THE IMPACT OF INSTITUTIONAL VOLUME OF TOTAL GASTRECTOMY FOR PATIENTS WITH GASTRIC CANCER ON SHORT-TERM OUTCOMES AND COSTS IN BRAZILIAN PUBLIC HEALTH SYSTEM
Daniel J. Szor*1, Francisco Tustumi2, Thaysa Venturini da Silva1, Gabriela Gerote Arvate1, Maria Eduarda Carvalhal Santos1, Fabiana Pereira Riviello Gouvea1, Júlia Politano de Oliveira1, Juliana Salem Mihich1, Nelson Wolosker2
1Faculdade Israelita de Ciências da Saúde Albert Einstein, São Paulo, São Paulo, Brazil; 2Sociedade Beneficente Israelita Brasileira Albert Einstein, Sao Paulo, São Paulo, Brazil
Purpose
This study aims to evaluate the influence of institutional total gastrectomy (TG) volume for patients with gastric cancer on the short-term outcomes and costs in the Brazilian public health system.
Methods
This population-based study evaluated the number of surgical procedures performed by institutions in the Brazilian Public Health system from 2008 to 2021. Data were extracted from public domain from the informatic departments of the Brazilian public health system (DATASUS).
We include the SUS Procedures, Medicines, and OPM Table Management System (SIGTAP) identifiers ‘Total Gastrectomy' (04.07.01.014-9) and ‘Total Gastrectomy in Oncology' (04.16.04.007-1). All hospitals supported by the SUS were included. Costs were expressed in US dollars, considering $1,00 = R$ 5,19 as of November 2022.
Results
Six hundred and sixty-six hospitals performed total gastrectomy for patients with gastric cancer between 2008 and 2021 in Brazil. The total number of hospitalizations was 18.466 (mean age 61.3; 64.3% male), with 1.716 in-hospital deaths. The highest number of procedures was recorded in the Brazilian Southeast region, responsible for 51% of the procedures. Total costs were U$ 19.052.371,12. The linear regression model showed that the number of hospital admissions for TG was negatively associated with hospital mortality (Coef -.323; p<0.001).
Only 24 hospitals performed at least 10 TG per year and were considered high-volume institutions. These hospitals were responsible for 6.161 procedures, while low-volumes (<10 TG per year) perfomed 11.262 TG. In-hospital mortality for high-volume institutions was significantly lower than for low-volume institutions (7.8% vs. 25.4%; mean difference: 17.4%; p<0.001). The mean length of stay in the ICU was also lower in high-volume centers (2.41 vs 1.32 days; mean difference 1.09; p=0.004). Total costs were higher in high-volume hospitals (U$1090,80 vs. U$856,95; mean difference U$235,54; p<0.001).
Conclusion
Institutional TG volume implies lower in-hospital mortality and less demand for intensive care. The findings of this nationwide study can affect how Public Health manages TG care and its resources.
Total Gastrectomies per state from 2008 to 2021 in the Public Health System of Brazil
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