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CC BY-NC-ND 4.0 · Rev Bras Ortop (Sao Paulo) 2021; 56(03): 360-367
DOI: 10.1055/s-0040-1721836
Artigos Originais
Ortopedia Pediátrica

Unmet Needs of Surgical Care for Children: A Case Study in the Brazilian Publicly-Financed Health System[*]

Article in several languages: português | English
Mario Bressan-Neto 
1   Departamento de Ortopedia e Anestesiologia, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
,
Marina Rosa Filezio 
2   Divisão de Ortopedia Mecânica Pediátrica, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canadá
,
Fabio Ferri-de-Barros 
2   Divisão de Ortopedia Mecânica Pediátrica, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canadá
,
Helton Luiz Aparecido Defino 
3   Departamento de Biomecânica, Medicina e Reabilitação, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brasil
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Abstract

Objective To measure and document the clinical impact of the waiting time for surgical treatment of patients with spinal deformities in a quaternary center in Brazil.

Methods In total, 59 patients with spinal deformity waiting for surgery on our hospital's list were evaluated to observe the impact of the waiting time on the progression of the deformity. Patient evaluation was performed using the SRS-22r questionnaire for health-related quality of life (HRQL) and radiographic images to evaluate the deformity of the spine at the time the patients were included in the waiting list and at the most recent appointment. The radiographic parameters selected for comparison were: Cobb angle of the primary and secondary curves, coronal alignment, apical vertebral translation, pelvic obliquity, sagittal vertebral axis, kyphosis (T5-T12), and lordosis (L1-S1).

Results Low HRQL scores according to the SRS-22r questionnaire were observed in patients waiting for surgery. The radiographic parameters showed progression of the deformity on the initial evaluation when compared with the most recent follow-up evaluation.

Conclusion The patients waiting for surgical treatment of spinal deformities in our center showed relatively low HRQL scores and radiographic progression of the deformity.

Keywords

spine - scoliosis - waiting list - vertebral curvatures - health policy

* Work developed at the Department of Biomechanics, Medicine and Rehabilitation, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil.




Publication History

Received: 27 May 2020

Accepted: 16 September 2020

Article published online:
31 March 2021

© 2021. Sociedade Brasileira de Ortopedia e Traumatologia. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commecial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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  • Referências

