Impacto da cirurgia bariátrica, em médio prazo, na utilização de serviços de saúde, morbi-mortalidade e custos com atenção médica

Abstract

Introduction: Morbid obesity has been identified as a major epidemic in developed countries. In Brazil, the numbers are alarming, with 0.76% of morbid obese patients (BMI40 kg/m²) and with trends of growing. This situation has raised public health measures, announced by the Ministry of Health in 2012. The challenge is to reverse the trend of growth with measures to prevent overweighted persons in population. Once morbidly obese, the individual has little chance of success undergoing conservative treatment including diet, exercise, change of life style and medication. Bariatric surgery takes place as an attractive and unique resolution for both morbid obesity itself and related comorbidities, such as hypertension and diabetes. In Brazil, either the Unified Health System (SUS) and its Suplementary Health System provides full coverage for bariatric surgery for all who meet the criteria for designation. The objectives of this dissertation are to assess mortality rate in patients who underwent bariatric surgery between January 2001 and December 2010, its causes and identify associated pre-operative characteristics and expertise of the main surgeon with this outcome. In a subgroup analysis of this cohort, we assessed healthcare services utilization before and after bariatric surgery, and their costs for 4004 patients who underwent surgery between January 2004 and December 2010. We also evaluated the in-hospital mortality and the associated characteristics for patients assisted by SUS or the health insurance plan.