Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2016 Jul 6;3(2):157-161.
doi: 10.1200/JGO.2016.004911. eCollection 2017 Apr.

Surgery for CNS Tumors in the Brazilian National Health Care System

Luciola Pontes  1 , Maryam Nemati Shafaee  1 , Benjamin Haaland  1 , Gilberto Lopes  1
Affiliations

Surgery for CNS Tumors in the Brazilian National Health Care System

Luciola Pontes et al. J Glob Oncol. .

Abstract

Purpose: Resource limitations in low- and middle-income countries make the management of CNS tumors challenging, particularly in Brazil, a country with major disparities in socioeconomic status and access to health care. We aimed to evaluate cancer-related neurosurgical procedures in the public health care system.

Methods: On the basis of Brazil's public health system database, we collected data for neurosurgical procedures related to CNS tumors performed between January 2008 and November 2013. Information about the number of procedures, costs, length of stay, and number of inpatient deaths were analyzed for each state and then correlated to the state-specific population, gross domestic product per capita, and number of procedures.

Results: In all, 57,361 procedures were performed, the majority of them in the Southeast region. The mean length of hospital stay was 14.4 days, but longer hospital stay was reported for patients treated in the North. The inpatient mortality rate was 7.11%. Mortality rates decreased as the number of procedures (P < .001), gross domestic product per capita (P < .001), or state population increased (P < .001). On multivariate analysis, only the number of procedures (odds ratio, 0.93; 95% CI, 0.91 to 0.96; P < .001) and state population (odds ratio, 1.25; 95% CI, 1.13 to 1.38; P < .001) had an independent association with mortality.

Conclusion: To the best of our knowledge, this is the first study to evaluate disparities in CNS tumor surgery in a middle-income country, confirming that regional disparities exist and that clinical and economic outcomes correlate with income level, number of procedures, and state population.

PubMed Disclaimer

Conflict of interest statement

The following represents disclosure information provided by authors of this manuscript. All relationships are considered compensated. Relationships are self-held unless noted. I = Immediate Family Member, Inst = My Institution. Relationships may not relate to the subject matter of this manuscript. For more information about ASCO's conflict of interest policy, please refer to www.asco.org/rwc or ascopubs.org/jco/site/ifc. Luciola PontesNo relationship to discloseMaryam Nemati ShafaeeNo relationship to discloseBenjamin HaalandNo relationship to discloseGilberto LopesHonoraria: AstraZeneca, Genentech, Merck Serono, Merck Sharp & Dohme, Fresenius Kabi, Novartis, Bristol-Myers Squibb, Janssen-Cilag Consulting or Advisory Role: Pfizer, Bristol-Myers Squibb, Eli Lilly/ImClone Systems Research Funding: Eli Lilly/ImClone Systems, Pfizer, AstraZeneca, Merck Sharp & Dohme, Eisai Expert Testimony: Sanofi

Figures

Fig 1
Fig 1
Distribution of neurosurgical procedures according to region. Used with permission. © 2014 American Society of Clinical Oncology. All rights reserved.
Fig 2
Fig 2
Length of hospital stay. Used with permission. © 2014 American Society of Clinical Oncology. All rights reserved.
Fig 3
Fig 3
Mortality rate according to region. Used with permission. © 2014 American Society of Clinical Oncology. All rights reserved.
Fig 4
Fig 4
Cost per admission according to region. Used with permission. © 2014 American Society of Clinical Oncology. All rights reserved.
See this image and copyright information in PMC

References

    1. Chang S, Long SR, Kutikova L, et al. Estimating the cost of cancer: Results on the basis of claims data analyses for cancer patients diagnosed with seven types of cancer during 1999 to 2000. J Clin Oncol. 2004;22:3524–3530. - PubMed
    1. Campos S, Davey P, Hird A, et al. Brain metastasis from an unknown primary, or primary brain tumour? A diagnostic dilemma. Curr Oncol. 2009;16:62–66. - PMC - PubMed
    1. Momin EN, Adams H, Shinohara RT, et al. Postoperative mortality after surgery for brain tumors by patient insurance status in the United States. Arch Surg. 2012;147:1017–1024. - PMC - PubMed
    1. Hooten KG, Neal D, Lovaton Espadin RE, et al. Insurance status influences the rates of reportable quality metrics in brain tumor patients: A nationwide inpatient sample study. Neurosurgery. 2015;76:239–247. discussion 247-248. - PubMed
    1. Trinh VT, Davies JM, Berger MS. Surgery for primary supratentorial brain tumors in the United States, 2000-2009: Effect of provider and hospital caseload on complication rates. J Neurosurg. 2015;122:280–296. - PubMed

LinkOut - more resources