Perioperative outcomes and economic impact of benign prostatic hyperplasia surgeries in Brazil’s public health system

Abstract

Background

Benign prostatic hyperplasia (BPH) is a common cause of lower urinary tract symptoms (LUTS) in aging men, and significantly affects their quality of life and productivity. In Brazil, where most of the population relies on the Public Health System (SUS), transurethral resection of the prostate (TURP) and simple prostatectomy (SP) are the primary surgical modalities. These procedures vary in cost-effectiveness, influencing clinical decisions and healthcare resource allocation. Therefore, we aimed to describe the perioperative outcomes of surgical modalities (TURP and SP) and the financial impact of these treatments in major Brazilian regions in recent years.

Method

This ecological study utilized data from the Brazilian Public Health System database (DATASUS) from 2009 to 2022. The records of patients diagnosed with BPH and undergoing TURP or SP were analyzed across Brazil’s major geographic regions. The key outcomes included annual surgery volumes, patient demographic characteristics, hospitalization characteristics (e.g., length of stay and intensive care unit utilization), intrahospital mortality rates, and government reimbursements to hospitals. Statistical analyses included descriptive statistics, comparisons between the two techniques, and regression models to assess the temporal trends in mortality rates.

Results

Over the 14-year period analyzed, Brazil recorded 204,358 BPH surgeries, with the Southeast region accounting for 46.56% of the procedures. TURP was the predominant procedure nationwide (61.44%), particularly in the higher-income regions. Perioperative outcomes favored TURP, with lower intrahospital mortality rates (0.25% vs. 0.55% for SP) and shorter hospital stays (median, 3 days vs. 5 days for SP). Both procedures resulted in decreasing mortality trends, although the differences were not statistically significant. Government reimbursements for hospitals were lower for TURP than for SP and did not keep pace with inflation during this period.

Conclusion

This study underscores the prominent role of the Southeast region in BPH surgeries within Brazil's public health system and highlights TURP’s favorable perioperative outcomes of TURP over SP. It also showed a financial deficit in surgery reimbursements, which may impact the sustainability of the public health system.