Efeitos da pandemia de COVID-19 na realização de cirurgias no Sistema Único de Saúde, Salvador-BA.

Abstract

Introduction: The World Health Organization (WHO) declared the COVID-19 pandemic as an International Public Health Emergency in March 2020. COVID-19 has spread worldwide, and Brazil is the fifth country with the highest number of accumulated cases in the world at the time of this study, and the second in the ranking of deaths from the disease on the planet. Due to the pandemic, in addition to social distancing, one of the coping measures was the suspension of services related to elective surgical procedures. It is estimated that, worldwide, around 73% of surgeries were canceled during the peak of the pandemic. Objective: To evaluate the effects of the COVID-19 pandemic on the performance of surgical procedures performed by the Unified Health System in Salvador, Bahia. Method: epidemiological, retrospective observational study, carried out in the city of Salvador, Bahia, Brazil. Records related to the period from January 1, 2018 to December 31, 2022, were consulted from the databases of the Hospital Information System (SIH), available at the Department of Information Technology of the Unified Health System (DATASUS). To identify the legal/temporal milestones related to the fight against COVID-19, the mapping of ordinances, decrees, and analysis of official gazettes were carried out. The Kruskal-Wallis test was used to compare medians of three groups, which in this study refer to the three moments of the COVID-19 pandemic: before the pandemic (January 2018 to February 2020), the initial phase of the pandemic (March to August 2020) and the final phase of the pandemic (September 2020 to December 2022). Results: During the pandemic, technical notes and municipal and state decrees were published to minimize the impact of COVID-19, which affected the entire health service chain. After March 2020, with the onset of the COVID-19 pandemic, and especially in its first months, a significant reduction in the number of surgical procedures was observed, with a reduction in elective procedures. The median hospitalizations for surgical procedures in the first part of the pandemic, from March to August 2020, were lower in all indicators, except for obstetric procedures. The median hospital mortality rates in the first part of the pandemic were higher in the indicator that measured all surgical procedures, and in more complex surgeries, such as circulatory and oncological surgeries. Conclusion: The findings indicated a significant drop in the performance of a series of surgical procedures in the first months of the pandemic, especially after mobility restriction measures and actions to reorganize hospital care in the municipality and state. This backlog of care in the SUS led to difficulties in the routine of hospital procedures, which generated pent-up demand and higher hospital mortality rates in hospitalizations for more complex surgeries.