Frequency of splenectomy for pediatric splenic injury in Brazil: a retrospective analysis.

Background: Non-operative management for pediatric blunt splenic injury is well established in high-income countries, leading to a low splenectomy rate in hemodynamically stable children. Splenectomy rate became a quality indicator for Trauma Center verification utilized by the American College of Surgeons Committee on Trauma. However, data on splenectomy rate in children from countries with different income levels, such as Brazil, remain limited. This study aimed to assess the post-traumatic splenectomy rate among Brazilian children over the past decade and the relation with local resources. Methods: Data on pediatric splenic injuries and splenectomies from 2008 to 2019, including patient age and admitting service (adult or pediatric), were obtained from FioCruz database, a public, free, cloud-based platform that offers extensive national health data. The regional numbers of pediatric surgeons, pediatric intensive care unit (PICU) beds, and computed tomography scanners were obtained from Brazilian national databases. A national analysis of splenectomy rate by year and service of admission and an analysis of splenectomy rate by the level of regional resources, the number of pediatric surgeons, PICU beds, and computed tomography scanners was performed. Findings: 4061 children were hospitalized with a splenic injury, and 2287 (51.8%) of them underwent splenectomy, unchanged over time. 76.8% were male and 23.1% female patients with splenic injury. Mean age was 11.61 years old. The odds of splenectomy was 14.77 times higher for pediatric patients admitted under adult surgical service compared to pediatric service (OR = 14.77, 95% CI 11.75-18.56, p < 0.0001). The overall increase in pediatric surgeons, PICU beds, and CT scanner availability did not correspond with changes in splenectomy rate. Interpretation: The post-traumatic splenectomy rate among Brazilian children is high, far exceeding that of high-income countries. Increased regional pediatric resources did not correspond to a decrease in splenectomy rate. Further research is essential to understand Brazil's barriers to adopting non-operative management for pediatric splenic injuries. Funding: This research received no specific grant from any funding agency in the public, commercial, or not-for-profit sectors.

Simultaneous Heart and Kidney Transplantation: A Systematic Review and Proportional Meta-Analysis of Its Characteristics and Long-Term Variables.

Patients with end-stage heart disease who undergo a heart transplant frequently have simultaneous kidney insufficiency, therefore simultaneous heart and kidney transplantation is an option and it is necessary to understand its characteristics and long-term variables. The recipient characteristics and operative and long-term variables were assessed in a meta-analysis. A total of 781 studies were screened, and 33 were thoroughly reviewed. 15 retrospective cohort studies and 376 patients were included. The recipient's mean age was 51.1 years (95% CI 48.52-53.67) and 84% (95% CI 80-87) were male. 71% (95% CI 59-83) of the recipients were dialysis dependent. The most common indication was ischemic cardiomyopathy [47% (95% CI 41-53)] and cardiorenal syndrome [22% (95% CI 9-35)]. Also, 33% (95% CI 20-46) of the patients presented with delayed graft function. During the mean follow-up period of 67.49 months (95% CI 45.64-89.33), simultaneous rejection episodes of both organ allografts were described in 5 cases only. Overall survival was 95% (95% CI 88-100) at 30 days, 81% (95% CI 76-86) at 1 year, 79% (95% CI 71-87) at 3, and 71% (95% CI 59-83) at 5 years. Simultaneous heart and kidney transplantation is an important option for concurrent cardiac and renal dysfunction and has acceptable rejection and survival rates.

Global Cardiac Surgery in Brazil: A Call to Action.

Global Cardiac Surgery is an innovative initiative with a focus on improving health outcomes and achieving healthcare equity for individuals worldwide affected by cardiac surgical conditions or in need of cardiac surgical care. Considering the existing disparities in access to cardiac surgery and the substantial burden of cardiac conditions amenable to surgical procedures in Brazil, it is imperative to support and scale Global Cardiac Surgery initiatives and leave no Brazilian patient behind. Here, we advocate for national initiatives within this field and highlight opportunities and challenges to support their development.

