ABSTRACT
Abstract: Introduction: In recent years, there has been an increase in the number of medical residency programs in all regions of Brazil, only in the last 4 years, from 2014 to 2018, there was an increase from 18,953 general spots offered for the first year of medical residency to 26,094, 37% more, this was also observed in General Surgery Residencies around Brazil. As a result, the number of general surgeons has increased substantially, from 12,430 in 2008 to 34,065 in 2018, an absolute percentage increase of 174%. These new surgeons are bringing with them their theoretical and practical knowledge already updated, regarding new techniques and surgical modalities. In this context, in the last 2 decades, video-assisted surgery has become the choice for numerous procedures in Brazil and in the World, considering its benefits for patients, such as less postoperative hospital stay and less metabolic response to surgical trauma, for example. The current study correlates the data between the increase in the number of spots in medical residency programs, related to the graduation of new surgeons in Brazil, to the increase of videolaparoscopic surgeries in the public health system. Methodology: Review and online analysis of the national electronic public health registry database - DATASUS. The most performed Surgeries in Brazil were chosen for our data analysis. Results: The results were divided into five geographically distributed areas in Brazil. At the end of the current study, the number of video-assisted surgeries increased by 233%, accompanied by a 63% increase in the number of medical residency openings and a 174% absolute increase in the number of new surgeons in Brazil at the same period. Conclusion: The current study showed that the increase in the number of video-assisted surgeries in the country is related to the exponential increase in the number of medical residency spots and, consequently, to the number of new graduated general surgeons. This increase occurs more and more in a context of videolaparoscopic techniques, revealing multiple benefits already recognized for patients. We could conclude, therefore, that the increase in the number of medical residencies in general surgery - which are increasingly teaching videolaparoscopic techniques - has contributed as a complementary factor to the increase in the number of video-assisted surgeries observed in all regions of Brazil.
Resumo: Introdução: Nos últimos anos, houve um aumento no número de vagas de residência médica em todas as regiões do Brasil. Apenas nos últimos quatro anos, de 2014 a 2018, houve um aumento de 18.953 vagas gerais ofertadas para o primeiro ano de residência médica para 26.094, 37% a mais, o que foi acompanhado também pela área de cirurgia geral. Em consequência, o número de cirurgiões gerais vem aumentando substancialmente, de 12.430 em 2008 para 34.065 em 2018, um aumento percentual absoluto de 174%. Esses novos cirurgiões vêm trazendo consigo seus conhecimentos teóricos e práticos já atualizados, em sua maioria, de novas técnicas e modalidades cirúrgicas. Nesse contexto, nas últimas duas décadas a cirurgia videoassistida vem se tornando a via de escolha para inúmeros procedimentos no Brasil e no mundo, tendo em vista seus benefícios para os pacientes, tais como menor permanência hospitalar no pós-operatório e menos resposta metabólica ao trauma cirúrgico. Este estudo correlaciona o aumento do número de vagas em residência médica e consequentemente de novos cirurgiões ao aumento de cirurgias videolaparoscópicas no sistema público de saúde. Metodologia: Os dados para revisão foram extraídos do Departamento de Informática do Sistema Único de Saúde (Datasus). Escolheram-se as cirurgias com maior frequência para análise dos dados. Resultados: Os resultados foram divididos nas cinco áreas geograficamente distribuídas pelo Brasil. Ao final do estudo atual, demonstrou-se que o número de cirurgias videoassistidas aumentou em 233%, acompanhado pela elevação de 63% no número de vagas de residência médica e acréscimo de 174% no número de novos cirurgiões no Brasil, no mesmo período. Conclusão: O atual estudo demonstrou que o aumento do número de cirurgias videoassistidas no país está relacionado diretamente com o aumento exponencial do número de vagas de residência médica e, por consequência, do número de novos cirurgiões gerais. A formação desses novos cirurgiões gerais ocorre, cada vez mais, num contexto de técnicas videolaparoscópicas que trazem consigo inúmeros benefícios já reconhecidos para os pacientes. Conclui-se, portanto, que o acréscimo no número de vagas de residências médicas em cirurgia geral - que cada vez mais empregam os ensinamentos em técnicas videolaparoscópicas - tem contribuído como fator complementar para o aumento do número de cirurgias videoassistidas observado em todas as regiões do Brasil.
ABSTRACT
Objective This study aimed to evaluate the results of thyroid surgeries with hospitalization periods shorter than 18 hours performed in a surgical endocrinology service, correlating these results with type of procedure, the definitive diagnosis and complications associated with the procedure.Subjects and methods The procedures performed, complications associated, hospitalization period, and relationships among these variables were assessed in consecutive patients subjected to different types of thyroid surgeries from January 1997 to March 2014 by the same group of surgeons. Data were analyzed by frequency, and the associations between the hospitalization period and other variables were analyzed using the Pearson chi-square test and Fisher’s exact test, using a multiple comparisons test with Bonferroni correction.Results Among the 3,411 surgeries performed, 799 of them were malignant neoplasia, 2,505 were benign tumors and 107 were Graves’ disease. The following procedures were performed: total thyroidectomy (1597 patients); total thyroidectomy with neck exploration (369 patients); lobectomy plus isthmectomy (1084 patients); total thyroidectomy complementation (145 patients); total thyroidectomy with neck dissection (84 patients); modified radical total thyroidectomy (13 patients); nodulectomy (11 patients); unresectable (9 patients); central neck dissection (48 patients); lateral neck dissection (38 patients); and others (13 patients). The following surgical complications, characteristic of the procedure: hemorrhage in 41 (1.2%) patients, hypoparathyroidism in 10 (0.3%) patients and recurrent laryngeal nerve (RLN) injury in 23 (0.7%) patients. Hospitalization shorter than 18 hours was observed in 97% of patients.Conclusion Thyroid surgery can be safely performed in virtually all patients on an overnight basis in specialized services.