Letalidade hospitalar da colecistectomia convencional e laparoscópica: um estudo transversal (2022-2025)

Abstract

Introduction: Acute cholecystitis, frequently associated with cholelithiasis, is a major cause of hospital admissions in Brazil. The distribution of laparoscopic technology across the country reflects marked structural disparities among the public healthcare system, the private sector, and academic medical centers. Methods: This cross-sectional study was based on secondary data obtained from the Brazilian Hospital Information System. The five Brazilian macro-regions (North, Northeast, South, Southeast, and Midwest) were compared according to the variables "hospitalizations" and "deaths" for both surgical procedures, with the aim of calculating the in-hospital case fatality rate. Results: Between 2022 and 2025, a total of 524,769 hospitalizations for conventional (open) cholecystectomy were recorded nationwide, with 2,274 deaths, resulting in an in-hospital case fatality rate of 0.43%. In contrast, the analysis of laparoscopic cholecystectomy data revealed 668,059 hospitalizations and 806 deaths during the same period. The nationwide in-hospital case fatality rate for the laparoscopic approach was 0.12%. Discussion: The Southeast region showed a decline in conventional procedures, accompanied by an increase in the case fatality rate, suggesting that this technique has been reserved primarily for more severe and emergency cases. The North, Northeast, and Midwest regions experienced an increase in the number of laparoscopic cholecystectomies; however, this growth was proportionally lower than that observed in the Southeast and South, highlighting persistent inequalities in healthcare delivery. Conclusion: The findings indicate that the profile of cholecystectomies performed within the Brazilian Unified Health System (SUS) underwent a substantial technical and epidemiological transition between 2022 and 2025, establishing laparoscopic cholecystectomy as the predominant and preferred approach for elective procedures nationwide, while conventional cholecystectomy has become the preferred technique for managing more severe and emergency cases. Nevertheless, healthcare inequalities persist in the North, Northeast, and Midwest regions of Brazil.