Cardiac Surgery Costs According to the Preoperative Risk in the Brazilian Public Health System

Background

Heart surgery has developed with increasing patient complexity.

Objective

To assess the use of resources and real costs stratified by risk factors ofpatients submitted to surgical cardiac procedures and to compare them withthe values reimbursed by the Brazilian Unified Health System (SUS).

Method

All cardiac surgery procedures performed between January and July 2013 in atertiary referral center were analyzed. Demographic and clinical dataallowed the calculation of the value reimbursed by the Brazilian SUS.Patients were stratified as low, intermediate and high-risk categoriesaccording to the EuroSCORE. Clinical outcomes, use of resources and costs(real costs versus SUS) were compared between established risk groups.

Results

Postoperative mortality rates of low, intermediate and high-risk EuroSCORErisk strata showed a significant linear positive correlation (EuroSCORE:3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of anypostoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively;p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and29.2 days (p < 0.001). The real cost was parallel to increased resourceuse according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versusR$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00,respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ±R$935,00; p < 0.001). However, as the EuroSCORE increased, there wassignificant difference (p < 0.0001) between the real cost increasingslope and the SUS reimbursement elevation per EuroSCORE risk strata.

Conclusion

Higher EuroSCORE was related to higher postoperative mortality,complications, length of stay, and costs. Although SUS reimbursementincreased according to risk, it was not proportional to real costs.