Epidemiology and Estimated Cost of Surgeries for Carpal Tunnel Syndrome Conducted by the Unified Health System in Brazil (2008–2016)

Abstract

Objective To define the epidemiological aspects and estimated costs of surgeries performed by the Brazilian Unified Health System (SUS, in the Portuguese acronym) for the treatment of carpal tunnel syndrome (CTS) in Brazil between 2008 and 2016.

Materials and Methods Documentary study, with data from the Informatics Department of the SUS (DATASUS, in the Portuguese acronym), about the absolute number and incidence of admissions, the total and mean length of stay (in days), the total expenses, and the hospital and professional services expenses in the surgical treatment of CTS.

Results During the period studied, there were 82,123 hospitalizations for surgery, with a 62% increase from 2008 to 2015, accompanied by an increase in the values of professional services. The incidence and the absolute number of procedures were higher in the South and Southeast regions. The North region presented the lowest expenses, absolute number, and incidence of admissions, as well as the longer mean length of stay. The mean length of stay decreased from 1.2 days in 2008 to 0.7 day in 2016. The expenses totaled BRL 29,463,148.80 during the period studied. After 2011, professional services became the largest portion of the total expenses. Hospital expenses corresponded to 52.49% of the expenditure in 2008, and to 36.24% in 2015, while professional expenses received the largest investment compared with the total amount expended in 2012.

Conclusion The present study was not consistent with the international literature regarding epidemiological data and cost estimates. Brazil presented a disparity between absolute numbers and annual incidence of admissions and length of stay. Future researches can assess variables that have influenced these results, as well as contribute to public interventions aimed at the improvement of health care.

Resumo

Objetivo Definir aspectos epidemiológicos e estimativas de custos decorrentes das cirurgias realizadas pelo Sistema Único de Saúde (SUS) para tratamento da síndrome do túnel do carpo no Brasil, entre 2008 e 2016.

Materiais e Métodos Estudo documental, com dados do Departamento de Informática do SUS (DATASUS), referentes ao número absoluto e à incidência de internações, dias totais e média de permanência nosocomial, valor total investido, e valor dos serviços hospitalares e profissionais no tratamento cirúrgico da síndrome.

Resultados No período estudado, realizaram-se 82.123 internações para cirurgia, com crescimento de 62% de 2008 a 2015, acompanhado de incremento no pagamento aos profissionais. A incidência e o número absoluto de procedimentos sobressaíram-se no Sul e Sudeste, invariavelmente. A região Norte apresentou número absoluto, incidência e valor investido menores, além do maior tempo médio de internação. A permanência hospitalar média reduziu-se de 1,2 dias em 2008 para 0,7 dia em 2016. Aplicaram-se R$ 29.463.148,80 no período. Após 2011, o valor do serviço profissional se tornou a maior parcela do total. A remuneração hospitalar correspondeu a 52,49% do gasto em 2008 e a 36,24% em 2015, enquanto o gasto com profissionais recebeu o maior investimento em relação ao total de despesas em 2012.

Conclusão O presente estudo foi discrepante da literatura internacional no que concerne a dados epidemiológicos e estimativas de custo. No Brasil, notou-se disparidade entre o número absoluto, a incidência anual e o tempo de internação hospitalar desses pacientes. Pesquisas futuras poderão avaliar as variáveis que influenciaram estes resultados, bem como contribuir para intervenções públicas que visem à melhoria da assistência.

Keywords

epidemiology - carpal tunnel syndrome/surgery - median nerve - health expenditures

Palavras-chave

epidemiologia - síndrome do túnel do carpo/cirurgia - nervo mediano - gastos em saúde

