The Impact of Hip Fractures in the Public Health System in Brazil (SUS) 2008 - 2017: The Orthopedist Task

Stolnicki, Bernardo; Teixeira, Bruno Casaes

doi:10.1055/s-0040-1713762

Acessibilidade / Reportar erro

Brasil

Revista Brasileira de Ortopedia

Español English

Brasil

Español English

sumário « anterior atual seguinte »

Sumário

Original Article • Rev. bras. ortop. 57 (04) • Jul-Aug 2022 • https://doi.org/10.1055/s-0040-1713762 copy

The Impact of Hip Fractures in the Public Health System in Brazil (SUS) 2008 - 2017: The Orthopedist Task

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective

The present study intends to describe the profile of hospitalization and ambulatory rehabilitation of patients ≥ 50 years old due to hip fracture in the Brazilian Public Health System (SUS, in the Portuguese acronym).

Methods

This is a cross-sectional study of patients hospitalized due to hip fracture in the SUS between 2008 and 2017. Data included 441,787 hip fracture-related hospitalizations from the hospitalization database of the department of informatics of the Brazilian Unified Health System (SIH/DATASUS, in the Portuguese acronym), and data of patients who underwent rehabilitation from the ambulatory database of the department of informatics of the Brazilian Unified Health System (SIA/DATASUS, in the Portuguese acronym.).

Results

Most of hip fracture-related hospitalizations (83.5%) happen to people ≥ 50 years old, with an average annual growth of 5.6% in hip fracture-related hospitalizations. The costs for the government have been growing in the same proportion and reached almost BRL 130 million in 2017, although with a 13.6% decrease in average cost per hospitalization. Besides the financial impact, hip fractures result in an in-hospital mortality rate around 5.0% in patients aged ≥ 50 years old. In addition, the percentage of patients that have undergone hip fracture-related rehabilitation increased from 2008 (14.0%) to 2012 (40.0%), and remained stable after that.

Conclusions

The progressive increase in the incidence of hip fractures shows the financial and social impact, and the need for immediate actions to prevent this rising trend. Hip fractures are a risk for secondary fractures, the prevention is crucial, and the orthopedist plays a central role in this process.

Keywords
hip fractures; rehabilitation; datasus; secondary prevention

Variables	Frequency	Percent
Patients ≥ 50 years old at hospitalization time	368,704	83.5%
Gender
Male	184,667	41.8%
Female	257,120	58.2%
Year of hospitalization
2008-2009	74,592	16.9%
2010-2011	78,920	17.9%
2012-2013	85,013	19.2%
2014-2015	93,848	21.2%
2016-2017	109,414	24.8%

		Discharged from Hospital	Death
2008	n	28,272	1,173
	Average Hospitalization length	8.0 ± 7.5	11.0 ± 13.9
	Average Cost (BRL)^*	3,016 ± 1,798	4,433 ± 5,006
2017	n	45,658	2,316
	Average Hospitalization length	8.2 ± 7.9	10.5 ± 11.8
	Average Cost (BRL)	2,581 ± 1,824	4,090 ± 4,425

				2008						2017
Individual procedure	2008 Ranking by Total Cost	No. of hospitalizations	Mean hospitalization length (days) -	Mortality rate (%)	Cost per procedure (BRL) - mean^*	Total cost (BRL)^*	2017 Ranking by Total Cost	No. of hospitalizations	Hospitalization length (days) - mean	Mortality rate (%)	Cost per procedure (BRL) - mean	Total cost (BRL)
SURGICAL TREATMENT OF TRANSTROCHANTERIC FRACTURE	1	13,228	8.1	2.8%	3,013	39,865,398	1	19,220	8.7	3.8%	2,562	49,240,036
PARTIAL HIP ARTHROPLASTY	2	3,858	9.0	4.8%	4,552	17,562,345	2	6,847	9.9	5.9%	3,957	27,090,220
NECK/PROXIMAL FEMUR FRACTURE SURGICAL TREATMENT (INTERNAL FIXATION)	3	4,420	8.4	3.5%	2,854	12,612,317	3	4,983	9.0	3.5%	2,105	10,487,855
CEMENTED PRIMARY TOTAL HIP ARTHROPLASTY	4	1,698	8.9	4.8%	5,332	9,054,779	7	1,742	11.5	3.0%	3,936	6,856,209
UNCEMENTED/HYBRID PRIMARY TOTAL HIP ARTHROPLASTY	5	689	11.2	4.5%	6,049	4,167,558	4	2,085	10.8	3.6%	4,794	9,994,540
SURGICAL TREATMENT OF SUBTROCHANTERIC FRACTURE	6	1,367	9.8	3.2%	2,545	3,480,386	6	3,110	9.8	4.1%	2,236	6,954,768
SPLINTING, IN LOWER LIMBS, A CONSERVATIVE TREATMENT OF FRACTURES	7	2,540	8.8	8.9%	568	1,440,772
POLYTRAUMA SURGICAL TREATMENT	8	175	9.9	7.4%	4,752	831,553	8	971	8.9	3.8%	4,164	4,043,205
TREATMENT WITH MULTIPLE SURGERIES	9	159	10.5	5.0%	4,588	729,328	5	1,762	7.5	3.3%	4,182	7,368,639
REMOVAL OF LARGE JOINT REPLACEMENT PROSTHESIS (SHOULDER/ELBOW/HIP/KNEE)	10	128	11.9	4.7%	1,676	214,424	18	61	16.4	14.7%	2,004	122,249
TREATMENT OF SPECIFIED/UNSPECIFIED TRAUMA	27	7	12.1	0%	479	3,361	9	1,613	7.4	10.9%	602	971,212
CONSERVATIVE TREATMENT/LIGAMENT INJURY/PELVIS FRACTURE	13	113	13.1	8.0%	490	55,431	10	1,945	9.1	11.2%	410	797,749
OTHER		1,063	4.7	3.4%	423	450,411		3,635	6.3	7.2%	938	3,408,854
TOTAL		29,445	8.4	4.0%	3,073	90,468,062		47,974	8.9	4.8%	2,654	127,335,535

Sociedade Brasileira de Ortopedia e Traumatologia Al. Lorena, 427 14º andar, 01424-000 São Paulo - SP - Brasil, Tel.: 55 11 2137-5400 - São Paulo - SP - Brazil
E-mail: rbo@sbot.org.br

Acompanhe os números deste periódico no seu leitor de RSS

[1] Address for correspondence Bernardo Stolnicki, MD, Osteometabolic Diseases Sector, Orthopedics Department, Hospital Federal de Ipanema, Rua Barão da Torre, 350/201, Ipanema, Rio de Janeiro, RJ, 22411-000, Brazil (e-mail: stolnick@hotmail.com).