ArticleEinstein (Sao Paulo, Brazil)2026
Cost-effectiveness of microsurgical reconstructions in reconstructive plastic surgery within the Brazilian Public Health System: a 15-year overview (2009-2023).
Article in Einstein (Sao Paulo, Brazil), 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveTo evaluate the national distribution and cost-effectiveness of oncologic microsurgical reconstructions performed within the Brazilian Public Health System over a 14-year period.
methodsA retrospective analysis of DATASUS data was conducted using three procedure codes related to oncologic microsurgical reconstruction. Surgical volume was assessed by state and geographic region. Hospital reimbursement values were compared with those of less complex reconstructive procedures, and inter-state patient referral patterns were analyzed to identify trends in service centralization.
resultsBetween 2009 and 2023, a total of 1,902 microsurgical reconstructions were performed nationwide. The Southeast and South regions accounted for the majority of cases, with São Paulo (n=563) and Rio Grande do Sul (n=474) representing the highest-volume states. In contrast, the North and Center-West regions exhibited substantially lower availability of microsurgical services. Reimbursement analyses demonstrated that microsurgical procedures were compensated at levels comparable to those of less complex reconstructions, despite their greater technical and infrastructural requirements. Referral flow analyses revealed a pronounced concentration of patients toward a limited number of high-volume centers.
conclusionMicrosurgical reconstruction within the Brazilian Public Health System is cost-effective; however, its availability remains unevenly distributed, restricting equitable access to complex oncologic reconstructive care. Public policies focused on workforce training, capacity-building, and regional decentralization are necessary to expand access and reduce reliance on a small number of specialized centers.
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