title: Cardiac surgery costs according to the preoperative risk in the Brazilian public health system.
abstract: BACKGROUND
  Heart surgery has developed with increasing patient complexity.
  
  
  OBJECTIVE
  To assess the use of resources and real costs stratified by risk factors of patients submitted to surgical cardiac procedures and to compare them with the values reimbursed by the Brazilian Unified Health System (SUS).
  
  
  METHODS
  All cardiac surgery procedures performed between January and July 2013 in a tertiary referral center were analyzed. Demographic and clinical data allowed the calculation of the value reimbursed by the Brazilian SUS. Patients were stratified as low, intermediate and high-risk categories according to the EuroSCORE. Clinical outcomes, use of resources and costs (real costs versus SUS) were compared between established risk groups.
  
  
  RESULTS
  Postoperative mortality rates of low, intermediate and high-risk EuroSCORE risk strata showed a significant linear positive correlation (EuroSCORE: 3.8%, 10%, and 25%; p < 0.0001), as well as occurrence of any postoperative complication EuroSCORE: 13.7%, 20.7%, and 30.8%, respectively; p = 0.006). Accordingly, length-of-stay increased from 20.9 days to 24.8 and 29.2 days (p < 0.001). The real cost was parallel to increased resource use according to EuroSCORE risk strata (R$ 27.116,00 ± R$ 13.928,00 versus R$ 34.854,00 ± R$ 27.814,00 versus R$ 43.234,00 ± R$ 26.009,00, respectively; p < 0.001). SUS reimbursement also increased (R$ 14.306,00 ± R$ 4.571,00 versus R$ 16.217,00 ± R$ 7.298,00 versus R$ 19.548,00 ± R$935,00; p < 0.001). However, as the EuroSCORE increased, there was significant difference (p < 0.0001) between the real cost increasing slope and the SUS reimbursement elevation per EuroSCORE risk strata.
  
  
  CONCLUSIONS
  Higher EuroSCORE was related to higher postoperative mortality, complications, length of stay, and costs. Although SUS reimbursement increased according to risk, it was not proportional to real costs.
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: David Provenzale
authors.initials: DP
authors.lastname: Titinger
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: Luiz Augusto Ferreira
authors.initials: LA
authors.lastname: Lisboa
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: Bruna La Regina
authors.initials: BL
authors.lastname: Matrangolo
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: Luis Roberto Palma
authors.initials: LR
authors.lastname: Dallan
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: Luis Alberto Oliveira
authors.initials: LA
authors.lastname: Dallan
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: Evelinda Marramon
authors.initials: EM
authors.lastname: Trindade
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: Ivone
authors.initials: I
authors.lastname: Eckl
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: Roberto
authors.initials: R
authors.lastname: Kalil Filho
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: Omar Asdrúbal Vilca
authors.initials: OA
authors.lastname: Mejía
authors.affiliation: Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, BR.
authors.forename: Fabio Biscegli
authors.initials: FB
authors.lastname: Jatene
mesh_terms: D000368:Aged; D001938:Brazil; D006348:Cardiac Surgical Procedures / Q000191:economics* / Q000401:mortality; D005260:Female; D006801:Humans; D007902:Length of Stay / Q000191:economics; D008297:Male; D008875:Middle Aged; D009313:National Health Programs / Q000191:economics*; D011183:Postoperative Complications / Q000191:economics; D057234:Preoperative Period; D011446:Prospective Studies; D012016:Reference Values; D012051:Reimbursement Mechanisms; D018570:Risk Assessment / Q000191:economics; D012307:Risk Factors; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D062606:Tertiary Care Centers / Q000191:economics