Global Cardiac Surgery in Brazil: A Call to Action

ABSTRACT Global Cardiac Surgery is an innovative initiative with a focus on improving health outcomes and achieving healthcare equity for individuals worldwide affected by cardiac surgical conditions or in need of cardiac surgical care. Considering the existing disparities in access to cardiac surgery and the substantial burden of cardiac conditions amenable to surgical procedures in Brazil, it is imperative to support and scale Global Cardiac Surgery initiatives and leave no Brazilian patient behind. Here, we advocate for national initiatives within this field and highlight opportunities and challenges to support their development.

Limitations of using the DATASUS database as a primary source of data in surgical research: a scoping review.

OBJECTIVE: DATASUS is the Brazilian Public Unified Health System (SUS) department responsible for providing health data that are used as a primary source of data in several studies on surgery and surgical specialties although its main limitations have not been previously reviewed. The objective of this work is to synthesize information from studies on surgery that used DATASUS systems as a data source and to identify the main gaps in this platform. METHODS: a scoping review was conducted according to the PRISMA-ScR method to identify papers on surgery, and other surgical specialties, that used the DATASUS platform as a primary data source. No restrictions were imposed regarding the type of study or year of publication. Grounded Theory was used to analyze the content of the articles. RESULTS: 248 works were initially analyzed and 47 were included in the final analysis of this study. The original articles included were published between 2009 and 2022 and the majority (12.76%, n=6) were published in the Journal of the Brazilian College of Surgeons. Retrospective studies (40.43%, n=19) were the most common type of study found. Content analysis of the articles identified four predominant domains in the scientific literature about the limitations of using DATASUS in surgical research: lack of data, reliability, precision and data integration. CONCLUSION: the information systems available in DATASUS are the largest source of information about the SUS, but the scientific literature on the quality of data available in these systems remains scarce and studies aimed at measuring this metric are necessary.

Cardiac manifestations in children with the multisystem inflammatory syndrome (MIS-C) associated with SARS-CoV-2 infection: Systematic review and meta-analysis.

According to the World Health Organisation, as of October 2022, there have been 55,560,329 reported cases of SARS-COV-2 in patients under 19 years old. It is estimated that about 0.06% of these patients may develop MIS-C, representing more than 2 million children worldwide. This systematic review and meta-analysis examined the pooled prevalence of cardiovascular manifestation and cardiac complications in children hospitalised with MIS-C. The PROSPERO register number is CRD42022327212. We included case-report studies, case-control studies, cohort studies, and cross-sectional studies, as well as clinical trials or studies describing cardiac manifestations of MIS-C and its sequelae in a paediatric population. Initially, 285 studies were selected, but there were 154 duplicates, and 81 were excluded because they did not fit the eligibility criteria. Thus, 50 studies were selected for review, and 30 were included in the meta-analysis. A total sample size of 1445 children was included. The combined prevalence of myocarditis or pericarditis was 34.3% (95% CI: 25.0%-44.2%). The combined prevalence for echocardiogram anomalies was 40.8% (95% CI: 30.5%-51.5%), that of Kawasaki disease presentation was 14.8% (95% CI: 7.5%-23.7%), and that of coronary dilation was 15.2% (95% CI: 11.0%-19.8%). The rate of electrocardiogram anomalies was 5.3% (95% CI: 0.8%-12.3%), and the mortality rate was 0.5% (CI 95%: 0%-1.2%). Furthermore, 186 children still had complications at discharge, with a combined prevalence of such long-lasting manifestations of 9.3% (95% CI: 5.6%-13.7%). Studies that assess whether these children will have an increased cardiovascular risk with a greater chance of acute myocardial infarction, arrhythmias, or thrombosis will be essential for healthcare planning.

Geographical Inequalities in Access to Bellwether Procedures in Brazil.

