Tratamento cirúrgico das fissuras de lábio e/ou palato pelo Sistema Único de Saúde no Brasil

Abstract

Oral clefts, including cleft lip, cleft palate and cleft lip and palate, are the most common congenital malformations in the craniofacial region, constituting an important public health problem. The treatment of cleft lip and/or palate, in general, is long, started with corrective surgery for the deformity, reflecting the need for other sequential surgical procedures. In Brazil, the treatment is predominantly offered by the Brazilian public health system in Lip and Palate Malformation Treatment Centers enabled by the Ministry of Health. The objective of this study was to evaluate surgical treatment by Brazilian public health system in enabled centers in Brazil, between the years of 2008 and 2018. This is an ecological, retrospective, analytical and census-based study. For the purposes of this study, data available from the Ministry of Health's publicly accessible databases were collected. These data were entered in the IBM - Statistical Package for the Social Sciences for Windows®, Inc., USA, version 24.0. Descriptive analysis was performed and the statistical tests were bivariate analysis, assuming a significance level of 95% (p<0.05). In 2008, Brazil had 22 Lip and Palate Malformation Treatment Centers enabled were identified in Brazil, present in 100% of the geographic regions and in 44.4% of the federative units (n=12). In 2018, Brazil had 29 Lip and Palate Malformation Treatment Centers enabled, in 51.8% of the federative units. In 2008 to 2018, 62,025 surgical procedures were performed to treat cleft lip and/or palate in the enabled centers. Multiple surgery was the most frequent procedure (n=26,034; 42%; p<0.001) and, in hospitalizations, the most frequent type of cleft in patients was cleft lip and palate (n=45,571; 73.5%; p< 0.001). The Southeast region predominated in the performance of surgical procedures (n=37,195; 60%; p<0.001). The federative unit that performed the most surgical procedures was São Paulo (n=31,085; 50.1%; p<0.001) and the enabled center was the Craniofacial Anomaly Rehabilitation Hospital of the University of São Paulo (n=26,485; 42.7%; p<0.001). The public financial resources invested in the surgical treatment of cleft lip and/or palate in the enabled centers were US$37,546 million, with an average of US$3,413,311.43 per year. The average value per hospitalization for surgical treatment of cleft lip and/or palate in Brazil was US$605.34 (SD=US$138.84), with the highest annual value of public investments in 2011, with an average value per hospitalization of US$834.54. Pearson's correlation showed a significant difference between the years 2008 to 2018 (p<0.001). Federal public funds spent for surgical rehabilitation of cleft lip and/or palate showed a heterogeneous distribution in the national territory. The Brazilian public health system performed and financed, over the years 2008 and 2018, an important volume of surgical procedures for cleft lip and/or palate, which presented a reduction in its annual production from 2016, polarization in the Southeast region, but with a discreet expansion trend to other regions of the country over the years evaluated. The amounts paid showed a heterogeneous distribution in the national territory.