Análise da demanda da cirurgia pediátrica e fatores associados à inadequação da idade de encaminhamentos no sistema público de saúde no norte de Minas Gerais

Abstract

The diverse levels of public health assistance must work in an articulate way, developing actions to guarantee the integrality of care. Pediatric surgery represents one of the specialties that receives a high demand of patients referred from primary health care services to evaluate the need for surgical intervention. This dissertation aimed to analyze the demand for pediatric surgery and the factors associated with the inadequacy of surgical age in the public health system in the northern of Minas Gerais state, Brazil. It is defined as a cross-sectional prevalence study, conducted between March 2018 and September 2018, with data collected through the application of a questionnaire to those responsible for children from 0 to 13 years old, during medical consultation with pediatric surgeon at the outpatient clinic at Montes Claros /MG city. The sample was random and obtained by conglomerates (each one of the health centers). Adequate age for surgery at the time of the specialist evaluation was defined as a dependent variable. Independent variables were associated to the social and demographic profiles; related to the referral, to the specialist evaluation and the surgical procedure. To conduct the analysis Poisson`s regression was adopted, prevalence ratio (PR) and respective 95% confidence intervals were estimated. A total of 532 children participated and among them 79,3% were male. The average age when the children were referred from primary health care was 4,4 years and at the moment of evaluation with pediatric surgeon was five years. The average interval between referral from primary health care to surgery was 9,2 months and between the specialist’s evaluation and the surgery was 4,7 months. Among the children that were evaluated and had surgical indication, 19,7% (105/488) were not yet operated and 44,4% had an age considered inadequate for the surgical procedure. After final evaluation, the determinants that justified the inadequate surgical age were: male (PR=1,09;CI95%=1,01-1,17) low maternal education (PR=1,07; CI95%=1,01-1,13), low family income (PR=1,08; CI95%=1,02-1,15) and age above 5 years at the time of the first consult with the specialist (PR=1,28; CI95%=1,21-1,35). These results demonstrate that there is a high prevalence of inadequate age for surgical procedures and among the factors that justify these findings are the low socioeconomic conditions of the families. Strategies must be developed to reduce the waiting time between specialist’s evaluation and definitive treatment.