BACKGROUND: Brazil is a middle-income country that aims to provide universal health coverage, but its surgical system's efficiency has rarely been analyzed. In an effort to strengthen surgical national systems, the Lancet Commission on Global Surgery proposed bellwether procedures as quality indicators of surgical workforces. This study aims to evaluate regional inequalities in access to bellwether procedures and their associated mortality across the five Brazilian geographical regions. METHODS: Using DATASUS, Brazil's national healthcare database, data were collected on the total amount of performed bellwether procedures-cesarean section, laparotomy, and open fracture management-and their associated mortality, by geographical region. We evaluated the years 2018-2020, both in emergent and elective conditions. Statistical analysis was performed by one-way ANOVA test and Tukey's multiple comparisons test. RESULTS: During this period, DATASUS registered 2,687,179 cesarean sections, 1,036,841 laparotomies, and 648,961 open fracture treatments. The access and associated mortality related to these procedures were homogeneous between the regions in elective care. There were significant geographical inequalities in access and associated mortality in emergency care (p < 0.05, 95% CI) for all bellwether procedures. The Southeast, the most economically developed region of the country, was the region with the lowest amount of bellwether procedures per 100,000 inhabitants. CONCLUSION: Brazil's public surgical system is competent at promoting elective surgical care, but more effort is needed to fortify emergency care services. Public policies should encourage equity in the geographic allocation of the surgical workforce.

Limitations of using the DATASUS database as a primary source of data in surgical research: a scoping review / Limitações do uso da base de dados DATASUS como fonte primária de dados em pesquisas em cirurgia: uma revisão de escopo

ABSTRACT Objective: DATASUS is the Brazilian Public Unified Health System (SUS) department responsible for providing health data that are used as a primary source of data in several studies on surgery and surgical specialties although its main limitations have not been previously reviewed. The objective of this work is to synthesize information from studies on surgery that used DATASUS systems as a data source and to identify the main gaps in this platform. Methods: a scoping review was conducted according to the PRISMA-ScR method to identify papers on surgery, and other surgical specialties, that used the DATASUS platform as a primary data source. No restrictions were imposed regarding the type of study or year of publication. Grounded Theory was used to analyze the content of the articles. Results: 248 works were initially analyzed and 47 were included in the final analysis of this study. The original articles included were published between 2009 and 2022 and the majority (12.76%, n=6) were published in the Journal of the Brazilian College of Surgeons. Retrospective studies (40.43%, n=19) were the most common type of study found. Content analysis of the articles identified four predominant domains in the scientific literature about the limitations of using DATASUS in surgical research: lack of data, reliability, precision and data integration. Conclusion: the information systems available in DATASUS are the largest source of information about the SUS, but the scientific literature on the quality of data available in these systems remains scarce and studies aimed at measuring this metric are necessary.

RESUMO Objetivo: o DATASUS é o departamento do SUS responsável por disponibilizar dados de saúde que são empregados como fonte primária de dados em diversos estudos sobre cirurgia e especialidades cirúrgicas, embora principais limitações não tenham sido revisadas anteriormente. O objetivo deste trabalho é sintetizar as informações de estudos sobre cirurgia que utilizaram sistemas do DATASUS como fonte de dados, identificando as principais lacunas. Métodos: uma revisão de escopo foi conduzida de acordo com o método PRISMA-ScR para a identificação de trabalhos sobre cirurgia, e outras especialidade cirúrgicas, que utilizaram a plataforma DATASUS como fonte primária de dados. Nenhuma restrição foi imposta em relação ao tipo de estudo ou ano de publicação. A Teoria Fundamentada em Dados foi utilizada para a análise do conteúdo dos artigos. Resultados: 248 trabalhos foram inicialmente analisados e 47 foram incluídos na análise final deste estudo. Os artigos originais incluídos foram publicados entre 2009 e 2022, maioria (12,76%, n=6) foi publicada na Revista do Colégio Brasileiro de Cirurgiões. Estudos retrospectivos (40,43%, n=19) foram o tipo de estudo mais comum encontrado. A análise dos artigos identificou quatro domínios predominantes na literatura científica acerca das limitações do uso de DATASUS em pesquisas em cirurgia: falta de dados, confiabilidade, precisão e integralização dos dados. Conclusão: os sistemas de informação dispostos no DATASUS constituem a maior fonte de informações sobre o SUS, porém a literatura científica sobre a qualidade dos dados dispostos nestes sistemas permanece escassa e trabalhos direcionados a mensurar essa métrica são necessários.