Epidemiological trends of adrenalectomies in Brazil: A cohort-based study of the Brazilian public health system.

Abstract

Objective: Population-based data on the surgical treatment of adrenal diseases in Brazil remain limited. Therefore, this retrospective cohort study aimed to characterize patients treated within the Brazilian public health system who underwent adrenalectomy over the past 15 years.

Materials and methods: Records of adrenalectomies from the Sistema Único de Saúde (Datasus) database were analyzed from January 2008 to December 2022. Descriptive demographic information was evaluated using incidence rates. Clinical, therapeutic, and mortality data were compared according to hospital procedure volume stratification.

Results: Over the study period, there was a 49.6% increase in procedures, totaling 6,771 adrenalectomies, with high-volume hospitals performing 62.3% of the cases. Most patients were female (65.5%), white (52%), and had a median age of 48 years. Oncological adrenalectomies increased by 154%, particularly in the southern region of Brazil. Although an overall reduction in in-hospital mortality rates was observed, a higher risk persisted in low-volume centers for both oncological (OR: 2.75; 95% CI: 1.53-4.93; p < 0.01) and non-oncological surgeries (OR: 6.60; 95% CI: 3.98-10.96; p < 0.01).

Conclusion: Given the increasing number of adrenalectomies performed within the Brazilian public health system and the likely continuation of this trend, health policies should prioritize referral to high-volume centers equipped with advanced techniques and appropriate infrastructure.