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Título

Overview of vascular neurosurgery procedures in Brazil before and after the Covid-19 pandemic: an ecological time-series study

Resumo

Background: Vascular neurosurgery comprises a wide range of procedures for the treatment of various health problems, which include brain arteriovenous malformation, ischemic and hemorrhagic strokes, and cerebral aneurysms. The Covid-19 pandemic created a global health crisis and had an overall impact on health care, delaying the scheduling of elective treatments and reducing the demand for emergency care. It is not known, however, if the pandemic has affected more complex procedures, such as vascular neurosurgery. Objective: to analyze the frequency and variation of vascular neurosurgery procedures in Brazil, from 2012 to 2021. Methodology: This is an ecological time-series study that used secondary data from the SUS’s Hospital Information System. Vascular neurosurgery procedures registered from 2012 to 2021 in Brazil were analyzed. The study's main outcome was the evolution of the surgery, and the data were analyzed according to the region of residence. The mortality rate was calculated according to the total number of procedures performed, as a percentage. The prevalence of events was estimated according to occurrence per 1,000,000 inhabitants. Results: 22,053 vascular neurosurgeries were performed in the period, of which 2,361 resulted in deaths. The mean (± SD) of procedures performed in 2020 and 2021 (pandemic period) was 41% lower than between 2012 and 2019 (1,260 ± 170; 2,170 ± 904, respectively). The analysis of the year-on-year percentage change reveals that the largest changes were recorded between 2014 and 2015 (-26%) and 2020 and 2021 (-17%). The total number of procedures oscillated by -65% in the period. The mortality rate was around 9%, with the year 2021 having the highest mortality in the period (14%). The South region had the highest mean (± SD) number of surgeries/1,000,000 inhab. (13 ± 7) and the Northeast region the smallest (8 ± 4). Conclusion: the number of vascular neurosurgeries procedures performed in Brazil decreased from 2012 to 2021 and has shown a sharp drop in the years 2015 and 2021. The comparison between the period before and after the Covid-19 pandemic revealed that, in the latter, the average of procedures was lesser. The mortality rate was higher in 2021. More studies should be carried out to confirm the hypothesis that the Covid-19 pandemic changed the care dynamics in the vascular neurosurgery scenario and influenced the prognosis of the procedures performed.