  • 1 Brasil. Conselho Nacional de Secretários de Saúde. Assistência de média e alta complexidade no SUS. Brasília: 2011 . (Coleção para entender a gestão do SUS 2011, v.4)
    PubMedGoogle Scholar
  • 2 Bressan-Neto M, da Silva Herrero CFP, Pacola LM, Nunes AA, Defino HLA. Community Care Administration of Spinal Deformities in the Brazilian Public Health System. Clinics (São Paulo) 2017; 72 (08) 485-490
    CrossrefPubMedGoogle Scholar
  • 3 Lima Jr P, Pellegrino L, Cafaro MF, Meves R, Landim E, Avanzi O. Escoliose idiopática do adolescente: perfil clínico e radiográfico da lista de espera para tratamento cirúrgico em hospital terciário de alta complexidade do Sistema Público de Saúde Brasileiro. Coluna/Columna 2011; 10 (02) 111-115
    CrossrefGoogle Scholar
  • 4 Ahn H, Kreder H, Mahomed N, Beaton D, Wright JG. Empirically derived maximal acceptable wait time for surgery to treat adolescent idiopathic scoliosis. CMAJ 2011; 183 (09) E565-E570
    CrossrefPubMedGoogle Scholar
  • 5 Yang JH, Bhandarkar AW, Rathanvelu B. et al. Does delaying surgery in immature adolescent idiopathic scoliosis patients with progressive curve, lead to addition of fusion levels?. Eur Spine J 2014; 23 (12) 2672-2679
    CrossrefPubMedGoogle Scholar
  • 6 Dabke HV, Jones A, Ahuja S, Howes J, Davies PR. Should patients wait for scoliosis surgery?. Orthop Proc 2006; 88 (Suppl II): 225
    Google Scholar
  • 7 Miyanji F, Newton PO, Samdani AF. et al. Impact of Surgical Waiting-List Times on Scoliosis Surgery: The Surgeon's Perspective. Spine 2015; 40 (11) 823-828
    CrossrefPubMedGoogle Scholar
  • 8 Calman R, Smithers T, Rowan R. Impact of surgical waiting time on paediatric spinal deformity patients. ANZ J Surg 2013; 83 (12) 929-932
    CrossrefPubMedGoogle Scholar
  • 9 Miyanji F, Slobogean GP, Samdani AF. et al. Is larger scoliosis curve magnitude associated with increased perioperative health-care resource utilization?: a multicenter analysis of 325 adolescent idiopathic scoliosis curves. J Bone Joint Surg Am 2012; 94 (09) 809-813
    CrossrefPubMedGoogle Scholar
  • 10 Clark S. Waiting times for scoliosis surgery. Lancet 2008; 371 (9606): 10-11
    CrossrefPubMedGoogle Scholar
  • 11 Tarrant RC, Queally JM, O'Loughlin PF, Sheeran P, Moore DP, Kiely PJ. Preoperative curves of greater magnitude (>70°) in adolescent idiopathic scoliosis are associated with increased surgical complexity, higher cost of surgical treatment and a delayed return to function. Ir J Med Sci 2016; 185 (02) 463-471
    CrossrefPubMedGoogle Scholar
  • 12 Wright JG, Li K, Seguin C. et al. Development of pediatric wait time access targets. Can J Surg 2011; 54 (02) 107-110
    CrossrefPubMedGoogle Scholar
  • 13 Bressan Neto M, Defino HLA. Surgical treatment of spinal deformities: clinical and epidemiological analisys of the consequences of underfunding [tese]. Ribeirão Preto: Universidade de São Paulo, Faculdade de Medicina de Ribeirão Preto; 2017
    Google Scholar
  • 14 Asano LY, Filézio MR, Defino MP, Andrade VA, Cesar AE, Rodrigues LM. Radiographic Implications Of The Surgical Waiting List For The Treatment Of Spinal Deformity. Coluna/Columna 2018; 17 (01) 19-22
    CrossrefGoogle Scholar
  • 15 Paim J, Travassos C, Almeida C, Bahia L, Macinko J. The Brazilian health system: history, advances, and challenges. Lancet 2011; 377 (9779): 1778-1797
    CrossrefPubMedGoogle Scholar
  • 16 Brasil. Lei n° 8.080, de 19 de setembro de 1990. Lei Orgânica da Saúde. Dispõe sobre as condições para a promoção, proteção e recuperação da saúde, a organização e o funcionamento dos serviços correspondentes e dá outras providências. Brasília, 1990. Disponível em: http://www.cofen.gov.br/lei-8080-lei-orgnica-da-saude_4163.html
  • 17 Ferri-de-Barros F, Gibson J, Howard A. An argument for explicit rationing of health resources within the public-private mix in Brazil. Cad Saude Publica 2012; 28 (06) 1211-1212
    CrossrefPubMedGoogle Scholar
  • 18 Ferri-de-Barros F, Andrew W, Howard AW, Martin DK. Inequitable Distribution Of Health Resources In Brazil: An Analysis of National Priority Setting. Acta Bioeth 2009; 15 (02) 179-183
    Google Scholar
  • 19 Inter-American Development Bank. Breve 16: Ethics of Health Resource Allocation in the Brazilian Publicly Financed Health Care System. Washington, DC: Inter-American Development Bank; 2016
    Google Scholar
  • 20 Camarini PM, Rosanova GC, Gabriel BS, Gianini PE, Oliveira AS. The Brazilian version of the SRS-22r questionnaire for idiopathic scoliosis. Braz J Phys Ther 2013; 17 (05) 494-505
    CrossrefPubMedGoogle Scholar
  • 21 Langensiepen S, Semler O, Sobottke R. et al. Measuring procedures to determine the Cobb angle in idiopathic scoliosis: a systematic review. Eur Spine J 2013; 22 (11) 2360-2371
    CrossrefPubMedGoogle Scholar
  • 22 Gupta MC, Wijesekera S, Sossan A. et al. Reliability of radiographic parameters in neuromuscular scoliosis. Spine 2007; 32 (06) 691-695
    CrossrefPubMedGoogle Scholar
  • 23 Paixão ALSD. Reflections on the judicialization of the right to health and its implications in the SUS. Cien Saude Colet 2019; 24 (06) 2167-2172
    CrossrefPubMedGoogle Scholar
  • 24 Guimarães R. Technological incorporation in the Unified Health System (SUS): the problem and ensuing challenges. Cien Saude Colet 2014; 19 (12) 4899-4908
    CrossrefPubMedGoogle Scholar
  • 25 Oudhoff JP, Timmermans DR, Knol DL, Bijnen AB, van der Wal G. Waiting for elective general surgery: impact on health related quality of life and psychosocial consequences. BMC Public Health 2007; 7: 164
    CrossrefPubMedGoogle Scholar
  • 26 Farley FA, Li Y, Jong N. et al. Congenital scoliosis SRS-22 outcomes in children treated with observation, surgery, and VEPTR. Spine 2014; 39 (22) 1868-1874
    CrossrefPubMedGoogle Scholar
  • 27 McCall RE, Hayes B. Long-term outcome in neuromuscular scoliosis fused only to lumbar 5. Spine 2005; 30 (18) 2056-2060
    CrossrefPubMedGoogle Scholar
  • 28 Ramo BA, Roberts DW, Tuason D. et al. Surgical site infections after posterior spinal fusion for neuromuscular scoliosis: a thirty-year experience at a single institution. J Bone Joint Surg Am 2014; 96 (24) 2038-2048
    CrossrefPubMedGoogle Scholar
  • 29 Basques BA, Chung SH, Lukasiewicz AM. et al. Predicting Short-term Morbidity in Patients Undergoing Posterior Spinal Fusion for Neuromuscular Scoliosis. Spine 2015; 40 (24) 1910-1917
    CrossrefPubMedGoogle Scholar
  • 30 Dayer R, Ouellet JA, Saran N. Pelvic fixation for neuromuscular scoliosis deformity correction. Curr Rev Musculoskelet Med 2012; 5 (02) 91-101
    CrossrefPubMedGoogle Scholar
  • 31 Martin CT, Pugely AJ, Gao Y, Weinstein SL. Causes and risk factors for 30-day unplanned readmissions after pediatric spinal deformity surgery. Spine 2015; 40 (04) 238-246
    CrossrefPubMedGoogle Scholar
  • 32 Pitt DF, Noseworthy TW, Guilbert J, Williams JR. Waiting lists: management, legalities and ethics. Can J Surg 2003; 46 (03) 170-175
    PubMedGoogle Scholar
  • 33 Abásolo I, Negrín-Hernández MA, Pinilla J. Equity in specialist waiting times by socioeconomic groups: evidence from Spain. Eur J Health Econ 2014; 15 (03) 323-334
    CrossrefPubMedGoogle Scholar