• References

• 1 Bongers FJ, Schellevis FG, van den Bosch WJ, van der Zee J. Carpal tunnel syndrome in general practice (1987 and 2001): incidence and the role of occupational and non-occupational factors. Br J Gen Pract 2007; 57 (534) 36-39
• 2 Mondelli M, Giannini F, Giacchi M. Carpal tunnel syndrome incidence in a general population. Neurology 2002; 58 (02) 289-294
• 3 US Department of Labor, Bureau of Labor Statistics. Nonfatal occupational injuries and illnesses requiring days away from work, 2013. UpdatedDecember2014. Available at: http://www.bls.gov/news.release/archives/osh2_12162014.pdf . Accessde November 10, 2016
• 4 Bland JD, Rudolfer SM. Clinical surveillance of carpal tunnel syndrome in two areas of the United Kingdom, 1991-2001. J Neurol Neurosurg Psychiatry 2003; 74 (12) 1674-1679
• 5 Chammas M, Boretto J, Burmann LM, Ramos RM, Dos Santos Neto FC, Silva JB. Carpal tunnel syndrome - Part I (anatomy, physiology, etiology and diagnosis). Rev Bras Ortop 2014; 49 (05) 429-436
• 6 Paget J. The first description of carpal tunnel syndrome. J Hand Surg Eur Vol 2007; 32 (02) 195-197
• 7 de Krom MC, Knipschild PG, Kester AD, Thijs CT, Boekkooi PF, Spaans F. Carpal tunnel syndrome: prevalence in the general population. J Clin Epidemiol 1992; 45 (04) 373-376
• 8 Huang YG, Chang SM. Double crush syndrome due to plating of humeral shaft fracture. Indian J Orthop 2014; 48 (02) 223-225
• 9 Flores LP. Compressão do nervo mediano no punho (Síndrome do túnel do carpo). In: Siqueira MG, Martins R. Síndromes Compressiva de Nervos Periféricos. Rio de Janeiro: Di Livros Editora; 2008
• 10 Mahto AK, Omar S. Carpal tunnel syndrome: prevalence and association with occupation among presenting cases in a tertiary care hospital in north east Bihar. Int J Sci Stud 2015; 3 (05) 108-111
• 11 Teixeira Alves MdeP. Prospective comparative study between proximal transverse incision and the conventional longitudinal incisions for carpal tunnel release. Rev Bras Ortop 2015; 45 (05) 437-444
• 12 Chammas M, Boretto J, Burmann LM, Ramos RM, Neto FS, Silva JB. Carpal tunnel syndrome - Part II (treatment). Rev Bras Ortop 2014; 49 (05) 437-445
• 13 Wongsiri S. The new wave of carpal tunnel syndrome (CTS) surgery. Bangkok Med J 2013; 6: 80-85
• 14 Saint-Lary O, Rébois A, Mediouni Z, Descatha A. Carpal tunnel syndrome: primary care and occupational factors. Front Med (Lausanne) 2015; 2: 28
• 15 Ferdinand RD, MacLean JG. Endoscopic versus open carpal tunnel release in bilateral carpal tunnel syndrome. A prospective, randomised, blinded assessment. J Bone Joint Surg Br 2002; 84 (03) 375-379
• 16 Kaleff PR, de Lima MS, Fernandes YB, Honorato DJP, Vargas AAR, Honorato DC. Carpal tunnel syndrome: treatment with small transverse incision. Arq Neuropsiquiatr 2010; 68 (01) 93-97
• 17 Ono S, Clapham PJ, Chung KC. Optimal management of carpal tunnel syndrome. Int J Gen Med 2010; 3: 255-261
• 18 Time series of Mid-Year Population Estimates, 1995–2015. Business Intelligence Statistical Bulletin. July 16. Available at: https:// www.kent.gov.uk/ data/assets/pdf_file/0018/14724/Mid-year- population-estimates-total-population-of-Kent-bulletin.pdf . Accessed in November 10, 2016
• 19 United States Census Bureau. Population Division. Annual Estimates of the Resident Population: April 1, 2010 to July 1, 2014. Available at: factfinder.census.gov/faces/tableservices/jsf/pages/productview.xhtml?src = bkmk . Accessed in November 10, 2016
• 20 Thoma A, Wong VH, Sprague S, Duku E. A cost-utility analysis of open and endoscopic carpal tunnel release. Can J Plast Surg 2006; 14 (01) 15-20
• 21 Chung KC, Walters MR, Greenfield MLVH, Chernew ME. Endoscopic versus open carpal tunnel release: a cost-effectiveness analysis. Plast Reconstr Surg 1998; 102 (04) 1089-1099