Abdominal Aortic Aneurysm Repair in the Brazilian Public Healthcare System: A 10-Year Analysis of Outcomes

The majority of studies evaluating outcomes after abdominal aortic aneurysm (AAA) repair originate from high-income countries. In Brazil, a middle-income country, the public health-care system (Sistema Único de Saúde; SUS) is the primary provider of high-complexity inpatient care. This study examines 10-year trends in AAA repair within SUS.

DATASUS, the information technology department of SUS, was queried using procedure-specific codes for open aneurysm repair (OAR) and endovascular aneurysm repair (EVAR) performed between 2014 and 2023. Procedures were stratified by timing of intervention (elective versus nonelective), sex, and ethnicity. We calculated the annual and 10-year means for procedure volume, length of stay (LOS), in-hospital mortality, inflation-adjusted expenditure, and reimbursement for each procedure type. Trends over the decade were analyzed using chi-squared and t-tests.

Of 11,140 AAA repairs performed from 2014-2023, 69.6% were EVAR and 59.2% were nonelective. Overall annual number of AAA repairs declined by 28.6% from 1,430 in 2014-1,021 in 2023. Concurrently, the proportion of elective AAA repairs decreased from 46.6%-41.6%, and the proportion of OAR increased from 26.8%-34.7%. Most patients were male (75.9%) and White (56.9%). Mean in-hospital mortality was higher after OAR than EVAR (40.3% nonelective OAR vs. 7.3% nonelective EVAR; and 16.0% elective OAR vs. 2.6% elective EVAR). Mean LOS declined by 29.3% for elective procedures. The annual expenditure on AAA repair decreased by 80.3%, with 92.0% spent on EVAR. Hospital reimbursement per EVAR procedure decreased by 81.3%, while OAR decreased by 66.8%.

There was a 28.6% decrease in number of AAA repairs performed in the Brazilian public health-care system over the past decade. This was associated with an increase in in-hospital mortality and decrease in LOS and reimbursement. Our results suggest a gap in AAA care in Brazil and raise concerns for an increasing number of untreated patients.