Dados do Trabalho

Título

An Epidemiological Analysis of the Endovascular vs Microsurgery Treatment of Intracranial Aneurysms Between the Brazilian Regions

Resumo

Introduction:The advances of the technology for the endovascular treatment for intracranial has brought a change in the approach for this pathology. Therefore, the choice for course of treatment in these lesions have been a topic of recent discussions. Objective:Compare, through a prevalence analysis, the endovascular and the microsurgical treatment of intracranial aneurysms among the Brazilian regions in the last decade (2012-2021), whilst comparing cost and mortality rate (MR). Methods: Epidemiological, retrospective, descriptive study, carried out with data obtained from the Hospital Information System (SIH/SUS) and from the Institute for Applied Economic Research (IPEA). From these data, the average dollar cost per procedure was calculated. We also compared both treatments for intracranial aneurysms over and under 15 mm. Results:In the period analyzed, 32.010 intracranial aneurysms were treated. When treating aneurysms >15mm the embolization technique was, throughout the regions, the most utilized, had the lowest MR but was also the most expensive. The biggest average cost gap between approaches was in the northeast region (108%) and the smallest in the north with 59%. The north region had the most difference in MR (8,49%) and the central-west region had the least (1,68%). The choice of approach had its biggest contrast in the northeast region with 76%, and smallest in the north region (11%). Regarding the course of treatment for intracranial aneurysms <15 mm, the north region was the only one to have a higher MR in endovascular treatment, and to showcase a higher average cost with surgery but was also the region with the highest percentage of this approach (89%). The north region had the smallest average cost variance (6%), with the southeast having the biggest (74%), and had the biggest difference in course of treatment (78%) while the central-west region has the smallest (19%) both favoring the surgery route. The MR showed its largest variation in the southeast region (6,62%) with its smallest in the central-west with 1,21%. Conclusion:We conclude that although its higher cost, the endovascular treatment for aneurysms >15 mm is already more utilized in all the regions. While the approach for aneurysms <15 mm still varies between the regions, with both the north and central-west regions having the lowest percentage for this treatment. Furthermore, we affirm that further studies are needed to evaluate these regional differences in Brazil more deeply.

Palavras Chave

Intracranial Aneurysms; Epidemiological Analysis; Endovascular; Microsurgery