC, the open technique during the years studied remained stable and the most used in the public health system in Brazil. The effectiveness of public health policies to shorten the complete implementation of videosurgery in SUS needs to be investigated in future epidemiological studies, as well as its impact on postoperative morbidity and mortality.
巴西的视频手术始于 1990 年，当时进行了腹腔镜胆囊切除术，2008 年纳入公共卫生系统。我们评估了统一卫生系统（SUS- Sistema Único de Saúde）中使用该技术的现状。
从 2013 年到 2019 年，分析了在 SUS 信息部门（DATASUS）注册的 1,406,654 名患者，以计算腹腔镜胆囊切除术（LC）与开放性胆囊切除术（OC）的比率。评估了患者特征、疾病表现和术后死亡率。
LC 率达到 41.5%（增长了 68%），OC 的绝对数量没有减少。在大学医院（UH），LC 率达到 91.96%。紧急情况下的开放性技术更与男性患者、60 岁或以上的患者、住院时间延长和 ICU 有关。LC 组术后死亡的风险均降低，包括择期（OR 0.49；95%CI 0.42-0.56；NNH=20）和紧急（OR 0.23；95%CI 0.20-0.25；NNH≈1），提供了保护作用。
尽管 LC 的适应证增加，但在研究期间，开放性技术保持稳定，并且仍是巴西公共卫生系统中最常用的技术。需要在未来的流行病学研究中调查公共卫生政策对缩短 SUS 中视频手术全面实施的有效性，以及其对术后发病率和死亡率的影响。
