Goiás and Pernambuco lead the waiting list for surgeries – 06/06/2023 – Health

The plans carried out by the states and the Federal District as a requirement for the transfer of funds from the National Queue Reduction Program, of the federal government, show Goiás and Pernambuco at the top of the waiting list.

In absolute numbers, Goiás (125,894), São Paulo (111,271), Rio Grande do Sul (108,066), Pernambuco (103,955) and Minas Gerais (86,414) head the list of states with the most waiting procedures.

When considering the population of each locality, however, the order changes.

In Goiás, the queue is equivalent to 1,747 stopped operations per 100,000 inhabitants and, in Pernambuco, to 1,074. Then appear Rio Grande do Sul, Acre and Rio Grande do Norte.

With the exception of Acre, cataract surgery represents the largest portion of stagnant procedures in these locations. There are 58,393 cases awaiting resolution.

In all, the country has 1,081,786 dammed surgeries. The expectation is that the program, with a transfer of approximately R$ 600 million, will lead to a reduction of approximately 45% in the list.

Which surgeries are elective?

President of the Brazilian College of Surgeons, São Paulo chapter, Elias Jirjoss Ilias explains that surgeries in which patients are not at risk of life are considered elective. This is the case, for example, of treatment for umbilical hernia. The condition can cause discomfort, but it does not pose a threat to health.

But that doesn’t mean patients can wait indefinitely. There are elective procedures that must be done more quickly, under the risk of complications. Ilias cites incisional hernias, which can incarcerate and result in urgent surgery, and removal of the gallbladder.

“Pain is the least of the complications in the case of a gallbladder stone. The stone can cause inflammation and lead to urgent surgery, putting life at risk. The stone can also move to the pancreas and cause pancreatitis, a very serious complication”, he says.

The risk of complications must be taken into account when choosing the procedures that will be prioritized, but it is not the only one. Some states have chosen to perform a portion of all procedures, while others will focus resources on a reduced number of types of surgery.

For Ilias, the difference may be related to the structure of each location and the availability of specialist doctors. “A general practitioner does not solve any of the items on the list”, he says.

He adds that many of the procedures performed are considered less complex and some, such as cataract surgeries, have a great impact on quality of life and are cheaper because they do not require hospitalization. The Ministry of Health expects to invest around BRL 600 million in 487,000 surgeries, an average of BRL 1,232 per procedure.

What do the states say?

Asked about the accumulated surgeries, the Department of Health of Goiás stated that “it carried out a mapping together with the Council of Municipal Health Secretariats of Goiás, and for the first time there was unification of the queue of elective surgical procedures”.

According to the folder, of the 125,894 people across the state waiting for some elective procedure, 13,893 (11%) are waiting in line at the State Regulatory Complex, which manages vacancies in state hospitals.

Through the national program, the state will receive approximately R$ 20 million to perform 25,085 surgeries, 19.9% ​​of the queue.

Like Goiás, the Government of Pernambuco assigned the queue to municipalities. “This amount was the sum accumulated in the internal queues of the main hospitals in the state and what the Pernambuco municipalities informed us in spreadsheets sent. Of this total, the largest amount is in the municipalities themselves, with more than 90 thousand patients”, stated the Secretariat of Pernambuco Health.

Management also pointed to the Covid-19 pandemic and the absence of a state regulatory policy capable of promoting surgeries on an ongoing and regular basis as factors responsible for the accumulation.

According to the Ministry of Health, the state will receive transfers to carry out 20,111 procedures, 19.3% of the total.

The money will be used in procedures such as surgical treatment of varicose veins, removal of the gallbladder, surgery to treat hernia, vasectomy, circumcision, tubal ligation and removal of the uterus.

The state accumulates 12,733 dammed cataract surgeries, but should not direct resources from the national program for these procedures. “They will be contemplated in a second moment, due to the fact that they manage to be carried out by the municipalities”, declared the secretariat.

Rio Grande do Sul also indicated the pandemic as the cause of the damming of elective care. The state will receive approximately R$ 32 million through the Ministry of Health program and plans to perform 16% of the surgeries on the list with this amount.

Like Pernambuco, the government of Rio Grande do Sul will use the resources in a specific part of the procedures, including gallbladder removal and treatment of varicose veins. 3,723 cataract surgeries are also planned.

Will the queue go down?

Experts consulted by Sheet estimate that the program will reduce the queue, but the effect will only be temporary if structural changes are not adopted. Ilias mentions, for example, the need for more specialist doctors and greater transparency in the allocation and use of funds.

The surgeon also points out that many municipalities do not have the structure to carry out simple procedures and it is important to facilitate dialogue and integration with state health equipment.

“With Covid-19, only emergency surgeries were performed and everything elective had to wait. This led to an increase in the list and we are going to need a great effort and a lot of investment in health to reach at least the pre-registration pandemic”.