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Geographical Inequalities in Access to Bellwether Procedures in Brazil

BACKGROUND: Brazil is a middle-income country that aims to provide universal health coverage, but its surgical system’s efficiency has rarely been analyzed. In an effort to strengthen surgical national systems, the Lancet Commission on Global Surgery proposed bellwether procedures as quality indicat...

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Autores principales: Faleiro, Matheus Daniel, Fernandez, Miguel Godeiro, Santos, Jéssica Moreira, Menezes, Catarina Ester Gomes, Lima, João Vitor Sabadine, Haddad, Júlia Oliveira Dabien, Viana, Sofia Wagemaker, Alonso, Nivaldo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Springer International Publishing 2022
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Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9714764/
https://www.ncbi.nlm.nih.gov/pubmed/36456731
http://dx.doi.org/10.1007/s00268-022-06855-9
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author Faleiro, Matheus Daniel
Fernandez, Miguel Godeiro
Santos, Jéssica Moreira
Menezes, Catarina Ester Gomes
Lima, João Vitor Sabadine
Haddad, Júlia Oliveira Dabien
Viana, Sofia Wagemaker
Alonso, Nivaldo
author_facet Faleiro, Matheus Daniel
Fernandez, Miguel Godeiro
Santos, Jéssica Moreira
Menezes, Catarina Ester Gomes
Lima, João Vitor Sabadine
Haddad, Júlia Oliveira Dabien
Viana, Sofia Wagemaker
Alonso, Nivaldo
author_sort Faleiro, Matheus Daniel
collection PubMed
description BACKGROUND: Brazil is a middle-income country that aims to provide universal health coverage, but its surgical system’s efficiency has rarely been analyzed. In an effort to strengthen surgical national systems, the Lancet Commission on Global Surgery proposed bellwether procedures as quality indicators of surgical workforces. This study aims to evaluate regional inequalities in access to bellwether procedures and their associated mortality across the five Brazilian geographical regions. METHODS: Using DATASUS, Brazil’s national healthcare database, data were collected on the total amount of performed bellwether procedures—cesarean section, laparotomy, and open fracture management—and their associated mortality, by geographical region. We evaluated the years 2018–2020, both in emergent and elective conditions. Statistical analysis was performed by one-way ANOVA test and Tukey’s multiple comparisons test. RESULTS: During this period, DATASUS registered 2,687,179 cesarean sections, 1,036,841 laparotomies, and 648,961 open fracture treatments. The access and associated mortality related to these procedures were homogeneous between the regions in elective care. There were significant geographical inequalities in access and associated mortality in emergency care (p < 0.05, 95% CI) for all bellwether procedures. The Southeast, the most economically developed region of the country, was the region with the lowest amount of bellwether procedures per 100,000 inhabitants. CONCLUSION: Brazil’s public surgical system is competent at promoting elective surgical care, but more effort is needed to fortify emergency care services. Public policies should encourage equity in the geographic allocation of the surgical workforce. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00268-022-06855-9.
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spelling pubmed-97147642022-12-02 Geographical Inequalities in Access to Bellwether Procedures in Brazil Faleiro, Matheus Daniel Fernandez, Miguel Godeiro Santos, Jéssica Moreira Menezes, Catarina Ester Gomes Lima, João Vitor Sabadine Haddad, Júlia Oliveira Dabien Viana, Sofia Wagemaker Alonso, Nivaldo World J Surg Original Scientific Report BACKGROUND: Brazil is a middle-income country that aims to provide universal health coverage, but its surgical system’s efficiency has rarely been analyzed. In an effort to strengthen surgical national systems, the Lancet Commission on Global Surgery proposed bellwether procedures as quality indicators of surgical workforces. This study aims to evaluate regional inequalities in access to bellwether procedures and their associated mortality across the five Brazilian geographical regions. METHODS: Using DATASUS, Brazil’s national healthcare database, data were collected on the total amount of performed bellwether procedures—cesarean section, laparotomy, and open fracture management—and their associated mortality, by geographical region. We evaluated the years 2018–2020, both in emergent and elective conditions. Statistical analysis was performed by one-way ANOVA test and Tukey’s multiple comparisons test. RESULTS: During this period, DATASUS registered 2,687,179 cesarean sections, 1,036,841 laparotomies, and 648,961 open fracture treatments. The access and associated mortality related to these procedures were homogeneous between the regions in elective care. There were significant geographical inequalities in access and associated mortality in emergency care (p < 0.05, 95% CI) for all bellwether procedures. The Southeast, the most economically developed region of the country, was the region with the lowest amount of bellwether procedures per 100,000 inhabitants. CONCLUSION: Brazil’s public surgical system is competent at promoting elective surgical care, but more effort is needed to fortify emergency care services. Public policies should encourage equity in the geographic allocation of the surgical workforce. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s00268-022-06855-9. Springer International Publishing 2022-12-01 2023 /pmc/articles/PMC9714764/ /pubmed/36456731 http://dx.doi.org/10.1007/s00268-022-06855-9 Text en © The Author(s) under exclusive licence to Société Internationale de Chirurgie 2022, Springer Nature or its licensor (e.g. a society or other partner) holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law. This article is made available via the PMC Open Access Subset for unrestricted research re-use and secondary analysis in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.
spellingShingle Original Scientific Report
Faleiro, Matheus Daniel
Fernandez, Miguel Godeiro
Santos, Jéssica Moreira
Menezes, Catarina Ester Gomes
Lima, João Vitor Sabadine
Haddad, Júlia Oliveira Dabien
Viana, Sofia Wagemaker
Alonso, Nivaldo
Geographical Inequalities in Access to Bellwether Procedures in Brazil
title Geographical Inequalities in Access to Bellwether Procedures in Brazil
title_full Geographical Inequalities in Access to Bellwether Procedures in Brazil
title_fullStr Geographical Inequalities in Access to Bellwether Procedures in Brazil
title_full_unstemmed Geographical Inequalities in Access to Bellwether Procedures in Brazil
title_short Geographical Inequalities in Access to Bellwether Procedures in Brazil
title_sort geographical inequalities in access to bellwether procedures in brazil
topic Original Scientific Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9714764/
https://www.ncbi.nlm.nih.gov/pubmed/36456731
http://dx.doi.org/10.1007/s00268-022-06855-9
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