Format

Send to

Choose Destination
Ann Vasc Surg. 2020 Jan 10. pii: S0890-5096(20)30017-0. doi: 10.1016/j.avsg.2019.12.040. [Epub ahead of print]

Epidemiological analysis of carotid artery stenosis intervention during 10 years in 
the public health system in the largest city in Brazil: stenting has been more 
common than endarterectomy 
.

Author information

1
Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita 
Albert Einstein, Av. Prof. Francisco Morato, 4293 - São Paulo - SP, 05521-200, Brazil.
2
Albert Einstein Israelite Hospital, Av. Albert Einstein, 627 - São Paulo - SP, 05652-900, 
Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita 
Albert Einstein, Av. Prof. Francisco Morato, 4293 - São Paulo - SP, 05521-200, Brazil.
3
Albert Einstein Israelite Hospital, Av. Albert Einstein, 627 - São Paulo - SP, 05652-900, 
Brazil.
4
Albert Einstein Israelite Hospital, Av. Albert Einstein, 627 - São Paulo - SP, 05652-900, 
Brazil; Faculdade Israelita de Ciências da Saúde Albert Einstein (FICSAE), Hospital Israelita 
Albert Einstein, Av. Prof. Francisco Morato, 4293 - São Paulo - SP, 05521-200, Brazil. Electronic address: marcelo.fiorelli96@gmail.com.

Abstract

BACKGROUND:

Stroke is the second leading cause of death worldwide with approximately 5.7 million cases/year and carotid atherosclerosis accounts for 10 to 20% of cases.

PATIENTS AND METHODS:

In Brazil, the Unified Health System (SUS) is a tax-funded public health care system that provides care for roughly half the population. São Paulo is the eighth largest city in the world with an estimated population of over 12 million people, of whom more than 5 million rely solely on SUS. This study aimed to describe rates of carotid artery stenting (CAS) and carotid endarterectomy (CEA) performed between 2008 and 2017 in the city of São Paulo through web scraping of publicly available databases.

RESULTS:

3,704 carotid revascularization procedures were performed between 2008 and 2017, of which 2,432 were CAS (65.7%). Rates of CAS ranged from 59.9% in 2016 to 86% in 2011. There were 57 in-hospital deaths (1.54%), 34 after CAS (1.4%%; 34/2,432) and 23 after CEA (1.81%; 23/1,272) (p = 0.562). SUS reimbursements were US$ 7,862,017.09 (81.44% of all reimbursements) for 2,432 CAS procedures and US$ 1,792,324.06 (18.56%) for 1,272 CEA procedures. Average SUS reimbursement for CAS (US$ 3,232.73) was more than double that for CEA (US$ 1,409.05).

CONCLUSIONS:

In a city whose population exceeds that of some European countries, costs of CAS and CEA to the public health care system totaled more than US$ 9 million over 10 years. Epidemiologically, CAS was performed more commonly than CEA with no difference in in-hospital mortality between CAS and CEA, but reimbursments were 2.29 times higher for CAS. The low adoption of CEA in São Paulo is in contrast to countries where utilization rates are higher for CEA than for CAS.

KEYWORDS:

Big data; carotid endarterectomy; carotid stenosis; cerebrovascular disorders; database; public health; stroke
; unified health system; vascular diseases


PMID:
31931132
DOI:
10.1016/j.avsg.2019.12.040

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center