BARIATRIC SURGERY IN BRAZILIAN PUBLIC HEALTH SYSTEM: THE GOOD, THE BAD AND THE UGLY, OR A LONG WAY TO GO. YELLOW SIGN

• Published in: Arquivos brasileiros de cirurgia digestiva : ABCD 2019-01, Vol.32 (4)
• Main Authors: TONATTO-FILHO, Antoninho José, GALLOTTI, Felipe Melloto, CHEDID, Marcio Fernandes, GREZZANA-FILHO, Tomaz de Jesus Maria, GARCIA, Ana Maria Stapasolla Vargas
• Format: Article
• Language: English
• Subjects: Bariatric surgery; Gastric bypass; Obesity; Original
• ISSN: 0102-6720; 2317-6326
• DOI: 10.1590/0102-672020190001e1470

ABSTRACT Background: In Brazil, there has been a significant increase in obesity rates in all age groups. Data from 2017 show that obesity affects 19% of the population. Due to the magnitude of the problem, public health policies have aimed to prevent complications related to obesity by increasing the offerfor bariatric surgeries. Aim: To analyze the current status of bariatric surgery performed in the Brazilian public health system, including data from macroregions and also the effect of digestive surgery training on the number of procedures. Methods: The database of the public health registry (DATASUS) was assessedbetween 2008 and 2018 for descriptive analysis of data and evaluation of the selected parameters. The main surgical techniques, comorbidities, mortality and the costs profile of the system were evaluated. Results: There was a 339% increase in the number of bariatric surgeries in the period evaluated. Gastric bypass was performed in 94% of cases whereas sleeve in 2.4%. Other techniques were used in 3.6%. There were discrepancies in the number of surgeries performed in different regions of the country. Conclusion: There was a considerable advance in the number of bariatric surgeries performed by the public health system between 2008 and 2018. However, there is a need to increase the offer of this service and alsospecialized training, as well as a correction in the distribution of these procedures in the national territory to achieve integrality among its users. RESUMO Racional: No Brasil, tem-se observado aumento expressivo nas taxas de obesidade em todas as faixas etárias. Dados de 2017 demonstram que a obesidade atinge 19% da população. Em virtude da magnitude do problema, as políticas de saúde pública têm focado suas atenções na prevenção das complicações relacionadas à obesidade, através de um incremento na oferta de operações bariátricas. Objetivo: Analisar o atual estado da cirurgia bariátrica realizada pelo sistemapúblico de saúde do Brasil, incluindo dados das macrorregiões e o efeito do treinamento em cirurgia digestiva no número de procedimentos. Métodos: Foi utilizado o banco de dados do registro de saúde pública (DATASUS) entre 2008 e 2018 para análise descritiva dos dados e avaliação dos parâmetros selecionados. Foram avaliadas as principais técnicas cirúrgicas, as comorbidades, a mortalidade e o perfil de custos ao sistema. Resultados: Demonstrou-se aumento de 339% no número de operações bariátricas no período avaliado. O bypass gás