Surgical Access Profiles in Bariatric Surgery in Brazil: An Analysis of DATASUS

• Grant number: 25/20614-0
• Support Opportunities: Scholarships in Brazil - Scientific Initiation
• Start date: November 01, 2025
• End date: October 31, 2026
• Field of knowledge: Health Sciences - Medicine - Surgery
• Principal Investigator: Daniel José Szor
• Grantee: Daphne Schivartche Schur
• Host Institution: Instituto Israelita de Ensino e Pesquisa Albert Einstein (IIEPAE). São Paulo , SP, Brazil

Abstract

INTRODUCTION: Obesity is a chronic multifactorial condition that has reached epidemic proportions and is strongly associated with various comorbidities. In this context, bariatric surgery has been established as the most effective intervention to promote sustained weight loss and significant improvement in metabolic outcomes. It is indicated for patients with a BMI ¿ 35 kg/m² with associated comorbidities or BMI ¿ 40 kg/m² regardless of them. Its effects go beyond weight reduction, encompassing metabolic, cardiovascular, psychological, and social benefits, which result in improved quality of life and increased survival. Over the years, different surgical approaches have been developed, mainly the open and the laparoscopic techniques, with the latter considered the gold standard. However, factors such as sex, age, race/ethnicity, and geographic region may influence the choice of method, highlighting structural inequalities in healthcare access. In Brazil, understanding these disparities is essential to expanding healthcare equity. The National Supplementary Health Agency (ANS) recognizes two main techniques: sleeve gastrectomy, which is a restrictive technique, and gastric bypass, which has a combined restrictive and malabsorptive effect. Access to these procedures is largely enabled by the Unified Health System (SUS), which serves the majority of the Brazilian population and provides open databases that are fundamental for nationwide monitoring and epidemiological analysis. OBJECTIVES: To compare the surgical approaches for bariatric surgery performed within the Brazilian Unified Health System, to analyze the epidemiological characteristics of patients undergoing bariatric surgery, and to describe the costs associated with surgical treatment of obesity, in-hospital mortality rate, length of hospital stay, and need for intensive care related to surgical treatment. METHODS: This is a retrospective study with an ecological time-series analysis design of the Brazilian population between 2007 and 2024, using data extracted from DATASUS. Records included will be based on ICD-10: bariatric surgeries by laparoscopy (04.07.01.038-6), gastroplasty with intestinal bypass (04.07.01.017-3), vertical banded gastroplasty (04.07.01.018-1), and obesity (E66). The epidemiological variables collected will be age, sex, federal unit, race, and color. Outcomes assessed will include length of hospital stay, use of ICU, in-hospital mortality, and hospitalization costs. Statistical analysis will be conducted using R software version 4.5.1, applying mean and standard deviation for continuous variables and absolute and relative frequencies for categorical variables. Student's t-test will be applied for continuous variables, chi-square test for categorical variables, and Wilcoxon test for normality assessment. The study was approved by SGPP (No. 5338) and is exempt from informed consent as it uses secondary public access data. EXPECTED RESULTS: It is expected that differences will be found in postoperative clinical outcomes among patients undergoing different bariatric surgery approaches. Furthermore, results are expected to show variations in epidemiological characteristics of patients according to surgical technique. The findings should provide information that will contribute to understanding the impact of surgical approach on clinical outcomes and support decisions to expand access to minimally invasive techniques throughout the country, thus promoting greater equity and improved surgical care delivery.